Radiology in the diagnosis of oral pathology in children

As additional information becomes available about the adverse effects of radiation, it is most important that we review current practices in the use of radiographs for diagnosis. It should be remembered that the radiograph is only a diagnostic aid and rarely can a definitive diagnosis can be made with this tool. Routine dental radiographs are often taken as a screening procedure m frequently this tool is used to replace good physical examination techniques. A review of procedures often employed in the practice of dentistry reveals that a history is elicited from the patient (usually by an auxiliary) and then radiographs are taken before a physical examination is completed. This sequence should be challenged inasmuch as most pathologic conditions that occur in the facial bones present with clinical symptoms. The following questions should be addressed before a diagnostic radiograph is taken. 1. When was the last screening radiograph taken? 2. Is there a clinical finding that suggests underlying osseous pathology? 3. Does the medical or dental history suggest underlying osseous pathology? 4. Will a radiograph augment the physical findings? 5. What type of radiograph will be most helpful? Diagnostic radiographs should only be taken when one of the following conditions exist: 1. A physical or history finding would suggest an underlying pathological condition, 2. When the physical finding is inadequate to make a differential diagnosis or to allow treatment. Employment of the above procedures would significantly reduce the number of diagnostic X rays taken. It is recognized that screening radiographs {excluding bite-wing radiographs) in children are generally nonproductive without positive, physical findings. With this fact in mind a child should probably have one screening radiograph (panorex) during the initial visit and not have another until the permanent dentition has erupted. Bitewing radiographs should be taken whenever the physical examination suggests that the possibility of caries or pulpal pathology exists. Pathological conditions excluding caries and pulpal pathology, that do occur in the oral cavity in children can be classified under the following headings: 1. Congenital or developmental anomolies; 2. Cysts of the jaws; 3. Tumors of odontogenic origin; 4. Neoplasms occurring in bone; 5. Fibro-osseous lesions; 6. Trauma. A good understanding of the clinical signs and symptoms, normal biological behavior, radiographic interpretive data, and treatment of pathological conditions which occur in the oral cavity will allow us to be more selective in the use of radiographs for diagnosis. It is not the purvue of this presentation to cover all of the disease entities that occur in the jaws. The more common or significant conditions which effect the welfare of the child will be presented.