Life seems to go in trends, like the day that you work on tooth #19 on every patient. Last week the trend was to discuss why I recommend a full mouth series of radiographs or a Panorex. The first time I got this question was during a presentation on the comprehensive exam, and the other two times were in the office once during our hygiene meeting and the other with a new patient. My experience of myself is that I fall into habit patterns of how around certain procedures, and radiographs is one of them. I have also noticed that team members like to have protocols that help create clarity, when do we take radiographs, which radiographs do we take and on what schedule.
The challenge with this approach for me, is that as soon as we create a protocol, a patient comes into the office who is an exception. Additionally I want our office to be about individualized care, so our recommendations are specific to each patient. Radiographs are the perfect conversation to discuss individualizing our recommendations. So why do I want to take a full series? This set of radiographs let’s me diagnose decay in the entire dentition, assess the interproximal bone levels, and closely look for bony defects due to perio, it also let’s me assess the periapical health of every tooth. I request this series for adult new patients who have a concern about health, and have a previous dental history that includes restorative or periodontal therapy.
A panorex radiograph allows me to assess the condition of the upper and lower jaws, look for osseous tumors and defects, see the medial aspect of the condyle and check for the presence of third molars or any congenitally missing permanent teeth. There are some carious lesions or periapical situations visible on a panorex, but if this is what I want to look for I find a full series much more diagnostic. Commonly we add taking bitewings to a panorex, which now allows us to diagnose the presence of interproximal decay in the posterior if we take four and in all of the teeth if we take a series of seven. I have many patients of all ages on whom I recommend this combination, as I have no reason to be concerned about periodontal or periapical lesions.
I know exactly what you are thinking, then why do insurance companies view them as equal, and once they pay for an FMX they will deny a Panorex? I don’t have an answer for this question that makes any logical sense to me, or would to you. The other side of this equation, is that my recommendations are based on what I believe to be int he patient’s best interest not what their insurance covers. I do have patients on whom I want both images, and I explain the difference in the two images for them and what the cost will be. You can also look at it from the point of view that a full mouth series includes eighteen individual films and a panorex!