Dental Myth Buster- You can’t get a cavity under a crown

This is one dental myth that I wish I did not have to see.  The myth typically plays out like this:

“Mrs. Jones, I can see both on the x-ray and upon clinical exam that there is decay on this particular tooth.”

She will typically respond by saying:

“How can I have a cavity on that tooth? It has a crown!”

After years of practicing dentistry, I can say that this happens about 98% of the time when there is decay on a tooth which already has a crown. So this dental myth definitely needs to be busted!

Photograph of a cavity under a crown

Seeing is believing, so let’s take a look at a photo taken from a patient in a dental office in Orange, CT.

Photo showing a cavity, also known as dental decay, under a dental crown

The decay is visible in the above photo at the gum line. Treatment will most likely involve a new crown. Without treatment, this patient will lose his tooth eventually.

By looking at the photo, you can see that it is possible to get decay under a crown. So the myth is busted! But let’s look at how it happens.

What are dental cavities?

Dental decay photo showing a cavity on an upper canine tooth

Dental decay (known less formally as dental cavities) occurs when bacteria inside the mouth ingest certain foods and then attack the teeth. This leads to a weakening of the tooth and can ultimately lead to an actual hole (a.k.a cavity) in the tooth.

Decay can occur on any part of any tooth in the mouth. It can occur on teeth that have never had a filling before. Or the decay can start on teeth that have had fillings, crowns, or root canals.  It can start at age 2 or age 100!

How teeth with dental crowns can develop decay

As stated earlier, decay can develop on any tooth. But cavities are more likely to occur in certain areas.

Dental x-ray radiograph showing decay or cavities under or below a dental crown

When it comes to teeth with crowns, the area most susceptible to developing decay is the margin. The margin, as you would guess, is where the crown meets the tooth. It is the weak spot. It is the Achilles Heel.

Food and other debris can collect right at the margin. A crown that was poorly made will collect even more food. If you combine this with a diet rich in sugar or acid, along with home hygiene that is not ideal, you have a perfect storm. That perfect storm affected the two crown to the upper right on the x-ray, resulting in decay.

Another Dental Myth Busted

The above photos, descriptions, and x-ray show that even with a crown, a tooth can still develop a cavity. So it bears repeating:

Crowns will protect an already weakened tooth but you still need to brush and floss sensibly. If you don’t, you can develop decay just like you would on any other tooth.

What is numbing jelly?

“Numbing Jelly” or Dental Topical Anesthesia.

I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot.  There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:

  • The sound of the dental drill.
  • The feeling of “too many things” in their mouth.
  • Being tilted back too far.
  • The thought of a “hole” being drilled into a body part.
  • The “suction thingy” (a.k.a. saliva ejector or spit sucker).
  • The spray of the water.
  • The taste of metal instruments.
  • Two individuals (dentist and assistant) staring into their mouth
  • And literally hundreds of other things…

All of these things are reasons why patients avoid the dentist.  However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic.  Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc.  It doesn’t matter whether you’re in Jupiter, FL where I practice or thousands of miles away, patients hate the shot!

Dentist and Needles | Topical anesthetic| West Hartford Family DentistryNot surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection.  Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles.  Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles.  I will cover the history of dental needles in a future blog post.  But regardless, a needle is still a needle!

Enter Dental Topical Anesthetic

Topical anesthetic dentists use for implants and fillings on teethTopical anesthetic is simply a local anesthetic that is applied to the soft tissue of the mouth prior to the shot.  It has the consistency of jelly or jam and is often referred to as “numbing jelly.”  I apply it with a cotton swab and allow it to remain on the soft tissue for at least 90 seconds.  The topical anesthetic numbs the soft tissue so that the patient feels little to no sensation of the needle.  Most topical anesthetics are composed of 20% benzocaine which is similar to what is found in OTC products such as Orajel and Orabase.

Does dental topical anesthetic work?

Yes!  As a practicing dentist who administers approximately 10 injections per day, I use topical anesthetic every time I need to numb a patient.  My experience is that topical anesthesia works for two reasons. First, it anesthetizes the soft tissue as described above so little to no sensation of the needle is felt.  Secondly and more importantly, it also works because the patient believes they will feel very little of the shot.

While the topical anesthetic is on the tissue, my patient’s anxieties are diminishing, their muscles are relaxing, and they are breathing normally.  My assistant and I talk to them about topics unrelated to dentistry to get their mind off the upcoming procedure.  They feel a tingling sensation at the location of the topical reminding them that the area is getting numb.  They become very relaxed and stop focusing on what is going to happen next. Then when I then go to administer the local anesthetic, they feel little to no sensation of the actual needle.  This is because they are no longer expecting it to hurt!

There are many other approaches to reduce the anxiety associated with The Shot.  Some of these will be described in future blog posts.  I occasionally use a more concentrated solution of topical anesthetic on many kids under the age of 12.  I will also occasionally use Nitrous Oxide (also referred to as “laughing gas”.)  I will often shake or wiggle the soft tissue prior to administering the local anesthetic, as this can also distract the patient.  Redheads are scientifically proven to need more local anesthetic than people with different hair colors.

On a related note, most formulations of topical anesthesia contain gluten. So those individuals with either celiac disease or gluten sensitivity should avoid the topical anesthesia.

For patients who are so anxious about the needle and dental procedures in general that topical anesthesia is not sufficient, I use conscious sedation.

If your dentist does not use topical anesthetic, simply ask for it.

What is a water pik and do I need one?

Water picks, sometimes called “oral irrigators,” make an excellent addition to your regular home care regimen of brushing and flossing. Especially helpful to those who suffer from periodontal disease and those patients of ours undergoing orthodontic treatment with full-bracketed braces, water picks use powerful tiny bursts of water to dislodge food scraps, bacteria, and other debris nestled in the crevices of your mouth. Children undergoing orthodontic treatment may find using a water pick is beneficial if their toothbrush bristles tend to get caught on their wires or brackets.

When you use a water pick, you’re not only dislodging any particles or debris and bacteria you might have missed when brushing, you are also gently massaging the gums, which helps promote blood flow in the gums and keeps them healthy. While water picks are an excellent addition to your daily fight against gingivitis and other periodontal diseases, they are incapable of fully removing plaque, which is why Dr. V and Patty want to remind you to keep brushing and flossing every day.

If you have sensitive teeth or gums and find it uncomfortable to floss daily, water picks are a good alternative to reduce discomfort while effectively cleaning between teeth. Diabetics sometimes prefer water picks to flossing because they don’t cause bleeding of the gums, which can be a problem with floss. If you have a permanent bridge, crowns, or other dental restoration, you may find that a water pick helps you keep the area around the restorations clean.

So how do you choose the right water pick?

Water picks are available for home or portable use. The home versions tend to be larger and use standard electrical outlets, while portable models use batteries. Aside from the size difference, they work in the same manner, both using pulsating water streams. A more crucial difference between water picks is the ability to adjust the pressure. Most home models will let you choose from several pressure settings, depending on how sensitive your teeth and gums are. Most portable models have only one pressure setting. If you want to use mouthwash or a dental rinse in your water pick, check the label first; some models suggest using water only.

Please give us a call at our office if you have any questions about water picks, or ask Dr.V or Patty during your next visit!

Root Canal Treatment: Is it Safe for Your Body?

Root Canal Treament Des Moines IowaWhat is a root canal treatment:A root canal is a safe and effective procedure. When a severe infection in a tooth requires endodontic treatment, that treatment is designed to eliminate bacteria from the infected root canal, prevent reinfection of the tooth and save the natural tooth.Root Canal Procudures At Plaza DentalSigns & Symptoms for the need of root canal procedures:

  • Severe toothache pain upon chewing or due to teeth pressure.
  • Prolonged sensitivity/ pain to heat or cold temperatures.
  • Discolouration or darkening of tooth.
  • Swelling & tenderness in the nearby gums.
  • Persistent or recurring sore on the gums.

Common Myths about Root Canals:

*Myth #1- Root canal treatment is painful.
*Myth #2- Root canal treatment causes illness.
*Myth #3- A good alternative to root canal treatment is extraction (pulling the tooth).

Most dental patients accept that they need a root canal without giving it a second thought. Over 41,000 root canals are performed every day in dental offices across the country—that’s 25 million every year. While root canals are standard practice and typically go off without a hitch, it’s important to understand the potential risks.

When you have a root canal, there is always the possibility of infection in the root canal teeth. Once the teeth are infected, the bacteria may travel to other regions in the body. There is a common consensus that sterilizing root canal teeth and instrumenting and irrigating the canal will wipe out all of the bacteria. In reality, most of the time, there is necrotic debris left behind. If a microbiological culture is taken for the surrounding bone, it will almost always show an infection.

While it may sound scary, the presence of bacteria doesn’t necessarily lead to disease. There are a number of factors at play that may contribute to the outcome for any given patient including the type of bacteria, the toxins that it produces, and the state of the immune system for the given patient.

It’s also important to note that the bacteria that stems from root canals may have a negative impact on other diseases. Studies confirm that the bacteria present in root canal teeth and gum disease is often the same bacteria present in blood clots and coronary arteries that lead to heart attacks. The presence of the same bacteria points to direct causation as opposed to correlation between oral infections and cardiovascular disease.

Additional research shows that the oral bacteria can wipe out white blood cells intended to eliminate them, which is why infection may present in close proximity to the root canal site, such as in the jaw bone. The bacteria can also get into the immune system by mimicking naturally occurring bacteria, breaking down antibodies and white blood cells, and creating sticky biofilms.

5 Tips when having Pain After Root Canal Treatment:

#1  Stick to antibiotics prescribed by your dentist. The medication takes atleast 24 to 48 hours after the medication regimen has begun.

#2 For relief from pain, take anti-inflammatory medications that allows reduction of inflammed periodontal fibers.These fibres anchor the tooth to the bone.

#3 Give the tooth that has had a root canal started or completed some time to settle down and become more comfortable. A night guard or relaxation techniques to keep your teeth slightly apart, can contribute to a more comfortable dental state.

#4 Avoid crunchy, hard or tough foods on a recently treated root canal tooth for several days afterwards.

#5 Having a crown made for a root canal treated tooth helps to maintain it, keep it intact, functional, and less likely to develop pain from fracturing.

As with many types of dental procedures, the best way to avoid root canals is eat a healthy diet and practice good oral hygiene. Brush twice daily, floss daily, and base your diet around whole foods, steering clear of sugar and processed carbohydrates. If you must undergo a root canal, talk to your dentist about ozone therapy. Having ozone therapy before a root canal or tooth extraction will wipe out any toxic material and boost the response from your immune system.

Root canal treatment is highly successful; the procedure has more than a 95% success rate. Many teeth fixed with a root canal can last a lifetime. If you are experiencing the pain and discomfort of an infected tooth and you live in the Jupiter/Tequesta area, call Dr.Villalobos today to get the treatment you need for a better quality of life

Teeth Grinding

 Teeth Grinding
“Keep a stiff upper lip” or “get a grip!” That’s often the advice we get—and give—on how to cope with stress. If you take it literally, the result could be grinding your teeth or clenching your jaws. It’s called bruxism, and often it happens as you sleep.

Teeth grinding can be caused not just by stress and anxiety but by sleep disorders, an abnormal bite or teeth that are missing or crooked. The symptoms of teeth grinding include:

  • dull headaches
  • jaw soreness
  • teeth that are painful or loose
  • fractured teeth

Your dentist can fit you with a mouth guard to protect your teeth during sleep. In some cases, your dentist or physician may recommend taking a muscle relaxant before bedtime. If stress is the cause you need to find a way to relax. Meditation, counseling and exercise can all help reduce stress and anxiety.

Teeth grinding is also common in children. However, because their teeth and jaws change and grow so quickly it is not usually a damaging habit that requires treatment and most outgrow it by adolescence.

Although in adults teeth grinding is often the result of stress, the same is not always true with children. Other possible causes of teeth grinding in children include:

  • irritation in the mouth
  • allergies
  • misaligned teeth

If you’re concerned about your child’s teeth grinding, ask your child’s dentist about the potential causes and, if necessary, the possible solutions.

Defeating Gum Disease

Gum disease runs rampant in our part of the world. Something like four out of every five Americans will be diagnosed with gum disease. That is an incredible high number for such a preventable disease! We can categorize most cases into one of three levels: gingivitis, periodontal disease, and advanced periodontal disease. Gum disease is progressive, which means that if it isn’t treated, it will continue to get worse. Read below for more details on these levels of gum disease and how we can knock it out of your mouth with our advanced dentistry!

This first level of gum disease is difficult for the patient to notice. There’s rarely any pain, and the swollen gums might not seem like cause for alarm, if the patient even knows they are there! We can treat gingivitis with one good, thorough dental cleaning. We will clear the bacteria and show you how to prevent it from happening again.

If gingivitis isn’t treated, it will go deeper into your gums, and turn into periodontitis. This form of gum disease is much more serious because the infection will begin to affect the bone structure holding the tooth root in place. In order to treat this, we must turn to a procedure called root scaling and planing, which is a deep cleaning of your tooth roots and a removal of debris found under the gums.

Advanced Periodontitis
If allowed to continue further, periodontitis will become more and more advanced. At this stage, you are probably beginning to lose your natural teeth because the damage to your bone structure is so severe that it cannot hold the root any longer. We treat this with pocket reduction surgery. We use the dental laser to clean out the infection and repair the damaged gums.

Gum disease is completely preventable with a good oral hygiene routine of brushing twice a day, flossing once before bed, and seeing a dentist every six months for a cleaning and exam, yet gum disease is the number one cause of lost teeth in the USA. Don’t be a negative statistic. today to schedule your appointment, and let’s get you back on track with a healthy smile!

Benefits Of Implant Supported Dentures









If you’re a candidate for getting traditional dentures (or if you’ve been living with them for some time and are considering other options) it’s worth knowing that when it comes to advances in cosmetic dentistry Jupiter, FL patients are fortunate — dental implants have become a mature, safe and effective oral surgery procedure that nearly everyone can benefit from.

With dentures that are supported by dental implants, Jupiter, FL patients see several advantages over traditional dentures. First, of course, implant supported dentures are more solidly attached to the jawbone than regular dentures, taking full advantage of the exceptionally strong bond that is formed between the implants and the bone itself. The strength of that bond is comparable to that holding your original teeth in place — and the process is permanent, meaning the posts will not move.

Traditional dentures rest on the gums themselves, and despite considerable advances in adhesive materials are still prone to slipping, which can cause embarrassment and irritation. What’s more, over the long term regular dentures actually contribute to jawbone deterioration, which changes the structure and look of a patient’s face — and making the dentures fit even less well.

After a post-surgical healing process that lasts several months, your new implants are ready for the implant-supported dentures to be mounted upon them; they’ll never slip, make noise, or fall out unless you or your dental professional removes them intentionally for cleaning. They are exceptionally durable, and easy to care for — they are very resistant to decay, and a minimal maintenance schedule will keep them in top shape for years.

For more information or to schedule a consultation with the experts in dental implants Jupiter/Tequesta trusts more than any other, call us today! We look forward to hearing from you!

From jewel-capped teeth to golden bridges – 9,000 years of dentistry

Ancient Dentistry - Golden Bridges

From jewel-capped teeth to golden bridges – 9,000 years of dentistry

Dentistry, in some form or another, has been practiced for at least 9,000 years, although tooth extraction and remedies for tooth aches probably go back much further.  The study of ancient remains from around the world has demonstrated the ingenuity that existed in the application of surgical and cosmetic dental practices going back many millennia.

The Indus Valley Civilisation has yielded evidence for the earliest form of dentistry, which dates back to 7000 BC.  Sites in Pakistan have revealed dental practices involving curing tooth related disorders with bow drills operated, perhaps, by skilled bead craftsmen. The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.

Bow and flint-tipped drill

An experimental reconstruction of a bow and flint-tipped drill used to bore through molar teeth found at a Neolithic graveyard in Mehrgarh, Pakistan. Photo source.

The oldest evidence of a dental filling was found in 2012 in Slovenia when a 6,500-year-old jawbone demonstrated that a cavity deep enough to impact the dentin layer of the tooth had been packed with beeswax. Scientists aren’t sure how effective this was, but it probably reduced the pain and swelling.

The myth of the tooth worm

Tooth WormThe first and most enduring explanation for what causes tooth decay was the tooth worm, as depicted in the ivory sculptures to the left, which was first noted by the Sumerians around 5000 BC. The hypothesis was that tooth decay was the result of a tooth worm boring into and decimating the teeth. This is logical, as the holes created by cavities are somewhat similar to those bored by worms into wood.

The idea of the tooth worm has been found in the writings of the ancient Greek philosophers and poets, as well as those of the ancient Indian, Japanese, Egyptian, and Chinese cultures. It endured as late as the 1300s, when French surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.

Dentistry in ancient Egypt

Historical records reveal numerous dental and hygiene procedures practiced by the ancient Egyptians. The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, includes the treatment of several dental ailments, and the Ebers Papyrus, dating to the 16th century BC, contains eleven recipes which pertain to oral issues. Four of these are remedies for loose teeth: the tooth in question is filled with a mixture that is akin to a modern day composite filling: a filler agent (ground barley) is mixed with a liquid matrix (honey) and an antiseptic agent (yellow ochre). This is either used as an actual filling, or as a splint to keep the tooth in place. Scientists performing CT scans on the head of a 2,100-year-old Egyptian mummy also found evidence for cavities being filled with linen, which may have first been dipped in a medicine such as fig juice or cedar oil.

Hesi-Re is the first named “dentist” in ancient Egypt and the world. He was an official, physician and scribe who lived during the Third dynasty of Egypt, around 1600 BC, and served under the pharaoh Djoser. He bore titles such as “Chief of Dentists and Physicians”, “Doctor of the Tooth” and “Chief of the King’s Scribes”. While he was ranked chief of dentists, it is not entirely clear what this title actually means, but he is credited as being the first man to recognise periodontal disease (gum disease).

Pharaonic physicians were no strangers to reconstruction works: there have been three instances of a dental bridge: one or more lost teeth reattached by means of a gold or silver wire to the surrounding teeth.  In some cases, a bridge was made using donor teeth.  However, it’s a bit unclear whether these works were performed during the life of the patient or after death – to tidy them up, as it were, before their burial.

Mummy Dental Work - 4000 years old

Incredible dental work found on a 4,000-year-old mummy. The two centre teeth are donor teeth.

Mayan bling

The Mayans are credited with being the masters of cosmetic dentistry as they were known to decorate teeth by embedding them with precious stones or by carving notches and grooves into them. Tiny holes were chipped out of teeth and ornamental stones—including jade—were attached with an adhesive made out of natural resins, such as plant sap, which was mixed with other chemicals and crushed bones. The dentists likely had a sophisticated knowledge of tooth anatomy because they knew how to drill into teeth without hitting the pulp inside.

Mayan ‘bling’ on a male skull found in Chiapas, Mexico

Mayan ‘bling’ on a male skull found in Chiapas, Mexico. Photo source.

Dentistry of the Middle Ages

During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection.

In the 1400s, dentures seemed to take more of the modernised shape that we see today. These dentures were still made from carved animal bone or ivory, but some were now made from human teeth. Grave robbers often used to steel the teeth from recently deceased people and sell them to dentists, and the poor used to make money by having their teeth extracted and selling them. The finished denture would not be very aesthetically pleasing or very stable in the mouth, and was often tied to the patients remaining teeth. Another problem that occurred with these dentures is that they tended not to last long and began to rot over time.

In 1723, French surgeon Pierre Fauchard published ‘The Surgeon Dentist, A Treatise on Teeth’, and became known as the Father of Modern Dentistry because his book was the first to describe a comprehensive system for caring for and treating the teeth.

The modern dental practices of today could not have developed without the ingenuity and experimentation of ancient people beginning at least 9,000 years ago.

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Mouth Rinses – A Compliment, Not a Substitute for Daily Oral Hygiene

Mouth wash and mouth rinses can play a key role in optimizing your daily oral hygiene to maintain healthy teeth and gums. However, mouth rinses and mouth washes are not a substitute for brushing and flossing.  They serve to compliment the actions and the benefits of brushing and flossing.  When used properly and as recommended by your family dentist or hygienist, mouth rinses can reduce breath odors, aid in preventing tooth decay and help reduce plaque.

The following lists different types of mouth rinses available today:

Mouth Rinses with Fluoride

Fluoride helps prevent tooth decay by strengthening teeth enamel – the white, hard substance that covers teeth. For the majority of people, fluoride mouth rinses are not an essential part of their daily oral hygiene. The fluoride found in toothpastes used in daily brushing regimens provides an adequate amount, but there are occasions when fluoride mouth rinses are important.

People with abnormal mouth dryness might use fluoride containing mouth rinses. Severe dryness in the mouth can cause excessive amounts of bacteria to grow which can lead to tooth decay. Supplementing brushing and flossing with a fluoride mouth rinse can help fight this problem.

Mouth Rinses to Freshen Breath

There are a variety of mouth rinses available that will make your breath smell good, but don’t provide any long-term oral health benefits. These cosmetic type mouth rinses serve only to fight halitosis (bad breath), not to reduce bacteria that cause plaque and gingivitis.

Anti-Plaque and Anti-Gingivitis Mouth Rinses

Anti-plaque and anti-gingivitis mouth rinses are a good way to enhance the effectiveness of daily brushing and flossing.  These types of mouth rinses kill harmful bacteria.

American Dental Association (ADA) Seal of Approval

As with all oral hygiene products, always look for the ADA seal of approval on the packaging of mouth rinses. The ADA seal provides assurances that the product has been independently tested and verified.

Prescription Mouth Rinses

While most mouth rinses are available over-the-counter, your dentist can prescribe stronger mouth rinses for those who need help with advanced forms of plaque and gingivitis.

Talk to Your Dentist and Hygienist

Discuss mouth rinses and overall hygiene with your general dentist and hygienist to see what products are right for you and your unique needs.


How Many Dental X-rays Are Too Many?

QUESTION: Every couple of times that I visit my dentist’s office, she asks me to submit to more dental X-rays. I seem to be getting an awful lot of them. I don’t want to increase my chances of getting cancer. How often should I be getting dental X-rays?

ANSWER: You’re not the only patient who has expressed concerns about exposure to radiation from dental X-rays. The thought has crossed my mind many times, too. So it’s a good question. But, unfortunately, there is not one answer for everyone.

It depends on many factors including how much dental work you’ve had in the past, the current condition of that work, your dental hygiene and if you have any signs or symptoms of dental decay or gum disease. Even your age needs to be taken into account because your risk of oral problems varies throughout your life.

The dentist’s decision to take an X-ray “always has to be patient-specific and risk-based,” explains Dr. Susan Sutherland, chief of dentistry at Sunnybrook Health Sciences Centre.

Dental X-rays, she notes, are necessary for identifying hidden dental decay — such as in the areas between teeth or beneath old fillings and crowns. They also reveal bone loss that accompanies gum disease. This information can help determine what treatments you might need. Early intervention might help save a tooth or limit the amount of required restoration.

There is clearly a benefit to having X-rays. But any level of radiation poses a potential risk to patients. For that reason, you want to minimize your exposure as much as possible.

“There is a general principal in radiation safety called ALARA — as low as reasonably achievable,” says Dr. Sutherland. In other words, you always prescribe the least amount of radiation that’s necessary to do a particular job — such as monitoring or diagnosing a certain condition.

To help dentists make these critically important decisions, professional dental organizations issue general guidelines about when X-rays should be performed.

For instance, a document produced for the American Dental Association suggests that an adult with good oral health and low risk of dental problems should have x-rays taken at intervals of every 24 to 36 months.

The Canadian Dental Association relies upon the same document for its recommendations.

Even with theses guidelines, dentists shouldn’t be blindly following them to the point where they automatically have X-rays taken at set times for their patients, says Dr. Ernest Lam, a professor of dentistry and head of oral and maxillofacial radiology at the University of Toronto.

“Whenever an X-ray is ordered, it should be done only after a clinical exam has been performed by the dentist,” he says. This approach helps ensure that the dentist uses his or her professional judgment to determine if an X-ray is really necessary.

Dr. Sutherland agrees, emphasizing the decision to order an X-ray should be made on a case-by-case basis. She says some of her adult patients have X-rays taken every five years. Others, however, get them every two years — or even more frequently.

In any discussion about X-rays — and the assessment of their potential risks and benefits — it’s important to keep in mind that we are also exposed to natural radiation in the environment.

Radiation constantly rains down on us from outer space, explains Dr. Paula Sikorski, an oral and maxillofacial radiology consultant in Sunnybrook’s Department of Dentistry. There are also elements in the earth that are producing a steady stream of radioactive particles.

Depending upon where you live and travel on our planet, you receive between 3,000 and 4,000 micro-Sieverts of radiation every year, says Dr. Lam. (The atmosphere acts to absorb or deflect some of the cosmic radiation. That means people who live at higher altitudes – where the air is thinner — tend to be exposed to more radiation than those who dwell closer to sea level.)

By contrast, you receive a dose of eight or nine micro-Sieverts for each intraoral X-ray, provided the dentist is using either fast-speed film or digital imaging, says Dr. Lam. With slower speed film, the dose would be roughly doubled.

Each intraoral X-ray shows several teeth, from the upper surface to the supporting bone. A dentist might order multiple images to reveal an area of concern.

A dentist can also rely upon a “panoramic” X-ray, which shows the entire mouth area – all the teeth in both the upper and lower jaws. The dose from this type of X-ray is about 24 micro-Sieverts, says Dr. Lam.

Overall, the amount of radiation you get from dental X-rays is relatively small — especially when compared with the radiation you receive from natural background sources.

Even so, “we can’t be indiscriminate about X-rays because radiation [risk] is cumulative,” says Dr. Sutherland. “As health professionals, we shouldn’t be contributing more than we need to in order to make a proper diagnosis.”

After all, it’s impossible say when radiation from any number of sources might randomly damage the genetic material of a cell and set the stage for a cancer.

Aside from keeping X-ray exposure to a minimum, dental offices are required by provincial regulations to follow certain procedures when the images are taken — such as placing lead aprons and neck collars on patients.

If you feel you may be getting too many X-rays, you should have a discussion with your dentist, advises Dr. Lam.

“Ask the dentist for an explanation and how those X-rays are going to impact on your care,” he suggests. In other words, how is the information from the X-ray going to be used and will it make any difference in your treatment?

Dr. Lam points out that many patients assume the dentist who is treating them will do the right thing.

“I think patients need to be their own advocates, they need to be educated, and they should not be afraid to ask questions,” says Dr. Lam.

You may find the dentist has a good reason for the frequency at which your X-rays are being taken. You may be one of those people who — for a variety of reasons — is especially vulnerable to dental decay and gum disease.

But, of course, if you are not satisfied with the answers, it’s your prerogative to say no to the X-rays.

Co-authored by Paul Taylor, Personal Health Navigator at Sunnybrook.