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Letters: X-rays in dental exam

September 07, 2015 Dr. Allen Finkelstein states in his column ("Medical Necessity: Friend or Foe," May 18 ADA News) that ADA guidelines "support that radiographic screening for the purpose of detecting disease before clinical examination should not be performed." I looked up the guidelines and couldn't find this recommendation. As a practicing periodontist, I take a full-mouth set of X-rays on the vast majority of my treated patients every five years. I do this even before I touch a probe to them. X-rays of tooth roots and supporting bone provide me with a multitude of information that I cannot detect clinically. Root fractures, root resorption, endodontic post perforations, periapical abscesses, increasing bone loss in furcations, cementum tears, occlusal trauma (in widening of periodontal ligament), crown and bridge cement on implant abutments, subgingival calculus, enamel pearls and peri-implantitis are just some of the "hidden" pathology that appears in full-mouth X-rays. Furthermore, impacted third molars need to be examined radiographically about every five years after age 30 if a patient elects to retain them. I have actually diagnosed an asymptomatic dentigerous cyst that involved the cancellous bone of an entire ramus once. All because a panoramic X-ray was taken before a dental examination was done. Without a doubt I believe that proper X-rays are medically necessary for a dental exam.

Thomas C. Reinhart, D.D.S.
Tampa, Florida