A child with Duchenne muscular dystrophy attends for a first visit with clinically detectable interproximal and occlusal caries. Which radiographs are MOST appropriate?

Correct answer: D. Two posterior bitewings

• A. A full-mouth series is a lengthy, poorly tolerated examination with substantially higher exposure, not justified at a first visit for caries detection.
• B. CBCT delivers far higher radiation and has no role in caries detection.
• C. A panoramic radiograph is for growth and development, impactions, pathology, and trauma assessment — it lacks the resolution to reliably detect interproximal caries.
• D. CORRECT. BITEWINGS are the appropriate initial radiographic examination when the clinical concern is interproximal caries, in line with the ADA/FDA selection criteria. In a child with Duchenne muscular dystrophy — who has progressive muscle weakness, limited head and neck control, possible respiratory compromise, and reduced ability to tolerate long procedures — the shortest, best-tolerated examination that answers the clinical question is the correct choice. Bitewings also image the crestal bone.

Note: ALARA plus the specific clinical question. Selection criteria always beat routine protocols, and this applies doubly for patients with limited tolerance.