Radiology · patient case question
Which radiographic examination is indicated for this patient?
Patient case: Films for a Patient Not Seen in Ten Years
Patient: 48-year-old male
Chief Complaint: “I want a full check-up. I know it's been a while.”
Background: Last dental visit approximately ten years ago. No current symptoms. Reports his gums bleed when he brushes.
Medications: None
Vital Signs: BP 128/80 mmHg · HR 76 bpm · RR 16 · T 98.4°F
Findings: Generalized 5–7 mm pockets with bleeding on probing and visible recession. Several teeth are slightly mobile. On imaging: a horizontally impacted #17 whose crown abuts the distal root of #18, which shows a concave defect at the contact point; a well-defined mixed radiolucent-radiopaque lesion at the apices of the mandibular anteriors, which all test VITAL; and a radiopaque structure superimposed over the mandible on both the panoramic and lateral cephalometric films.
Show answer and explanation
Correct answer: B. A full mouth series
- A. A panoramic film is excellent for a broad survey — impactions, jaw pathology, sinus and condyle — but its resolution at the crestal bone and interproximal contacts is inadequate for periodontal assessment or caries detection.
- B. CORRECT. A FULL MOUTH SERIES is the ADA/FDA-recommended examination for a NEW adult patient with clinical evidence of generalized dental disease or a history of extensive treatment. It gives the periapical and interproximal bone detail needed to stage his periodontitis, which a panoramic film cannot provide at the level of individual teeth.
- C. A lateral cephalogram is an orthodontic and orthognathic tool for skeletal relationships. It has no role in this examination.
- D. Bitewings alone show interproximal caries and crestal bone but give no apical information, which is essential given his periodontal status and the anterior lesion.
Note: The prescribing rule: a new adult patient WITHOUT clinical evidence of disease gets posterior bitewings with selected periapicals or a panoramic. A new adult patient WITH generalized disease gets a full mouth series.