The current status of panoramic radiography

The current status of dental panoramic tomography (rotational panoramic radiography) is reviewed. This technique is based on a combination of tomography and slit-beam radiography to provide an image of both jaws on a single film. There is a greater degree of image degradation when compared with conventional radiographic techniques due to tomographic blurring, magnification and distortion, secondary images and burn-out. Meticulous patient position is essential to accommodate their jaws to the image layer determined by the manufacturers. The absorbed doses from panoramic radiography are of a similar order to that from bitewing radiography and lower than those from a full-mouth periapical series. The individual risk of 1.3 X 10(-6) is compared with that from other radiographic examinations and smoking. The collective risk, 1.04 deaths in the UK in 1981, is relatively insignificant as is the genetic dose. The risk to the dentist and his staff is also low compared to other risks. The methods of dose limitation currently available are reviewed. The clinical indications are considered in relation to the guidelines of the American Dental Association and the Dental Estimates Board in the UK. The problems associated with attempts to measure diagnostic yield are considered. In view of the world-wide public concern at the potential dangers of ionising radiation, dentists are urged to maximize the diagnostic yield from their panoramic radiography by taking such radiographs only when clinically necessary, ensuring meticulous positioning and processing, followed by scrupulous assessment of the radiography for any sign of pathological change.