- An X-ray is taken only if it will change a decision
- Panoramic, periapical, bitewing and 3D: each has its own job
- A written, prioritised treatment plan at the end of the examination
Oral diagnosis is the assessment that comes before treatment: listening to your complaint, learning about your medical history, examining your mouth and the area around it and, where needed, using X-rays to see what the eye cannot. Radiology is the imaging part of that process. The aim is to look not at a single tooth but at the whole mouth, and to establish what is urgent, what can wait and what is not needed at all.
A good share of wrong or incomplete treatment comes from a rushed first examination. That is why we treat the first appointment not as a formality but as the foundation of the whole plan.
What we do at the first examination, step by step
- Your complaint and expectations. Why you have come, how long it has been going on, and what bothers you most.
- Medical history. Long-term conditions, the medicines you take (especially blood thinners and osteoporosis medication), allergies, pregnancy, smoking. These directly change which treatment is done and how.
- Examination outside the mouth. Facial symmetry, the lymph nodes in the neck, the jaw joints and the chewing muscles.
- Examination inside the mouth. The teeth, existing fillings and crowns, decay, gum pockets and the bite; and the soft tissues of the tongue, palate, inner cheeks and floor of the mouth.
- Additional tests if needed. A cold test to check whether a tooth is still alive, plus tapping and biting tests.
- Imaging. Only as far as the examination findings require.
The soft-tissue examination is a step that should never be skipped. If we see a sore that has lasted more than two weeks, a white or red patch, or unexplained swelling or hardness, we record it and, if necessary, refer you for further investigation.
Which X-ray is taken, and when?
Each X-ray shows something different; one does not replace another.
| Image | What it shows | When it is needed |
|---|---|---|
| Panoramic | Both jaws, all the teeth, impacted teeth, the jaw joints and the lower part of the sinuses on a single image | An overview at the first examination, impacted teeth, comprehensive planning |
| Periapical | One or two teeth in high detail, down to the root tip and the surrounding bone | A painful tooth, infection at the root tip, the stages of root canal treatment |
| Bitewing | The crowns of the upper and lower back teeth together, and the bone level between the teeth | Decay between teeth that cannot be seen by eye, monitoring decay under fillings |
| 3D scan (CBCT) | Bone and teeth in three dimensions, slice by slice | Implant planning, impacted teeth close to a nerve, complex root canal and cyst cases |
A panoramic image gives a broad map but limited detail; it can miss early decay between teeth and small lesions at the root tip. That is why periapical or bitewing images are requested alongside the panoramic when needed. For orthodontic planning, a lateral cephalometric X-ray of the skull is added.
Is a 3D CBCT scan always necessary?
No. A CBCT scan is taken when there is a question that a two-dimensional image cannot answer. When planning dental implants, we need to see the width of the bone and its distance from the nerve canal and the sinus to the millimetre. If the roots of a lower wisdom tooth look very close to the nerve on a panoramic image, the CBCT shows the true relationship. It also guides us with teeth whose canals cannot be found, or that have not healed despite treatment. But a CBCT for a routine check-up or a decision about a filling means unnecessary radiation and unnecessary expense.
How much radiation does a dental X-ray involve?
All of us receive natural background radiation every day, from the ground, the air and space. Dental X-rays are among the lowest-dose medical imaging there is. The dose from a single intraoral image is roughly in the region of one day's natural radiation or less; a panoramic is equivalent to a few days. The dose from a CBCT scan varies with the machine and the size of the area scanned, and is markedly higher than that of two-dimensional images.
Our principle is simple: an image is taken only if it will change a treatment decision. If you have recent, clear images taken elsewhere, bring or send them; they may not need to be repeated. If you are pregnant or could be, always tell us; we postpone non-urgent imaging until after the birth.
From examination to written treatment plan
Once the examination and images have been assessed, we give you a written plan. It includes:
- A list of the problems found, tooth by tooth
- The options and alternatives for each one; sometimes "let's monitor it for now" is one of them
- The order of priority: pain and infection first, then the gums, then work that saves teeth, such as fillings and root canal treatment, and prosthetic and cosmetic work last
- The estimated number of sessions and the timeline
This order is not arbitrary. The margin of a crown placed before gum inflammation has been treated will not stay healthy for long, and a prosthesis built on a tooth whose infection has not been resolved will not last. You can take the plan away and think about it, and show it to another dentist if you wish; giving you copies of your images is routine for us. We have gathered what to look for when choosing a clinic in 18 questions to ask a dental clinic before you pay a deposit.
Cost and how often to have check-ups
The cost of the examination and imaging depends on which images are needed; after the examination at our İzmir clinic you receive a written, itemised quote. How often you need check-ups afterwards depends on your risk of decay and gum disease: every six months for some patients, while once a year is enough for others. Bitewing images are not taken at every check-up either, but at intervals based on your risk.
Common questions
How long does the first examination take?
Usually 30–60 minutes. If imaging is needed, it is done at the same appointment. If extensive treatment is needed, we can review the images in detail and give you the plan at a second short meeting or in writing.
Can I use X-rays taken at another clinic?
If they are recent and clear, usually yes. If you bring or send the digital files, or the raw data of a CBCT scan, we can assess them better. If your symptoms have changed or the images are old, a new image may be needed.
Can I have a dental X-ray while pregnant?
We postpone non-urgent imaging until after the birth. If something cannot wait, such as pain or infection, a single targeted image needed to make a decision can be taken; with intraoral images the beam is not directed at the abdomen. If there is any chance you are pregnant, always tell us before the image is taken.
I have already had a panoramic X-ray. Why do I need small ones as well?
A panoramic is a general map of the mouth, but its detail is limited. Periapical and bitewing images show early decay between teeth and small changes at the root tip much more clearly. The two complement each other.
Why isn't a CBCT scan taken for every patient?
Because its dose is higher than that of two-dimensional images, and for most decisions it adds no useful information. We take one when three-dimensional information genuinely changes the decision, as with implants, impacted teeth close to a nerve or complex root canal cases.
Can I take my treatment plan to another dentist for a second opinion?
Of course. We give you the written plan and copies of your images. Getting a second opinion before extensive treatment is a sensible and normal step.
Not sure if this is right for you?
Send us a photo. We will tell you honestly what you need — and what you do not.