The Real Reason Dentists Take X‑rays: What They Reveal Beyond the Smile

You can brush, floss, and still have a problem brewing where you cannot see it. We sit down with Dr. Stephen Blank, Port St. Lucie’s longtime dentist, to pull back the curtain on dental X-rays and the “invisible” side of oral health, including what’s happening under your gums, inside your jawbone, and between teeth that look perfectly fine in the mirror.

We talk through what dentists are actually looking for when we take images: early cavities hiding between contacts, bone levels linked to gum disease, root length and anatomy that affect how stable a tooth is, and even the rare but important findings that do not belong in the jaw. Dr. Blank also explains why baseline imaging matters for treatment planning, so we know where you’re starting and can track real change over time rather than guessing.

If you’ve ever worried about radiation, we get practical. You’ll hear how digital dental X-rays and modern sensors reduce exposure compared with old film, plus how we decide which images to take, from bitewing X-rays for cavity checks to periapical X-rays for full root views, panoramic X-rays for broad planning, and cone beam CT for detailed 3D dental imaging when a case is complex. We also cover general timing, like annual bitewings for many patients and a fuller series every four to five years, adjusted to your personal risk factors.

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To learn more about Dr. Stephen Blank visit:
https://www.PSLdentist.com
Dr. Stephen Blank, DDS
184 NW Central Park Plaza 
Port St. Lucie, FL, 34986
772-878-7348  

Transcript

Welcome And What We Cannot See

SPEAKER_00 0:03

Welcome to the PSL Dentist Podcast, where healthy smiles meet real talk. Hosted by Port St. Lucie's very own Dr. Stephen Blank, the one dentist who's been making the treasure coast smile for decades. From one visit crowns to clear aligners, Botox, and even lifting threads, yep, your dentist does that too. So sit back, open wide, not literally fleet. And get ready to sink your teeth into today's episode.

SPEAKER_01 0:36

Let's talk about the invisible world inside your teeth, the one even the best mirror can't show you. Today's topic reveals how dentists catch problems early, long before you feel a thing. Welcome back everyone. Frederick, co-host and producer here, back in the studio with Dr. Stephen Blank, your Port St. Lucie dentist. Dr. Blank, great to see you. How are things going today?

SPEAKER_02 0:58

Great to see you, Frederick. It's great to be here, and things are wonderful in Port St. Lucie.

SPEAKER_01 1:03

Nice, nice.

Why Dentists Take X-Rays

SPEAKER_01 1:04

So, Dr. Blank, today we're exploring something every patient experiences, but not everyone understands. Why do dentists take x-rays? Can you walk us through why these images matter so much in dental care?

SPEAKER_02 1:15

That's a great question, Frederick, because that's usually where we always begin with new patients, is with taking x-rays. And people always ask, do I need to have x-rays? Why are you taking those? And uh I think a little understanding of the value might be informative to patients. Also, the safety or the risks versus benefit is always a good question for any procedure. So when we take an x-ray, it shows us what's underneath your gums, in your jawbone, in the upper and lower bones, and uh we see the teeth in an area that we normally cannot see. We usually just see the part you bite with, but there's a whole lot more tooth underground. So we can see the jaw bones, we can see if there's any cavities between the teeth in areas where two teeth touch tightly together, and we just can't see in the middle. So when the holes get big, we can find them, but so could a blind guy. Our goal is to find things when they're small and easily cared for because that's less trouble for the patient, easier recovery from the procedure, or virtually no symptoms, versus gigantic problems where patients can come in and there's no x-ray needed because the tooth is so bombed out. But even then, we still need to know what shape the root is so we can fix it. So we can find cavities between teeth, we can see bone levels, we can see also the root length. How big is the root? Somebody with little short roots has a much more difficult time keeping teeth attached to their jaw than somebody with big roots. So all that comes into play, and even in the same mouth, the left side might not be the same as the right side. Everything can be different. So we need to know that. Um, one other thing that x-rays allow us to see is growth and development in the jaws. So for children, for example, we can see the adult teeth forming underneath in the mouth, and we can see if they're forming properly in the right location, if there's a crowding issue, or in the more difficult situations, if there's an adult tooth not forming. So we might not want to remove a baby tooth. We might want to try to keep it for as much of the adult life as possible. These are things we don't know unless we look. Um, so that that's a big start to it. Uh, the other one, uh, and we don't like to talk about it a lot, but is we find things in the jawbone that don't always belong there. So sometimes a cancer or a growth could happen. Often they're benign little things that don't need any care, but there are some times where it does need follow-up uh on more of an oral surgical or medical level, uh, that it's not just a little cavity anymore. So this screens things out. In my office, I like to have a complete set of pictures as a wonderful baseline so I know how you're starting with me. What condition did you come into? Um, what do you have that I need to be concerned with? And then we can start treatment planning based on the rest of the exam.

SPEAKER_01 4:16

Gotcha, gotcha. Thanks for that. Uh, you mentioned x-rays can help you catch cavities, uh, check the root, and also detect other things such as cancers and those things. Um, are there different types of x-rays? And if so, how do you decide which type of x-ray a patient needs?

Bitewings Periapicals Panoramic CBCT

SPEAKER_02 4:35

Oh, that's a new modern question. In the past, just took a picture and that was it. It was on a little piece of Kodak film. That's all gone bye-bye. Now we have digital x-rays, so the images are up on the screen immediately, and we use a little sensor that replaces the film, so it's just connected to the computer. Um, so that's what we call an intraoral film. And then we have different intraoral films. So sometimes we take a picture on each side, our two pictures, and that shoots right between, and we get half the top tooth and half the bottom tooth. We call those bite wings because mostly you're biting on a little plastic tab that holds them in, and we get to see uh whether there's any cavities in between the teeth. Those show up real nicely, if they if they're present, um, on that type of an image. We also take pictures from up above and from down below to see the entire root structure of a tooth. We call those periapical x-rays. We don't take those every visit. We take those in my office, typically once every five years, possibly sooner if you've had a lot of changes in your mouth. If I did a lot of dentistry or a lot of problems were present that were never cared for, uh this way we can see the progression of dental disease, or I can check the results of my care. I want to make sure that what I did is sound and doing well. Um so the periapical x-rays are less frequent. The bite wing x-rays, uh, I typically do those every 12 to 18 months, depending on the patient. Somebody with very few fillings and very good home care, we might delay that 12 uh to 18 months. Somebody who has a lot of fillings already in between their teeth, they might need to be inspected a little bit more often to make sure nothing new is happening. And then we have the other kind of x-rays. You asked about different types. Uh there's pictures that are taken around the outside of the mouth where you bite on a little tab, but the x-ray machine goes around your head and it captures the entire jawbone from bottom all the way up to here. And we can see bone structures, sinuses, nerve canals, all sorts of things that the smaller pictures may not get. Uh that comes in handy for surgical planning on wisdom teeth and and other procedures like that. And then the more modern one uh is the comb beam x-ray. It's like a CAT scan image, it is a CAT scan image of the jaw areas. It can be limited to which part. We don't do the whole head, we just focus on the areas that we need an image of to reduce radiation exposure. And that allows us to see the jaw in three dimensions. So we can take the area and turn it this way, that way. We can see the teeth from straight on on the end or straight up and down. It allows visualization. If there's three roots, four roots, uh, for root canals, is there an extra canal? Um, does the tooth take a bend at the bottom? All sorts of information that we couldn't see otherwise. If there's a crack in a root, things that just don't show up in the mouth. So we get a lot more information and exposure.

SPEAKER_01 7:38

Nice, nice. So you did talk a little bit about modern dental or modern x-rays as well as radiation.

Digital X-Rays And Radiation Worries

SPEAKER_01 7:45

So the question that I have for you is many patients do worry about radiation. So, how do modern dental x-rays address that concern?

SPEAKER_02 7:54

Well, this is a really good uh advancement in in science and dentistry. The digital revolution has made the sensors replace film, and the sensor technology that the part that absorbs the x-ray after it's gone through your tooth is much more sensitive than the film. So we can crank the machine, the the settings on our x-ray, how much energy goes out the tube and through your uh your tooth, uh, almost in half. So when you get an x-ray now, it's not the same x-ray you got when the dentist was using film. Um, but yeah, we get a much more clear image uh and we're able to adjust contrast and brightness uh on that image. We can even colorize them if we want to. So the digital revolution has made it safer for patients and uh reduced the exposure.

SPEAKER_01 8:44

That is amazing. Thanks for that. So

Risk Factors And Prevention Mindset

SPEAKER_01 8:47

are there any specific symptoms or risk factors that make x-rays especially important?

SPEAKER_02 8:55

Um patients don't feel most dental pathology, cavities, periodontal disease, um, impacted wisdom teeth until they're really bad. So with x-rays, we're able to see things before you feel it. If you wait until you feel a cavity, you got a problem. So if we can find it when it's tiny, clean it out, fill it up, and you don't even know you ever had a problem, you're much better off than when you come in saying, My tooth's been throbbing for a week. Now you might need a filling or you might need a root canal treatment, uh, or in severe cases you might lose a tooth. So prevention is always the best treatment, and that begins with good home care and not having a problem to begin with, and then early treatment or early intervention is the next best thing. So that's how the x-rays play a role in that.

SPEAKER_01 9:48

Thanks

How Often Most People Need X-Rays

SPEAKER_01 9:49

for that. And I know you mentioned you touched on this earlier, but if someone has a lot of fillings, maybe they get x-rays more often. If they don't, they get them less often. So, in general, um, if you could just give a general uh just general number, how often should the average patient expect to have dental x-rays taken?

SPEAKER_02 10:07

Typically once a year to take the four cavity checking pictures we call bite wings. Um, if their oral health is exceptional, we stretched out a little bit longer. Um, and then the full series of pictures about every five years is a good uh interval. Four to five, depending again on the condition of the patient, their home care levels, how much dentistry or missing teeth they've had, or how many cavities are present. Excuse me. So not everybody's the same, so we don't treat everybody the same.

SPEAKER_01 10:39

Makes sense, makes sense. Yes. Well, thank you, Dr. Blank, uh, for breaking that down so clearly. We appreciate your insight. And for everyone tuning at home, we will see you next time.

Wrap Up And How To Book

SPEAKER_00 10:52

That's a wrap for the PSL Dentist Podcast, where smiles are brighter and laughs are always cavity-free. To keep your smile in shape, call 772-878-7348 or visit psldentist.com to schedule your appointment with Dr. Stephen Blank, the one stop doc for smiles, beauty, and everything in between. Until next time, keep lost, keep smiling, and keep listening.