This number 20 is the only shock value thing in this thread. Yet if you went to any dental school, this is exactly the survey you'd get. Google full mouth series.
Again, 95 percent of dentists take 5. 4bw and a pano.
If you take a panoramic xray, then why do you still need the bitewings? Isn't that the reason that you take the panoramic xray, to get the entire mouth? Not trying to pile on the anti-dentite crowd here, just honestly curious?
And what percentage of dentists in general are doing the xrays to ensure standard of care vs the group who is doing it for the discovery of issues/upsell opportunity with the cleaning profitless customer? It has seemed that the business model is being pushed towards profit driving services over the last few years and the chains are certainly leading that pack.
Great question. The panoramic x-ray gets all the teeth and roots in view. However, it is not diagnostically accurate for the in between teeth cavities due to angulation issues and not getting magnified enough on those back teeth in between the teeth.
50% of cavities are in between the teeth and are only picked up by a bitewing unless they are massive cavities.
In lieu of bitewings, you are only going to visually discover a cavity when it is too late to fill... by then it will need a crown or possibly a root canal and crown..
I can't answer the final question. When you are educated in school on the proper way to diagnose and treat people, it is very difficult after school to run into the buzzsaw that is the general public who have an entirely different idea of what is appropriate and reasonable.
The bottom line is that is impossible to read people's minds.
Obviously there are a lot of people in this thread concerned about upsells and over-radiation. But there are a lot of people on the other end of the spectrum that really want and value a through examination and would be very upset if I missed something that would have prevented them from having a tooth break (finding a cracked tooth that's apt to break but currently doesn't hurt) or finding a small cavitiy before it necessitated a root canal.
When someone walks in the door it's pretty hard to figure out which side of the coin they are on. It's better to default to doing things the way you were taught. The way scholarly articles suggest you should do them.
All I can do is diagnose what I see, attempt to photograph it and show people what's going on in their mouths.. and tell them about it. Some people view that as a cashgrab and an upsell.. even if I'm not really pushing any of it... and they leave and never come back. Others appreciate seeing what's going on, knowing their alternatives, and then choosing to pursue or not pursue treatment as they see fit.
But it's a really tough business.. which is one of many reasons why I'd like to get out of it ASAP... because it is very hard to give people the experience they want since they rarely tell you even if you ask them... what they really want.... and then is what they want even remotely compatible with standard of care? Tough.
