Submerging deciduous teeth and the value of x-rays

In dentistry and medicine we try hard to reduce the amount of x-ray radiation we use, it is a basic rule of radiation protection. This means we should only use x-rays when we really need to, when it could potentially alter our treatment. I take less radiographs now than I did when I qualified as an orthodontist. The standard I was taught as a dental student for orthodontic assessment was a panoramic (to show all the teeth) and an upper anterior occlusal (to check for supernumerary teeth and midline problems). As panoramic quality has improved the occlusal view is rarely needed, and I only take cephalographs in more severe cases now.

Sometimes there's a risk of not taking radiographs when we really need to, and there seems to be a real reluctance from some dentists to take radiographs on children, when they can help to manage a case.

The picture above is from an 11 year old boy I saw yesterday. His second deciduous molars are still present and are submerging quite significantly, being now below the contact points of the molar teeth and almost at gingival level. Having looked in the mouth I was certain that the premolar teeth must be missing, as is often seen when the deciduous molars submerge. A radiograph was indicated to confirm this before I decided on treatment.

Have a look at the radiograph and you can see that they are in fact all present and relatively well positioned. I have to admit to being rather surprised, but it does demonstrate that radiographs can be useful tools when correctly used.

Has it changed my management of the case? In the short term, no, as teeth submerged this far are best extracted anyway. But it does change my follow up of the case and the long term management (it also makes the IOTN 5s, so what appears to be a mild case now has a high need for treatment). I will need to make sure the space is maintained until the premolars erupt, I don't anticiapte any problems with this but I will review the patient regularly until the premolars erupt. If the premolars had been absent I'd have been more likely to allow some natural space closure before orthodontics (his anterior teeth are mildly crowded).

If you are a GDP please remember to monitor for submerging deciduous teeth, in this case the patient had been referred for another reason. If you are registered on Dentinal Tubules have a look at this thread which shows more severe sequalae for untreated submergence.