Referral Criteria for Dental Radiography
When the clinician (referrer) wishes to refer a patient for radiographs, sufficient clinical
information must be supplied to the practitioner (person taking the radiograph) to enable a
decision as to whether the exposure is justified.
The following information should be supplied:
 Unique identification of the patient
 Clinical information to justify the exposure
 Unique identification of the referrer
 Information regarding possible pregnancy (where applicable)
In some situations the referrer will also be the practitioner (i.e. when the orthodontist is
prescribing and taking the radiograph). The formal exchange of information is therefore not
necessary.
Clinical examination and history is ESSENTIAL before any referral for radiographic
examination. This will enable the clinician to determine the appropriate radiographic
examination and justify the exposure.
There is NO justification for ‘routine’ radiographic examination of ‘new’ patients prior to clinical
examination.
When justifying a radiographic examination the practitioner must give appropriate
consideration to:
 Availability and findings of previous radiographs
 Objectives of the exposure in relation to the clinical findings and history
 Diagnostic benefit to the patient
 Radiation risk to the patient
 Alternative imaging techniques which would reduce exposure risk
For the exposure to be justified the benefit of the diagnostic information obtained
should outweigh the detriment of the exposure.
The authorisation of the radiograph will be noted by the referrer’s signature/initials in the
electronic notes following the clinical examination.
Exposure for medico-legal or third party reasons needs careful consideration if it is to be
justified. The request must come from a medical or dental practitioner. Written, informed
consent from the patient is necessary in these circumstances.
Selection Criteria for the use of radiographs in Orthodontics
Radiographs may be required when a clinical examination suggests an abnormality or when
active orthodontic treatment is being considered.
Typically this will be to determine:
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Presence or absence of permanent teeth
Presence and position of displaced teeth or supernumerary teeth
The stage of dental development of permanent teeth
The morphology of erupted or unerupted teeth
Presence and extent of dental pathology
Presence, extent and type of dental anomalies
Relationship of teeth to each other and within the jaw bases
Relationship of the jaws to each other and the wider facial skeleton
Assess treatment progress and jaw growth changes
At Pallant Orthodontics two types of radiographs are taken; Dental Panoramic Tomographs
(DPTs) and Lateral Cephalographs (Lat Cephs).
Dental Panoramic Radiographs (DPTs)
Principle use in orthodontic assessment is to determine the state of the dentition and presence
and absence of teeth.
DPTs should only be taken on the presence of specific clinical signs and symptoms.
Screening asymptomatic, ‘new’ patients cannot be justified.
Consideration should be given to the limitations of DPTs such as the narrow focal trough in
the incisor region and superimposition of the cervical spine.
Lateral Cephalometric Radiographs
Principle use is to aid diagnosis, treatment planning and monitoring treatment progress in
patients where there is an underlying jaw discrepancy and where labio-lingual movements of
incisors is required.
It may also aid in the localisation of displaced teeth and, when serial images are taken, assist
in determining the pattern of facial growth.
It is recommended that referrers at the practice also consult the following publications.
1. Guidance Notes for Dental Practitioners for the safe use of X-Ray Equipment (2001)
London, HMSO
2. FGDP (UK). Selection criteria for dental radiography (2004) 2nd Edition. London, Royal
College of Surgeons of England.
3. Orthodontic Radiographs – Guidelines (2008) 3rd Edition. British Orthodontic Society
All of these publications are available for reference at the practice. Please ask the RPS for
further information.
Updated: May 2015
Reviewed by: Dr Alastair Smith