Ask Toby

Although they don’t last as long as permanent teeth, your child’s first teeth play an important role in his/her development. While they’re in place, these primary teeth help your little one speak, smile and chew properly. They also hold space in the jaw for permanent teeth. If a child loses a tooth too early (due to damage or decay), nearby teeth may encroach on that space, which can result in crooked or misplaced permanent teeth. Your child’s general health is also affected by the oral health of the teeth and gums.

We recommend taking X-rays around the age of two and a half or three. The first set consists of simple pictures of the front upper and lower teeth, which the doctor will use to check for trauma and cavities. If the baby teeth in back are touching one another, then cavity detecting X-rays are recommended on an annual basis. Permanent teeth start coming in around age six, and X-rays help us make sure your child’s teeth and jaw are healthy and properly aligned. If your child is at a high risk of dental problems, we may suggest having X-rays taken more frequently.

NOW! The American Academy of Pediatric Dentistry recommends that a child be seen when the first tooth appears, or no later than his/her first birthday. We at Dental Derby like to start sooner. In fact, we like to meet with moms before their babies are even born! Why? Because there are a lot of steps expectant mothers can take even at that these early stages to prevent disease not only in their own mouths, but also in the mouths of their children for years to come. We like to see babies early too. 100% of cavities can be prevented with proper eating and brushing habits. The sooner we start with these good habits, the less likely your child will ever need to have a cavity fixed. Dr. Cangas believes so strongly in this that he’ll even do consultations for expectant mothers and babies under the age of one for FREE.

The best preparation for your child’s first visit to our office is maintaining a positive attitude. Children pick up on adults’ apprehensions, and if you make negative comments about trips to the dentist, you can be sure that your child will fear an unpleasant experience and act accordingly (Check out our My First Visit tab). Show your child the pictures of the office and staff on the website. Let your child know that it’s important to keep his teeth and gums healthy and that the dentist will help him do that. The Dental Derby staff is specially trained to handle fears and anxiety. Putting children at ease during treatment is our specialty.

It is common for parents to request that no radiographs be taken on their children, but the reasoning behind their request varies.  The usual concerns expressed are fear of radiation,  discomfort, and cost.  Please allow us to explain why radiographs are so important and why they are a necessary part of optimal patient care.

A visual dental examination, that is, an exam without radiographs, allows Dr. Cangas to see only 3 of 5 exposed surfaces on each tooth (that’s 60% of each tooth). Also, keep in mind that 2/3 of each tooth lies below the gumline and into the bone. A visual exam allows Dr. Cangas to see only what is happening above the gumline.  So if only 1/3 of the tooth is above the gumline, and he is only able to see 60% of that 1/3, doing a dental exam without radiographs is essentially allowing him to inspect only 18% of each tooth.  That is not a very thorough exam. Radiographs are necessary to evaluate and definitively diagnose most oral diseases and conditions.  Most commonly what we find is dental decay and periodontal disease, but in many cases, we find much more than that.  Because of the use of radiographs, Dr. Cangas has detected countless diseases and conditions in his fourteen years of treating patients.  He has detected numerous tumors and cysts. He has discovered calcification of glands, and also calcification of arteries, which is a life-threatening condition. He has found congenitally missing teeth. He has found foreign bodies.  He has revealed developmental anomalies which, if not discovered early, could end up costing the patient a lot of time, discomfort, and money.  Very few of our patients have only permanent teeth.  Most have a combination of baby and adult teeth, and their smiles are still developing.  Radiographs help us confirm that their smiles are developing normally and make it possible to detect problems early.  We can determine when permanent teeth are erupting ectopically and may need assistance in finding a path into the mouth.  We can find out early if crowding and misalignment is going to be an issue, and often take steps to eliminate the need for orthodontics or minimize the amount of time spent in braces.  Although the presence of these diseases and conditions is the not usual case, in the two years alone that Dental Derby has been open, we have encountered every condition mentioned above in our office, some of which were missed by the patients’ previous dentists who did not take radiographs.

Another important reason to have dental radiographs is for forensic purposes. More than 800,000 children in America are reported missing each year. Since the passage of the Missing Children Act in 1982, and the creation of the National Crime Information Center, the dental profession has provided much of the information used to compare missing persons with the unidentified living and dead. Numerous cases have been published in which law enforcement agencies called upon dentists to provide information that proved vital to the identification process. Dental Derby recognizes the importance of our role in the provision of data for identification of missing and/or deceased children. God forbid any of our patients should ever go missing, but if it ever happens, we would like to be prepared to assist the authorities, in any way possible, to help the families in their time of need.

If radiation exposure is your main concern, we completely understand.  That is why Dental Derby follows all the ADA/FDA guidelines and recommendations to minimize our patients’ exposure.   We take the minimum number of radiographs necessary to perform our exams.  We use lead aprons, thyroid collars, beam collimation and we have the most advanced sensors on the market, which require the least amount of exposure to obtain a diagnostic image.  We take every step possible to minimize exposure, but in reality, the amount of radiation we use is so low that it can be considered close to negligible.   On average, Americans receive a radiation dose of about 620 millirem each year. The average dental radiograph exposes the patient to 1.5 mrem.  We take 2-4 images every 12-24 months.  So even on our highest risk patients that get radiographs take every year, we are only exposing them to about 6 mrem per year.  We get a lot more radiation from the food we eat (about 30-40 mrem/year) than we do from dental x-rays. For those of us who work with and around radioactive material, the U.S. Nuclear Regulatory Commission (NRC) has established standards that allow exposures of up to 5,000 mrem per year.

The last reason, and a very important one from a professional perspective, is that we have a legal duty to provide competent care, and radiographs are vital for a proper diagnoses. Without the necessary films, we compromise our ability to provide competent care. Many offices even have a policy that states if a patient refuses to have the necessary radiographs, the patient will be dismissed from the practice. While this practice may seem rather inflexible and harsh, it may be the wisest policy from a legal and professional standpoint.  Even if it is at the request of the patient, if a radiograph is not taken when it is needed for proper diagnosis, and later a serious dental or medical problem arises,  Dr. Cangas, as the healthcare provider can be held liable.  No signed waiver or signed refusal would protect him in court.  No patient, or parent, can give consent for a dentist to be negligent. In fact, Dr. Cangas’ malpractice insurance carrier, while not specifically prohibiting it, recommends not accepting patients who refuse radiographs. Their literature reads as follows: “Dentists should proceed with great caution when patients insist on sub-standard care that may lead to serious harm. Treating without x-rays may lead to unreasonable results or risks, and withdrawing from care may be necessary. If a lawsuit is filed, the dentist’s professional judgment will be scrutinized.”

We very much want you to be comfortable with our office’s policies and Dr. Cangas is more than happy to discuss with you, in person or over the phone, any concerns you may still have.  Please let us know how we can be of service and help!