> ## Documentation Index
> Fetch the complete documentation index at: https://docs.bizaxl.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Dental Radiography
> How to order, perform, and document dental X-rays - OPG (panoramic), IOPA (periapical), and bitewing radiographs - using Observations and Diagnostic Reports.
Dental radiography is a core diagnostic tool at every dental clinic. The system allows you to order X-rays from the dental examination, document radiographic findings as structured observations, and compile findings into a Diagnostic Report that can be shared with the patient or a referring clinician. This gives every X-ray a permanent home in the patient's clinical record.
***
## Before You Start
* **Clinical Procedure Templates** must be set up for each X-ray type (OPG, IOPA, Bitewing).
* **Observation Templates** must be set up to define the structured findings to record for each X-ray type.
* You need the **Healthcare Practitioner** role to order X-rays and record findings.
***
## Setting Up Observation Templates for Dental X-Rays
Observation Templates define the structured fields that will be completed when a specific X-ray's findings are recorded.
1. Go to Healthcare workspace → Diagnostic Module card → **Observation Template** → New
### OPG (Panoramic Radiograph) Findings Template
| Observation | Data Type | Example Values |
| -------------------------- | --------- | -------------------------------------------------------------------- |
| Bone Level (Generalised) | Select | Normal / Mild loss / Moderate loss / Severe loss |
| Bone Level (Localised) | Data | Specify tooth(teeth) and amount |
| Missing Teeth | Data | List missing teeth in FDI notation |
| Unerupted / Impacted Teeth | Data | e.g., "18 and 28 horizontally impacted", "38 partially erupted" |
| Root Morphology Concerns | Data | e.g., "dilacerated roots 16", "short roots 11-21" |
| Periapical Pathology | Data | e.g., "periapical lucency at tooth 26" |
| Maxillary Sinus | Select | Clear / Opacification / Other |
| Temporomandibular Joints | Select | Normal / Degenerative changes / Asymmetry |
| Calcifications | Data | e.g., "sialolith left submandibular region", "carotid calcification" |
| Caries Detected on OPG | Data | e.g., "caries visible 17 mesial" |
| Summary | Long Text | Overall radiographic impression |
| Action Required | Select | No action / Refer / Further investigation / Monitor |
### IOPA (Periapical Radiograph) Findings Template
| Observation | Data Type | Example Values |
| --------------------- | --------- | -------------------------------------------------------------------- |
| Tooth Number | Data | FDI notation (e.g., 36) |
| Region | Data | Specify: periapical, furcation, crestal bone |
| Bone Level at Tooth | Select | Normal / Mild / Moderate / Severe loss |
| Periapical Status | Select | Normal / Widened PDL space / Periapical lucency / Periapical opacity |
| Lucency Size (mm) | Float | Size in mm if periapical pathology present |
| Root Length (mm) | Float | Root length for endodontic planning |
| Canal Visibility | Select | Calcified / Patent / Partially visible |
| Root Fracture | Select | Not visible / Suspected / Confirmed |
| Crown Status on X-ray | Data | e.g., "MO amalgam, margins satisfactory" |
| Caries on X-ray | Data | Surface and extent |
| Summary | Long Text | Radiographic impression |
### Bitewing Radiograph Findings Template
| Observation | Data Type | Example Values |
| ---------------------------------- | --------- | ---------------------------------------- |
| Side | Select | Right / Left / Both |
| Crestal Bone Level | Select | Normal / Mild loss / Moderate loss |
| Caries Detected | Data | e.g., "mesial caries 46, DO caries 35" |
| Existing Restorations | Data | e.g., "MOD amalgam 36, satisfactory" |
| Overhang or Deficient Margins | Data | e.g., "overhang 24 distal" |
| Secondary Caries under Restoration | Data | e.g., "secondary caries suspected 16 MO" |
| Summary | Long Text | Overall bitewing findings |
***
## Step 1: Ordering an X-Ray from the Examination
From the Patient Encounter, raise a Service Request for each X-ray needed:
1. In the Patient Encounter, go to the Orders / Investigations section
2. Click Add and select the X-ray procedure template:
* OPG (Orthopantomogram)
* IOPA - Upper Right Region (or specify tooth)
* IOPA - Lower Left Region
* Bitewing - Right
* Bitewing - Left
3. Save the encounter
A Clinical Procedure record is created for each ordered X-ray.
***
## Step 2: Taking the X-Ray
The dental nurse or radiographer positions the patient and takes the X-ray:
* For OPG: patient stands at the OPG machine, bites the bite block, no movement during exposure
* For IOPA: position the film or sensor, use film holder, correct angulation
* For Bitewing: position the film or sensor with bitewing tab, patient bites to hold
After the X-ray is taken, update the Clinical Procedure status to "Completed" and attach the digital X-ray image to the record using the Attachment feature.
***
## Step 3: Recording Radiographic Findings
After taking the X-ray, the dentist reviews it and records findings using an Observation record:
1. Go to Healthcare workspace → Diagnostic Module card → **Observation** → New
2. Link to the patient and the Service Request
3. Select the Observation Template (OPG Findings, IOPA Findings, or Bitewing Findings)
4. Fill in each structured field based on the X-ray findings
5. Submit the Observation
***
## Step 4: Creating a Diagnostic Report
A Diagnostic Report compiles one or more Observations into a formal report that can be printed for the patient or sent to a referring clinician.
1. Go to Healthcare workspace → Diagnostic Module card → **Diagnostic Report** → New
2. Link to the patient
3. Add the relevant Observations
4. Add an overall impression and recommendation
5. Submit the Diagnostic Report
The report appears in the patient's history timeline and can be accessed through the patient portal.
***
## X-Ray Justification and Recording
Every dental X-ray must be clinically justified. Record the clinical indication in the procedure notes or the Observation's summary field:
| X-Ray Type | Common Clinical Indications |
| ---------- | ---------------------------------------------------------------------------------------------------------------------------------- |
| OPG | New patient survey, missing teeth assessment, wisdom tooth assessment, orthodontic planning, implant planning, bone pathology |
| IOPA | Periapical abscess, endodontic planning and working length, post-obturation check, periapical monitoring, root fracture assessment |
| Bitewing | Caries detection (interproximal), bone level assessment, restoration margin check, monitoring caries risk patients |
***
## Common Radiographic Findings and How to Record Them
### Periapical Abscess
Observation (IOPA Findings):
* Periapical Status: "Periapical lucency"
* Lucency Size (mm): measured on calibrated digital X-ray
* Summary: "Well-defined periapical lucency measuring approximately 5mm at tooth 46. Consistent with periapical abscess. Root canal treatment or extraction indicated."
* Action Required: Refer / Treat
### Impacted Wisdom Tooth
Observation (OPG Findings):
* Unerupted / Impacted Teeth: "38 mesioangularly impacted, crown overlapping ramus of mandible. Lower border cortex intact. Inferior dental canal appears close to apex."
* Action Required: Further investigation (consider CBCT for nerve relationship before surgery)
### Interproximal Caries (Bitewing)
Observation (Bitewing Findings):
* Caries Detected: "Mesial caries 46 extending into outer dentine. Distal caries 35 in enamel only."
* Summary: "Bitewing radiographs show early-moderate interproximal caries. Tooth 46 requires restoration. Tooth 35 may benefit from preventive management and monitoring."
***
## Field Guide: Observation
| Field | Description |
| -------------------- | ---------------------------------------------------------------------- |
| Patient | Linked patient |
| Observation Template | The template defining the finding fields (OPG Findings, IOPA Findings) |
| Service Request | The X-ray order that prompted this observation |
| Date | Date the X-ray was reviewed |
| Practitioner | Reviewing dentist |
| Status | Draft → Submitted |
| Values Table | Individual structured findings from the template |
| Notes | Additional free-text radiographic notes |
***
## Best Practices
* Attach the actual digital X-ray image to the Clinical Procedure record using the Attachment feature - the written observation is not a substitute for the image in the record
* Use FDI tooth notation (international two-digit system) in all observations to ensure consistency across records and practitioners
* Record the clinical justification for every X-ray in the observation notes or procedure notes - unjustified X-ray exposure has regulatory implications
* For endodontic cases, always take a pre-operative IOPA, an in-progress working length radiograph, and a post-obturation radiograph, and attach all three to the same treatment sequence
* Baseline OPGs for all new patients (unless a recent one is available from another practice) provide a complete baseline record and reveal findings the intraoral examination may miss (impacted teeth, bone pathology, salivary calculi)
***
## Troubleshooting
**The X-ray observation is not appearing in the patient's history timeline**
Check that the Observation has been submitted. Draft observations are not included in the history timeline.
**The Observation Template fields are not showing the options I need**
Open the Observation Template and check that the field options are correctly configured. You may need to update the template to add additional options.
**The Diagnostic Report cannot link to the observation**
Ensure the Observation is submitted before linking it to a Diagnostic Report. Draft observations cannot be linked.
***
## Related Features
* [Dental Examination](/health-wellness/dental-clinic/dental-examination): X-rays are ordered from the Patient Encounter during examination
* [Dental Treatments](/health-wellness/dental-clinic/dental-treatments): X-ray findings inform the treatment plan
* [Oral Surgery](/health-wellness/dental-clinic/oral-surgery): Surgical planning relies on OPG and IOPA findings
* [Orthodontics](/health-wellness/dental-clinic/orthodontics): Orthodontic assessment requires an OPG as a baseline