Your child's baby teeth may look healthy, but underneath them, permanent teeth are developing and preparing to emerge. Sometimes, we need a wider view of your child's mouth to understand how those teeth are growing.
A panoramic dental X-ray captures the upper and lower jaws, teeth, and surrounding structures in one broad image. It can help us assess developing permanent teeth, investigate eruption concerns, or understand the position of a tooth that has not appeared as expected.
Not every child needs a panoramic X-ray, and it isn't a routine requirement at every dental checkup. The decision depends on your child's dental development, examination findings, and individual needs.
At Pedodontic Associates, we offer pediatric dental imaging as part of our care for children on Oahu and Maui. Here's what parents should understand when a panoramic X-ray is recommended.
What Is a Panoramic Dental X-Ray?
A panoramic X-ray, sometimes called a panorex, is a type of dental image taken from outside the mouth.
Unlike smaller dental X-rays that focus on individual teeth or a particular area, a panoramic image provides an overview of the mouth and jaws.
This broader view can help us examine:
- Permanent teeth developing beneath baby teeth
- Teeth that are delayed in erupting or may be impacted
- Missing or extra teeth
- The position of teeth within the jaws
- Certain abnormalities involving the jawbone or surrounding structures
A panoramic X-ray is especially useful when we need to understand how several teeth relate to one another.
However, a wider view does not automatically make it the right image for every dental concern. Smaller X-rays often provide more detailed information about individual teeth.
When Might Your Child Need a Panoramic X-Ray?
The need for panoramic imaging depends on what we find during your child's dental examination.
1. When permanent teeth aren’t coming in as expected
Children lose baby teeth and develop permanent teeth at different rates.
Sometimes, a permanent tooth takes longer to appear than expected. In other situations, a tooth erupts in an unusual position, or a baby tooth remains in place after neighboring teeth have changed.
A panoramic X-ray may help us investigate whether the permanent tooth is present and how it is positioned.
The image can also help identify potential obstacles to normal eruption, such as an additional tooth.
Not every delayed tooth requires treatment. Imaging helps us gather information before deciding whether monitoring, additional assessment, or a referral may be appropriate.
2. When there are concerns about crowding or tooth development
As your child grows, the relationship between their baby teeth, permanent teeth, and jaw changes.
During regular dental examinations, we monitor tooth eruption and bite development.
If we notice crowding, unusual eruption patterns, or another developmental concern, a panoramic image may help us evaluate the position of teeth that have not yet emerged.
This information can support conversations about whether further evaluation is needed.
We also assess developing bite concerns as part of our pediatric dental services. If your child needs orthodontic treatment beyond the scope of our care, the appropriate next step will depend on their findings.
3. When a tooth may be impacted
An impacted tooth is a tooth that cannot erupt normally because it is blocked or positioned in a way that prevents it from emerging.
While wisdom teeth are a familiar example, other permanent teeth can also become impacted.
A panoramic X-ray may reveal where an unerupted tooth sits and how it relates to neighboring teeth.
Depending on what we find, we may recommend monitoring, additional imaging, or evaluation by another dental specialist.
4. When a broader view of the jaw is needed
Certain dental findings require more information than a visual examination or small X-ray can provide.
Panoramic imaging may help evaluate suspected developmental abnormalities or changes involving the jaw.
The image is one part of the diagnostic process. It does not replace a clinical examination, and other imaging may be necessary when a more detailed view is required.
Panoramic X-Rays vs. Bitewing X-Rays: What’s the Difference?
Parents sometimes wonder why their child might need another type of X-ray after having images taken during a previous appointment.
Different dental images answer different clinical questions.
| Feature | Panoramic X-ray | Bitewing X-ray |
|---|---|---|
| Area shown | Broad view of both jaws and developing teeth | Crowns of upper and lower back teeth in a focused area |
| Main purpose | Evaluating tooth development, eruption, and broader jaw concerns | Detecting cavities between teeth and evaluating certain supporting structures |
| How the image is taken | Imaging equipment moves around the head | A small image receptor is positioned inside the mouth, or an appropriate alternative is used |
| Routine use | Only when clinically indicated | Frequency depends on individual findings and cavity risk |
A panoramic X-ray does not replace bitewing images for detecting decay between closely positioned teeth.
Similarly, a bitewing X-ray cannot provide the same broad overview of developing teeth and the jaws.
If we recommend a particular image, you can ask what information it will provide and how that information may affect your child's care.
For more detail on the imaging we offer, visit our dental X-rays service page.
What Happens During a Panoramic Dental X-Ray?
If your child has never had a panoramic X-ray, the equipment may look unfamiliar.
Unlike bitewing X-rays, panoramic images are taken with equipment positioned outside the mouth.
Although the exact setup varies by machine, the process generally involves the following steps.
Step 1: Getting into position
Your child will stand or sit at the imaging machine, depending on its design.
The dental team will help position their head and may ask them to rest their chin on a support or bite gently on a positioning guide.
Step 2: Removing objects that interfere with the image
Jewelry, glasses, or other removable objects around the head and neck may need to be taken off before imaging.
Step 3: Holding still
The equipment rotates around your child's head to capture the image.
Your child will need to remain still during the scan. Moving can blur the picture and may require additional imaging.
Step 4: Reviewing the findings
The resulting image gives the dentist information about the teeth and surrounding structures.
We can discuss the findings with you and explain whether any follow-up assessment or treatment planning is appropriate.
The scan itself does not require a needle or dental drilling. Some children may find positioning unfamiliar or have difficulty staying still.
If your child is nervous about the equipment, let our team know. We use age-appropriate explanations and behavior guidance techniques, including Tell-Show-Do, to help children understand dental procedures.
When to Schedule a Pediatric Dental Evaluation
You do not need to request a panoramic X-ray simply because your child is getting older.
Instead, schedule a dental evaluation if you are concerned about a permanent tooth that has not appeared as expected, unusual tooth positioning, or another change in your child's dental development.
During an examination, we can assess the concern and determine whether imaging is appropriate.
Our pediatric dental team serves families at three Hawaii locations:
- Pearlridge Office, Aiea: 808-487-7933
- Kahala Office, Honolulu: 808-735-1733
- Maui Office, Kahului: 808-877-0066
For new patients, you can review our first-visit information to learn what to bring and what happens during an initial examination.
You can also contact our office to schedule an appointment. Our website provides a message form for non-medical inquiries, while appointment and clinical concerns can be discussed by calling your preferred location.
Our goal is to help you understand your child's developing teeth and make informed decisions about the care they need.
This article provides general educational information and is not a substitute for an individual dental examination or professional medical advice.