General Recommendations for Pediatric Patients

Consideration must be given to the susceptibility of children and young adults to the effects of radiation. As such, radiographic imaging must be prescribed judiciously and effective dose-reduction measured applied including selection criteria, collimation, optimization of exposure settings.^2,3,52,113 Lead shielding of pediatric patients during imaging is not indicated.³⁸

The frequency of radiographic examinations for the patient in the primary, mixed, or early adolescent dentition depends upon the medical/dental history, clinical examination, caries and periodontal risk assessment, tooth eruption, and trauma experience assessment.^3,27 Follow-up radiographic imaging after the initial radiographic examination should be determined similarly.^3,71,82

Radiographic examination after dental trauma is indicated in addition to a thorough clinical examination in accordance with the International Association of Dental Traumatology guidelines.^1,7,69

Intraoral radiographic imaging recommendations for pediatric patients with primary, mixed, early adolescent dentitions presenting with severe gingival inflammation from systemic conditions follow.

• Initial assessment should include maxillary and mandibular occlusal, periapical, and bitewing radiographs.¹

• Tooth mobility should be evaluated rather than periodontal probing of hemorrhagic gingiva.^3,82

Extraoral imaging recommendations for pediatric patients include:

• An initial panoramic radiograph should only be obtained after complete eruption of permanent first molars and all mandibular incisors unless needed earlier to assess oral pathosis (Figure 13).¹

Extraoral bite-wing radiographs (Figure 14) may be used for children with special health care needs or who are unable to tolerate intraoral radiography. They should only be considered after clinical examination and assessment for caries and periodontal disease risk, trauma experience, eruption deviations, and third molars.^2,3,72 Extraoral bitewings provide a radiation dose three times higher than intraoral bitewings and may have lower diagnostic quality.^2,3,72 Therefore, they should be used judiciously.

CBCT specific recommendations include the following:

• Initial assessment should include maxillary and mandibular occlusal, periapical, and bitewing radiographs.¹

• The evidence does not support the use of CBCT for caries detection.^{71,72,114-116}

• CBCT may be considered when 2-dimensional imaging does not provide adequate information, such as during suspected pathosis, trauma, or localization of impacted teeth.⁷¹

The child’s ability to follow instructions and remain still should be considered when prescribing radiographic imaging, especially when the modality requires longer exposure time, like panoramic or CBCT imaging procedures.⁷¹