The panoramic radiograph provides an overview of both jaws; the stage of tooth development; condylar development; tooth eruption pattern; and the presence or absence of teeth, including supernumerary teeth or other pathology. There is no one absolute answer to when the first panoramic radiograph should be obtained. But rather, it depends on the situation. If there is suspected pathology, such as ectopic eruption of maxillary canines/incisors or supernumerary teeth, that a panoramic radiograph would be of value for evaluation or diagnosis, then that is the time to obtain it. If there is no suspected pathology, and the radiograph is being considered for monitoring of dentofacial growth and development, and/or assessment of dental skeletal relationships, then timing is primarily one of clinical judgement and may not apply to every patient. Guidelines for obtaining dental radiographs have been published by the American Dental Association Council on Scientific Affairs and the United States Department of Health and Human Services, Public Health Service, Food and Drug Administration. However, these guidelines are to be used by dentists only after reviewing the patient’s health history and completing a clinical examination. Generally, a panoramic radiograph is not indicated before the ages of 8 or 9 unless it is needed to address an identified concern.
Pretreatment diagnostic records for comprehensive orthodontic treatment should include radiographic imaging to permit relative evaluation of the size, shape, and positions of the relevant hard and soft tissue craniofacial structures including the dentition, and to aid in the identification of skeletal anomalies and/or pathology.
American Dental Association Council on Scientific Affairs and US Food and Drug Administration. Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. Available at: https://www.ada.org/~/media/ADA/Publications/ADA%20News/Files/Dental_Radiographic_Examinations_2012.pdf?la=en. Accessed March 3, 2020.
White SC, Scarfe WC, Schulze RK, et. al. The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathl Oral Radiol. 2014;118:257–261.
American Association of Orthodontists. Clinical Practice Guidelines for Orthodontics and Dentofacial Orthopedics. Available at: https://www.aaoinfo.org/d/apps/get-file?fid=12939. Accessed March 3, 2020.