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Digital X-rays

Sept. 1, 2003
"Ouch that hurts! It doesn't fit in my mouth. Is this the only size you have?"

by Victoria DaCosta

"Ouch that hurts! It doesn't fit in my mouth. Is this the only size you have?"

Have you heard this recently from your patients when using the new computer "size two" sensor while taking digital X-rays?

Click here to enlarge image

With discounts and incentive buys and sales, dental supply reps are introducing your doctor to the latest technology at dental trade shows and in dental practices. Dentists are switching from "wishing" to actually purchasing this new technology called digital X-rays. The purchase package includes a "size two" sensor (the film) with the software application (which interprets the image taken from the sensor to the computer).

So what is all of the "hoopla" about this new technology? I thought the diagnosis of the digital X-ray was not valid, or so I had heard! Our office bought into digital X-rays two years ago, and I can honestly say, "I would never go back to taking film X-rays!"

It turns out that not only is the diagnosis valid, but my patients are co-diagnosing with me while looking at an enlarged version of their hard tissue. They can actually see — with a little guidance from me — that "hole" in their tooth. I can change the colors of the "hole" on the decayed area with a click of the mouse, utterly impressing them with our diagnostic tool. I am not joking when I report that patient case acceptance climbed to 100 percent in our office.

In my opinion, the digital X-ray purchase has been one of the best communication tools my doctor has invested in for our office.

So that's why we have all of this hoopla about digital X-rays! It's worth the investment. The cost ranges from $8,000 to $14,000 for a basic setup of one "size two" sensor (adult) and software application.

Let's take a look at the features, advantages, and disadvantages of the technology. Below, I list some facts about becoming a "digital" dental hygienist.

Before you begin

One concept that I strongly emphasize is to think of it as a long-term integration of technology. What that means is building upon acquired technology through planned steps.

The first step is the purchase of a computer to be put inside the dental hygiene operatory. The second step is the purchase of digital X-ray software to install on the computer. Hopefully, your doctor has previously purchased dental office management software from a company such as Dentrix Dental Systems, EagleSoft, or PracticeWorks. With any of the current versions of these management software systems, you will be able to integrate the digital X-ray software into your patients' digital chart records. Just as you would put the "hard copy" of X-rays inside a patient's chart, you would be using "soft copy" X-rays that are integrated into soft copy charts.

By helping your doctor understand the importance in the building steps of a digital communication system inside the dental hygiene operatory, you will begin to create a sound foundation for future technology.


Click on "take X-ray" and you're in business! Now you have your first computerized digital X-ray image on the computer screen. If you want to "wow" your patients just for fun, click on the "positive/negative" icon. This feature shows the patient's teeth in reversed black and white. It's quite cool! Or you can click on the "density" icon and view the image with color contrast. The contrast with different colors shows the density of the teeth and bone.

Another software feature is the "flashlight." Click on the icon and it highlights with a flashlight technique over a certain area on the image. That is kind of neat to use.


It's quick! Saves me two steps, dropping and mounting film — not to mention costs. Instead of taking 10 minutes to take X-rays, the digital approach now takes about one minute for four bitewings. I just throw away the cover on the sensor and I am done. Honestly, I used to dread taking X-rays; now I really do enjoy it!

Besides if I cone cut, I know immediately and can "retake" in an instant. Forget about looking at a cone cut film at the end of your hygiene appointment. The hassles of cone cutting, machines eating films, and films falling out of charts without names are finally eliminated!

In addition, by using this new technology, you will be saving the environment of chemical disposal and trash.

There are some disadvantages

There are not too many, but the few I have dealt with start with the aforementioned sensor size. Most doctors purchase size two, which is an adult size. For the most part, the size will work for about 60 percent of your patients. The other 40 percent can be categorized as adults with small mouths, children, and gaggers. The size two sensor is not a good fit for them. I recommend buying the two different sizes — size one (child) and size two (adult).

If your patients cannot bite down completely, then the image is mostly black on the screen, showing some white nubs.

In addition, the sensors are connected to a wire that is connected to your computer tower. If the wiring is not underground, then you can trip over the wire while scrambling out of the room to push the button on the wall.

These sensors can break if you drop them. They also will not bend like film, which is harder to work with.

Sensors are estimated to have a 10 percent failure rate, which, of course, is not ideal.

So you end up saying "it's a software glitch" when:
• The X-ray software is not working and the sensor is in your patient's mouth; the patient is waiting for you to "click" on "take X-ray."
• The office network is down.
• You have only one sensor, and there are three dental hygienists in the office!


o Increased communication — Bridge the gap of your diagnostic language because now patients can see decay. Patients will begin to co-diagnose with you!

o Perceived value — With increased communication and understanding, your patient views your office as being on the cutting edge of technology and perceived value goes way up, probably more than the dentist would realize. You just look smarter with digital X-rays because you can now explain disease much easier with a picture.

o Less radiation — Besides "wowing" your patients, one important benefit for you the hygienist and patient is the lowering of radiation output. Depending on the X-ray machine used there can be up to 90 percent less radiation. Consumers are starting to learn of this lower radiation technology and are looking to find dental offices that use this technology.

Victoria DaCosta, RDH, BS, is founder and president of GumAerobics, Inc. A practicing dental hygienist for 17 years, DaCosta is a speaker, author, consultant, and an expert in the design of medical/dental software. She is also on the new technologies committee for the California Dental Hygienists' Association. DaCosta can be contacted at [email protected].