Why Some Patients Choose to Skip Dental X-rays — And When They Actually Matter

A dental X-ray is a low-radiation imaging tool used to detect oral health issues that are not visible during a routine visual exam. Dental X-rays help reveal problems such as cavities between teeth, gum-related bone loss, infections at tooth roots, impacted wisdom teeth, and other changes in the jawbone. Modern dental X-rays use very low radiation levels and are considered safe when clinically indicated, often with protective measures like lead aprons and thyroid collars. Common types of dental X-rays include bitewing, periapical, and panoramic (OPG) images, each serving a specific diagnostic purpose. Not every patient needs X-rays at every visit, and decisions are based on individual risk, dental history, and clinical findings. Understanding when dental X-rays are useful helps patients make informed, confident decisions about their care.

when a dental xray is required

TL;DR – Key Takeaways

• Dental X-rays show problems that cannot be seen by the naked eye

• They help detect cavities, gum disease, infections, impacted teeth, and bone changes

• Common types include bitewing, periapical, and panoramic (OPG) X-rays

• Modern dental X-rays use very low radiation and are considered safe

• X-ray frequency varies based on age, risk, and dental history — not a fixed schedule

• In some cases, skipping or delaying an X-ray is reasonable

• The goal is informed choice, not routine imaging

  
  

Many patients today choose to skip dental X-rays — and that hesitation is understandable.

If nothing hurts and everything looks fine, it’s natural to wonder:“Do I really need a dental X-ray?”

Dental X-rays are not about doing more treatment. They are about seeing what the eye can’t — when it actually matters. Understanding what they show, when they’re useful, and when they can reasonably be deferred helps patients make informed, confident decisions about their care.

What Is a Dental X-ray?

A dental X-ray (radiograph) uses low-dose radiation to create images of the teeth, gums, and jawbone. These images allow dentists to detect issues that are often hidden beneath the surface and not visible during a routine visual examination.

Dental X-rays are primarily used for early detection, diagnosis, and treatment planning, especially when symptoms are mild—or not present at all.

What Dental X-rays Can Reveal (That Eyes Can’t)

Dental X-rays help identify a wide range of conditions that may otherwise go unnoticed:

• Cavities between teeth, where brushing and visual checks cannot reach

• Gum disease and bone loss around tooth roots

• Infections or abscesses at the tip of a tooth root

• Impacted teeth, commonly wisdom teeth trapped in the jaw

• Bone changes, such as cysts or abnormal growths

• Tooth development issues, especially in children and adolescents

These findings often appear long before pain or swelling, which is why X-rays can prevent small issues from becoming complex, costly treatments later on.

Why Many Patients Choose to Opt Out of Dental X-rays

Patients who decline X-rays are not being difficult — they are being cautious.

Common reasons include:

• “I feel fine — nothing hurts”

• Concerns about radiation exposure

• Having had recent X-rays at another clinic

• Wanting to avoid unnecessary procedures

• Questions about cost or value

These concerns are valid. Modern dentistry recognises that X-rays should never be routine by default — they should be clinically justified.

Types of Dental X-rays (And When Each Is Used)

Intraoral X-rays (Taken Inside the Mouth)

Bitewing X-rays

Show the crowns of upper and lower teeth together. Commonly used to detect decay between teeth and early bone loss from gum disease.

Periapical X-rays

Capture the entire tooth, from crown to root tip, along with surrounding bone. Useful for diagnosing root infections, abscesses, or trauma.

Occlusal X-rays

Provide a broader view of the upper or lower dental arch and are sometimes used to assess tooth development or jaw issues.

Extraoral X-rays (Taken Outside the Mouth)

Panoramic X-ray (OPG)

A single wide image showing all teeth, jaws, and surrounding structures. Commonly used for wisdom teeth assessment, implants, and surgical planning.

Cephalometric X-ray

A side-profile image of the head, mainly used for orthodontic treatment planning and airway analysis.

When Skipping a Dental X-ray Can Be Reasonable

In certain situations, postponing or declining a dental X-ray may be appropriate, such as:

• You have recent, good-quality X-rays that can be reviewed

• You are a low-risk patient with stable oral health

• There are no symptoms and no clinical warning signs

• The X-ray would not change the treatment plan

Good dentistry is not about taking more X-rays — it’s about taking the right X-rays, at the right time.

When Dental X-rays Truly Matter

Dental X-rays become important when they directly influence care decisions, including:

• Detecting cavities early before they require large restorations

• Identifying bone loss linked to gum disease

• Assessing wisdom teeth position and risks

• Planning procedures such as implants, root canal treatment, or extractions

• Monitoring changes over time to prevent future complications

In these cases, X-rays help ensure treatment is accurate, targeted, and predictable.

Are Dental X-rays Safe?

Modern dental X-rays are considered very safe.

• They use minimal radiation, comparable to natural background exposure

• Digital X-ray technology significantly reduces radiation levels

• Protective measures such as lead aprons and thyroid collars are commonly used

• X-rays are taken only when clinically useful, not routinely

There is no fixed rule for how often X-rays should be taken. Frequency can range from every 6 months to every 2–3 years, depending on age, risk factors, dental history, and current findings.

Making an Informed Choice: Questions You Can Ask Your Dentist

If you’re unsure whether a dental X-ray is necessary, consider asking:

• “What are we trying to rule out with this X-ray?”

• “How would this X-ray change my treatment plan?”

• “What happens if we skip it today?”

• “Can this be reviewed again at my next visit?”

These questions encourage shared decision-making, ensuring your care is guided by clarity rather than pressure.

Clarity Over Compliance

Choosing to decline a dental X-ray doesn’t make you a difficult patient.And recommending one doesn’t mean your dentist is upselling.

Dental X-rays are simply a tool — valuable when used appropriately, unnecessary when they’re not. The goal is clarity, so you can make informed decisions about your oral health with confidence and peace of mind.

Frequently Asked Questions About Dental X-rays

1. Are dental X-rays safe?

Yes. Modern dental X-rays use very low levels of radiation and are considered safe when clinically indicated. Digital X-ray technology significantly reduces exposure, and protective measures such as lead aprons and thyroid collars are often used. Dentists recommend X-rays only when the benefits of early detection outweigh the minimal exposure involved.

2. How often should dental X-rays be taken?

There is no fixed schedule for dental X-rays. Frequency varies based on age, dental history, risk of decay or gum disease, and current findings. Some patients may need X-rays every 6–12 months, while others may only require them every 2–3 years. The decision is individualised, not routine.

3. Can I refuse a dental X-ray?

Yes. Dental X-rays are taken with patient consent, and you have the right to ask questions or decline. However, it’s important to understand what the X-ray is meant to assess and how skipping it may affect diagnosis or treatment planning. Many dentists will discuss alternatives or timing if appropriate.

4. Why does my dentist recommend an X-ray even if I have no pain?

Many dental problems — such as cavities between teeth, early gum-related bone loss, or infections at tooth roots — can develop without pain or visible symptoms. X-rays help detect these issues early, before they become more complex or costly to treat.

5. What types of dental X-rays are commonly used?

Common dental X-rays include bitewing X-rays (to detect decay between teeth), periapical X-rays (to assess the entire tooth and root), and panoramic (OPG) X-rays (to view all teeth and jaws in one image). Each type is used for a specific diagnostic purpose.

Reviewed by

Dr Jonathan Liu

Dental Surgeon

Dr Jonathan Liu is a highly experienced dentist in Singapore with over 25 years of clinical practice. He is known for his calm, patient-centred approach and clear, practical explanations that help patients make informed decisions about their oral health.

His clinical scope includes general dentistry, preventive care, dental diagnostics, and aesthetic treatments. Dr Liu places strong emphasis on appropriate, evidence-based use of diagnostic tools such as dental X-rays, ensuring imaging is recommended only when it adds genuine clinical value to diagnosis or treatment planning.

Last updated Dec 2025. This article is written and medically reviewed to reflect current dental standards, patient safety considerations, and informed consent principles.