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How Far Should A Radiograph Be Trusted?
Excerpt from Dental Infections by Weston A. Price. Published in The Dental Digest, XXXI, 1925.
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When radiographs of the teeth were first possible, they were regarded by many dentists as affording exact and conclusive evidence of the conditions shown in the picture. Thousands of teeth were extracted or retained because of the radiographic findings. That is more or less true today.
But before radiographs had been long in existence, dentists began to have uncomfortable experiences with them. Perhaps one of the most frequent was to open into a tooth which showed a normal condition, or which was more radiopaque than normal, only to find a non-vital pulp.
After a while a few dentists began to realize that the tissue conditions shown in a radiogram might not correspond exactly with the actual tissue conditions. And such dentists then gave weight to radiographic evidence only in association with other evidence.
In the book from which the material for this article is taken Dr. Price shows, by what appears to be conclusive evidence, that very serious pathological conditions may exist about the root of a tooth and not be discoverable by the radiograph. Cysts which menace the health, extensive absorption sometimes involving a large part of a root lateral canal inaccessible to any form of treatment and therefore possible sources of great danger to susceptible patients, deposits and incrustations on the teeth and extensive periapical involvement are some of the conditions that may exist and not show in a radiograph.
If the largest of the multiple foramina in a tooth is directly labial or directly lingual to the root, so that it is in line with the root in the picture, neither the foramen nor the granulomatous mass which may form about its exit may be shown in the radiograph.
Such evidence goes far to lessen the diagnostic value of the radiograph and especially the value of the diagnosis by any person who knows about the case only what he can see in the picture.