Dental and oral development

Children's Dental X-Rays

What a dental X-ray shows that an examination cannot, how often they are recommended, and why the lead apron has gone.

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A smiling toddler holding a wooden toothbrush

Reviewed by Dr. Yana Pekarski, DDS · Last updated August 27, 2026

Dental X-rays let a dentist see what an examination can't — decay between teeth, developing permanent teeth, and the bone supporting them. Modern pediatric dental X-rays use very low doses, and digital sensors have reduced exposure substantially compared with older film. Professional guidance is that X-rays should be taken based on an individual child's need and risk rather than on a fixed schedule, so how often they're recommended will vary between children and should be explained. Decay between teeth is the most common reason, because those surfaces can't be seen directly — and it's also the most common place cavities start in children, since flossing is done less consistently than brushing.

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What dental X-rays show that an exam cannot

A dentist looking in your child's mouth can see the biting surfaces and the outer and inner faces of every tooth. What they cannot see is where two teeth touch each other — and in children that is exactly where cavities most often start, because flossing is the part of the routine that gets done least consistently.

X-rays also show things that are not visible at all from the surface:

  • Permanent teeth developing inside the jaw, including whether any are missing, extra, or heading in the wrong direction
  • Bone level and infection around a tooth root
  • How deep an existing cavity goes, which determines what treatment is needed
  • Injury to a root after a knock, where the tooth looks fine from outside
  • Whether there is room for the permanent teeth still to come

How often should a child have dental X-rays?

There is no interval that applies to every child, and there is not meant to be.Professional guidance is that radiographs are prescribed for the individual patient after an examination and a caries risk assessment — not taken automatically because a certain amount of time has passed. Two children the same age can correctly be given very different answers.

To give a sense of the range, the American Academy of Pediatric Dentistry's guidance for posterior bitewing images — the ones taken to look between the back teeth — describes intervals of roughly six to twelve months for a child who has cavities or is at increased risk, and roughly twelve to twenty-four months for a child with no cavities and not at increased risk, and only where those surfaces cannot be checked visually or with a probe.

Risk here is not a judgment of your parenting. It reflects things like previous decay, the shape and depth of the grooves in the teeth, enamel defects, diet pattern, fluoride exposure, saliva, and how easy the teeth are to clean.

Because it is individual, you can ask about it. "Why is this one being taken?" and "what would it change?" are entirely reasonable questions, and a dentist should be able to answer both readily. Guidance being risk-based is precisely what makes them fair questions rather than obstructive ones.

How much radiation is in a child's dental X-ray?

The dose from a modern pediatric dental X-ray is very small, and several things in current practice keep it that way:

  • Digital sensors in place of film, which need substantially less radiation to produce an image
  • Rectangular collimation — narrowing the beam to the size of the sensor, so nothing outside the target area is exposed
  • Taking the smallest number of images that answers the clinical question
  • Settings adjusted for a child rather than an adult
  • The ALARA principle — as low as reasonably achievable — applied to every exposure
We do not publish a dose comparison on this page. The familiar equivalences — so many days of natural background radiation, a fraction of a flight — vary with the type of image, the equipment, and which conversion is used, and we could not source one we would stand behind for pediatric dental imaging specifically. Your dentist can tell you the dose for the exact image being proposed, which is more useful than an average.

Why your child may not get a lead apron

If your child is not given a lead apron and thyroid collar, that is not a corner being cut.Many parents expect an apron because that is what happened when they were children. Professional radiology guidance has since moved: the American Academy of Pediatric Dentistry, citing the American Academy of Oral and Maxillofacial Radiology, records a recommendation to discontinue patient thyroid, gonadal and fetal shielding during dental imaging, and the position is consistent with that of the American College of Radiology and the American Academy of Pediatrics.

The reasoning is worth knowing, because it is not that shielding was found to be harmful in itself. The AAOMR gives two reasons directly: there is no evidence of radiation-induced heritable effects in humans, and the dose to the gonads and to a fetus from dental imaging is negligible. On the thyroid, the committee judged the risk of thyroid cancer from contemporary dental imaging to be negligible and recommends that thyroid shielding not be used for intraoral, panoramic, cephalometric or cone-beam CT images.

Two further reasons appear in the wider radiology literature. Digital imaging has substantially reduced patient doses, so a shield now removes very little. And routine shielding carries its own costs: a misplaced shield can obscure the anatomy the image was taken to show, and can interfere with automatic exposure control in a way that increases dose. A non-diagnostic image means taking it again.

Practice varies, and some offices still offer an apron. Either way, it is a reasonable thing to ask about, and a practice should be able to explain their approach.

If your child finds dental X-rays difficult

The examination is one thing; holding a rigid sensor against the roof of the mouth or the inside of the cheek and staying completely still is another. For a child with a strong gag reflex or sensory sensitivity, this is frequently the hardest part of an entire appointment.

What genuinely helps:

  • Say in advance that it is difficult, before the sensor comes out
  • Ask about alternatives — a panoramic image is taken from outside the mouth with nothing held inside it, and depending on what the dentist needs to see, it may answer the question
  • Ask about smaller sensors, or a softer holder
  • Let your child hold it first, feel the edges, and put it in their own mouth
  • Practice at home with something similar in size, for a couple of seconds at a time
  • Breathing out slowly through the nose reduces gagging for many children
  • Agree a stop signal the dentist will honor
  • Take one image at a time with a break, rather than a full set in one go

RelatedDental signs of sensory processing differencesSensory over-responsivityPreparing for the first dental visit

Questions worth asking your dentist

  • Why is this image being taken today?
  • What will it change about what we do next?
  • Is my child considered higher risk for decay, and why?
  • Is there an alternative view that would be easier for my child?
  • Can we do one at a time?
  • Can you show me what you are seeing?

None of these are obstructive. Imaging being individually prescribed is exactly what makes them the right questions.

Frequently Asked Questions

What is a bitewing X-ray?

The image taken to see between the back teeth, where a dentist cannot look directly and where cavities most often start in children. It is the type the frequency guidance above refers to.

Are dental X-rays safe for children?

The dose from a modern pediatric dental X-ray is very small. Digital sensors need substantially less radiation than the film they replaced, the beam is narrowed to the size of the sensor, settings are adjusted for a child rather than an adult, and the number of images is kept to what answers the clinical question.

Can I refuse dental X-rays for my child?

You can decline, and it is reasonable to ask why an image is being proposed and what it would change before deciding. It is worth knowing what you would be accepting in exchange, since decay between the back teeth cannot be seen during an examination and is the most common place cavities start in children.

Are dental X-rays safe during pregnancy?

The AAOMR recommends discontinuing fetal and pelvic shielding during dental imaging specifically because the dose reaching a fetus from dentomaxillofacial images is negligible. Tell the practice you are pregnant regardless — it is relevant to other decisions — but the imaging itself is not a reason to avoid dental care.

How often should my child have dental X-rays?

There is no single interval, because guidance is that images are prescribed for the individual child after an examination and a caries risk assessment. For posterior bitewings, AAPD guidance describes roughly six to twelve month intervals for a child with cavities or at increased risk, and roughly twelve to twenty-four months for a child with no cavities and not at increased risk, where those surfaces cannot be checked visually.

Why doesn't my child get a lead apron anymore?

Professional guidance changed. The AAPD, citing the American Academy of Oral and Maxillofacial Radiology, records a recommendation to discontinue patient thyroid, gonadal and fetal shielding for dental imaging. Collimation and digital sensors have reduced exposure substantially, shielding does not protect against scatter occurring inside the body, and a misplaced shield can block the image and require a repeat exposure.

My child gags on the sensor. What are the options?

Say so before the sensor comes out. A panoramic image is taken from outside the mouth with nothing held inside it and may answer the question depending on what the dentist needs to see. Smaller sensors and softer holders exist, letting your child hold it and place it themselves helps, breathing out slowly through the nose reduces gagging for many children, and images can be taken one at a time with breaks.

What do dental X-rays show that an examination can't?

The surfaces where two teeth touch each other, which cannot be seen directly and are where cavities most often begin in children. They also show permanent teeth developing inside the jaw, whether any are missing or extra, bone level and infection around a root, how deep an existing cavity goes, and damage to a root after an injury.

Sources

The shielding guidance below is quoted from the AAOMR recommendations themselves.

  1. Benavides E, Bhula A, Gohel A, et al. Patient shielding during dentomaxillofacial radiography: recommendations from the American Academy of Oral and Maxillofacial Radiology. J Am Dent Assoc. 2023. doi:10.1016/j.adaj.2023.06.015 · PMID 37530694
  2. Benavides E, Krecioch JR, Connolly RT, et al. Optimizing radiation safety in dentistry: clinical recommendations and regulatory considerations. J Am Dent Assoc. 2024. doi:10.1016/j.adaj.2023.12.002 · PMID 38300176
  3. Hwang JY, Choi YH, Eo H. The end of patient shielding: rationale for discontinuing the practice. J Korean Soc Radiol. 2025. doi:10.3348/jksr.2025.0099 · PMID 41415647
  4. American Academy of Pediatric Dentistry. Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. The Reference Manual of Pediatric Dentistry. aapd.org

Medical disclaimer. This page is for general educational purposes and does not constitute medical or dental advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.