Espelid I, Mejàre I, Weerheijm K EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003; 4:40-48
Kühnisch J, Anttonen V, Duggal M Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document. Eur Arch Paediatr Dent. 2020; 21:375-386
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American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. 2023. http// (accessed March 2024)
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Kaakko T, Riedy CA, Nakai Y Taking bitewing radiographs in preschoolers using behavior management techniques. ASDC J Dent Child. 1999; 66:320-324
Elfrink ME, Veerkamp JS, Kalsbeek H. Caries pattern in primary molars in Dutch 5-year-old children. Eur Arch Paediatr Dent. 2006; 7:236-240
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Practical Tips for Successful Bitewing Radiographs in Children

From Volume 51, Issue 4, April 2024 | Pages 269-276


Isabel C Olegário

DDs, MSc, PhD

Assistant Professor in Paediatric Dentistry; Division of Public and Child Dental Health, Dublin Dental University Hospital, Trinity College, Dublin, Ireland

Articles by Isabel C Olegário

Email Isabel C Olegário

Rona Leith

BA, BDentSc, DChDent, FFD, FIADT, BA, BDentSc, DChDent, FFD (RCSI)

Lecturer in Paedodontics, Dublin Dental School and Hospital, Lincoln Place, Dublin 2, Ireland

Articles by Rona Leith


Bitewings are a fundamental tool for treatment decision-making in young patients as they provide essential information on caries depth, the presence of a dentine bridge and pulp retraction, radiographic signs of pulp necrosis and presence of a permanent successor. The article updates the practitioner on the use of bitewing radiographs for primary molars and provides hints and tips for maximizing success in children.

CPD/Clinical Relevance: The correct use of bitewing radiographs is essential for clinical decision-making in children.


Bitewing radiographs are one of the most valuable special investigation tools used to assist diagnosis in primary molars in the paediatric dental patient. The term ‘bitewing’ (BW) refers to the little tab (or wing) in the centre of the X-ray film on which the patient bites to hold it in place, thus providing an equal image of both the maxillary and the mandibular teeth.

Recommendations for the use of bitewing radiographs have changed in recent years with the publication of contemporary guidelines that have moved away from screening radiographs in young children,1 in favour of targeting individuals following a risk-based analysis. New evidence has emerged to inform the practitioner regarding patients or lesions that will benefit most from taking bitewing radiographs.2 Therefore, dentists should be aware when a radiographic examination is indicated to aid treatment decision-making for their patient.

High-quality bitewings are essential for treatment planning, especially for deep caries lesions.3 Bitewings allow an estimation of the extent of dentine caries lesions and their proximity to the pulp, as well as the pulp response to the lesion (pulp retraction by deposition of tertiary dentine). More than a half of all primary molars have accessory canals in the furcation area,3 so pulp necrosis is often apparent by detection of an inter-radicular rather than a peri-apical radiolucency. This area is more clearly visible on a bitewing than on a peri-apical radiograph.4 Furthermore, bitewings assist in assessment of the status of previous restorations, marginal bone levels, and presence of permanent successors, which is imperative if planning for extractions and space maintenance.5 Finally, there is anecdotal evidence that a child's ability to cooperate during bitewings can assist the clinician in determining whether the child will tolerate further dental intervention.

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