What is a Bitewing Radiograph? – Unfold the Facts

Dental x-rays are a visual aid for dental professionals to look at the depth of a dental condition that may not be visible to the naked eye. There are several types of dental x-rays that are taken during a routine check-up. However, one of the most commonly accepted diagnostic x-ray is bitewing.

The name bitewing is derived from the tab or holder, which used to place the x-ray film in the mouth. The patient is then asked to bite on the tab to hold the film in place. Bitewings are a unique type of dental x-rays that are used to capture the upper and lower crowns of the teeth above the gumline. Additionally, bitewings also show the relationship of the surrounding bone with the exposed teeth.


Typically, bitewings are taken to diagnose proximal tooth decay, bone loss due to gum or periodontal disease, and to check the stages of tooth development in children and adolescents. Bitewings emit minimal radiations as compared to other types of x-rays. Therefore, it is considered a safe or periodic dental evaluation. However, in pregnant women, the use of bitewings may be suggested after the third trimester.

Today’s article will highlight the use of bitewing in dental x-ray examinations. Moreover, we will also discuss the safety, cost, and frequency of bitewing radiographs.

What are bitewing radiographs?

Bitewings are one of the most commonly used dental x-rays that show teeth of both the arches above the gumline. The x-ray films are usually placed in the mouth with the help of a holder or a cardboard tab on which the patient bites to hold the film in place. Hence, the name of the x-ray is known as ‘Bitewing.’

Bitewings are the most accurate and most straightforward dental x-rays to take. It provides an objective assessment with distortion-free results. Ideally, bitewing radiographs are used to identify dental cavities between the teeth and check the progression of gum or periodontal disease. (1)

During a first dental visit, four bitewings are taken as a set. For people with frequent cavities, six months follow up is usually required.

 What is the use of a bitewing radiograph?

Ideally, bitewings are used to visualize the posterior teeth and the height of the alveolar bone in relation to the cementoenamel junction.

Typically, bitewing radiographs are used for the following purposes –

  • To diagnose gum disease
  • To identify and check the progression of interdental bone loss
  • To diagnose proximal dental caries or cavities (tooth decay between two teeth) (2)
  • To diagnose recurrent caries under existing restoration/ tooth filling
  • To check the health of developing permanent teeth in children and adolescents

What is the procedure for taking bitewing radiographs?

Bitewings, like any other dental x-ray, are taken by placing an x-ray film behind the teeth that are to be evaluated. The film is usually set in a vertical direction to show the density, volume, and pattern of interdental bone loss for a periodontal evaluation. Moreover, it helps to explain the teeth on both the arches above the gum line. (3)

Typically, a set of four bitewings are taken, two on each side, to capture the premolars and molars. In young children below the age of ten, one bitewing per side will suffice.

When should you get a bitewing radiograph?

The frequency of taking bitewing radiographs always depends on the clinical requirements of the patient. A dentist usually evaluates the risks, benefits, and alternatives associated with the procedure of dental x-ray.

Additionally, the patient’s age plays a crucial role in determining the frequency of bitewings. Usually, children and adolescents may require periodic bitewing monitoring and evaluations to keep a check on the stages of tooth development. Moreover, children are prone to tooth decay. A bitewing taken during a routine dental check-up can help to diagnose early stages of tooth decay. (4)

Typically, bitewings are made as often as every six to twelve months for children and adults who are at high risk of tooth decay.

How safe are bitewing radiographs?

Out of all the types of dental x-rays, bitewings expose the patient to a minimal range of radiation. A set of four bitewings taken during a routine dental check-up will expose 22 to 51 micro Sv (microsievert) radiation.  (5)

The emissions detected on taking a bitewing are so low that they are considered safe for both the children and adults. Moreover, the precautionary measures followed by dentists today has reduced the radiation exposure to the patients in the following ways –

  • Dental x-rays are usually taken by covering the patient with a lead apron. The lead apron covers the chest, abdomen, and pelvic region to prevent unnecessary radiation exposure.
  • The use of digital x-rays has significantly reduced the amount of radiation exposure as compared to traditional dental x-rays. (6)

One of the exceptions where bitewings may not be ideal is during pregnancy. This is because any radiation is considered harmful to the developing fetus. Pregnant women should always try to avoid any dental x-rays at least until the third trimester. After that, dental x-rays may be taken in severe cases of tooth pain or emergency dental conditions. (7)

What is the cost of bitewing radiographs?

A singe bitewing may usually cost around $50 – $100. However, it may differ depending on the location of the dental office, the number of images required, and any discount policies followed at the dental office.

Most dental insurance covers the cost of bitewings. This is because bitewings are considered a part of the routine dental examination, which is covered by dental insurance. You can talk to your insurance provider along with the dentist and clarify the financial expenses regarding dental x-rays.

Take away message

Bitewing is a type of dental x-ray that shows the upper and lower teeth and the supporting bone of a selected area in one x-ray film. Ideally, bitewings are a crucial part of a routine dental examination. This is because they help to diagnose proximal caries, bone loss, gum disease, and identify the stages of tooth development in children.


Like any other dental x-ray, bitewings are taken using an x-ray film placed vertically to cover the teeth and surrounding bone. Radiation exposure is usually minimal from bitewings, which makes it safe for a routine dental examination. However, precautions such as the use of a lead apron may be taken in pregnant women.

The frequency of bitewings can be determined depending on the type of dental condition, age of the patient, and the risk of tooth decay. Most dental insurance covers the cost of bitewings, which makes it an affordable choice.


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