A dental panoramic X-ray — also called an OPG (Orthopantomogram) or panorex — is a specialised X-ray that captures the upper jaw (maxilla), the lower jaw (mandible), all of the teeth, the jaw joints (TMJs), and parts of the sinuses, all in a single curved image. It is the standard "big-picture" dental X-ray, distinct from the small intraoral films that focus on individual teeth.
You may have a dental panoramic X-ray as part of a routine dental checkup, before orthodontic treatment, before wisdom tooth removal, or as part of planning for dental implants.
Common Indications for a Dental Panoramic X-ray
Your dentist or orthodontist may request an OPG to:
- Assess the position of unerupted teeth, especially wisdom teeth.
- Plan orthodontic treatment.
- Evaluate before dental implant placement.
- Look for cysts, tumours, or other abnormalities in the jaw bones.
- Investigate jaw pain, particularly TMJ-related pain.
- Assess fractures of the jaw after trauma.
- Screen for infection around the roots of teeth.
- Evaluate the developing dentition in children.
What exactly does a dental panoramic X-ray show?
The OPG shows:
- All upper and lower teeth (erupted and unerupted).
- The shape and structure of the upper and lower jaw bones.
- The temporomandibular joints (where the jaw meets the skull).
- Parts of the maxillary sinuses above the upper teeth.
- The nasal floor.
- Any retained roots, impacted teeth, cysts, or tumours.
- Generalised bone loss patterns associated with gum disease.
It is excellent for overview but does not show the fine detail of an individual tooth that a periapical X-ray would. The two types of X-ray are complementary, not interchangeable.
What happens during the procedure?
- You remove any earrings, necklaces, glasses, hairpins, or hearing aids that could obstruct the image.
- You stand or sit in front of the panoramic machine, which has a chin rest and bite block.
- You bite gently onto the bite block to position your jaw, and you grasp the handles on either side.
- The radiographer makes small adjustments to your head position.
- You are asked to stand still, close your lips, and place your tongue on the roof of your mouth.
- The X-ray arm slowly rotates around your head, capturing a single panoramic image. The rotation takes about 15 to 20 seconds.
- The whole appointment takes 5 to 10 minutes.
Do I need to prepare?
- No fasting required.
- Remove jewellery, glasses, hearing aids, and hairpins from your head and neck.
- Tell the team if there is any chance of pregnancy.
- If you have severe difficulty standing still, mention it so the team can adjust the setup.
Will the test be painful?
No. The OPG is painless and contactless apart from the chin rest and bite block. You feel the bite block in your mouth and stay still while the machine rotates, but there is no discomfort.
How long do the results take?
The dentist or orthodontist usually reviews the image immediately, often during the same appointment. If a radiologist's report is requested separately, it typically arrives within a few working days.
Are there risks?
A low-dose examination
A dental panoramic X-ray uses a small dose of ionising radiation. The exact dose varies with the machine, settings, field size, and patient size, so fixed comparisons with background radiation or another examination can be misleading. It should be requested only when the result is expected to affect dental care.
The radiation dose is small but not zero, so:
- Tell the team if there is any chance of pregnancy. A clinically necessary dental X-ray can still be performed. Current radiation-protection guidance does not recommend routine patient shielding because a shield can obscure anatomy or interfere with exposure controls; the team should instead justify the examination, limit the beam, and use an optimised technique.
- For children, the dose can be reduced further. Dentists do not request OPGs routinely in children unless there is a clinical question.
How does it differ from a CBCT scan?
A cone-beam CT (CBCT) is a 3D dental scan that gives detailed cross-sectional images of the jaws and teeth — much more detail than an OPG, but at a higher radiation dose. CBCT is reserved for specific complex questions: implant planning in difficult anatomy, third molar removal where the nerve is close, root canal complexity, jaw tumour assessment.
For most dental purposes, a panoramic OPG is enough. CBCT is added when the clinical question demands it.
Why does the dentist need this if I just had a checkup X-ray?
The small intraoral X-rays taken in the chair (bitewings, periapicals) show one or a few teeth in fine detail. The OPG shows everything in a single overview but with less detail per tooth. Most dentists rely on a combination — periodic bitewings for cavity surveillance, OPG every few years or when a broader assessment is needed.
What can this X-ray miss?
A panoramic image is a two-dimensional overview. It is less detailed than small intraoral dental X-rays for individual teeth and is not reliable for precise implant measurements or every cavity, root fracture, soft-tissue problem, or temporomandibular-joint disorder. Your dentist may need targeted dental films, CBCT, CT, MRI, or clinical examination depending on the question.
Sources and further reading
Conclusion
A dental panoramic X-ray is a fast, low-dose overview of the teeth and jaws. It may help with selected extractions, orthodontic planning, implants, and jaw disease, but it is not automatically required for every patient and does not replace clinical examination or targeted dental images.