Doctor—Your Hygienist Needs a Digital X-ray System!

Dentistry Today


So, what do you do with that?” asked the new patient, whom I was showing around the office (Figure 1).
“It is our exciting, new digital x-ray system,” I replied. “You are going to like this.”

I always try to take new patients on an introductory tour of the practice, to lessen their fears of the sounds, equipment, or environment. My goal is to foster warm and safe feelings. And I like to show off our great office, our modern equipment, and give the patient the chance to ask questions.
It is a good sign when a patient asks questions. Questions indicate that a patient is curious and thinking about his or her oral health. Most patients ask about the brand of toothpaste they should be using, how often they should floss, that kind of thing. And, among other things, I get asked a lot of questions about taking x-rays—specifically about their safety, usefulness, and comfort. 


Figure 1. A digital x-ray system in a dental office.

Figures 2a and 2b. A patient having a digital x-ray taken by a hygienist.
Figure 3. Image of a calibration tool over a digital x-ray.

My first experience with digital x-rays was several years ago. I was standing in for a colleague in another office who was going on maternity leave. I have always been adept at learning new tools and procedures, so I regarded this as a great opportunity to learn something new.

As I explored this first system, I found that after studying the manual I could navigate from screen to screen, and was able to set up a patient file, and shoot an x-ray. But none of it was particularly straightforward. For example, I had to return to the keyboard every time I wanted to take a shot in a full mouth series and had to accept or deny each image before I moved on to the next one. I got the sense that the designers behind this system were not practicing clinicians—or at least they had never talked to the hygienists or assistants who take most of the x-rays in a busy office!
Fortunately, I have worked with several other systems since then, and have come to know that a key to productivity in the hygiene room is well-thought out and well-engineered software. Such systems have transformed the daily routine for thousands of hygienists (and dentists) around the world. I am a passionate advocate for digital x-rays. I believe that every hygienist should ask his or her doctor to make the investment in one of the proven digital x-ray systems as soon as possible. They are simple to learn and easy to use. And, as I will go on to explain, a digital x-ray system will change your work processes for the better and dramatically improve your ability to educate your patients.
Let’s start with a few questions. We all take x-rays every day, don’t we? Would it be fair to say that x-rays are the basic diagnostic tool of any dental practice? Then would it also be fair to say that every office owes it to their patients to keep abreast of the developments in x-ray technology? 

Shooting digital x-rays is the same as film-based x-rays in almost all respects. A digital sensor substitutes for a piece of film, and it is positioned in the patient’s mouth just as we do with film. The x-ray cone is pointed at the patient and the button is pressed. We must take all the same precautions as we do with film x-rays (lead apron for the patient, step out of the room, etc) (Figures 2a and 2b). 

A distinction that is important to most patients is that each digital x-ray uses less radiation than conventional D-speed film—50% to 70% less in most cases. And because of the wide range of response of most sensors, it is hard to take a bad x-ray. This means fewer repeat shots and significantly lower cumulative radiation exposure.

Patient comfort is something that we hygienists are concerned about. How many of you “bend the corners” of x-ray film to make it more comfortable in the patient’s mouth? A couple of the digital x-ray manufacturers have included this feature in the shape of their sensors—nice touch! 
Think of what we have to go through with film to take a routine full-mouth series. We have to position and shoot 18 times. We develop and process each image. We mount the films on the film holder. Then we look to see if one or more images need to be retaken. If necessary we repeat one or more of the shots. What a frustrating performance—typically 30 minutes or more per patient. 

In contrast, consider the “one-touch” full-mouth series. Select the patient in the system. Position the sensor for the first shot. Press the x-ray key on the computer. Step outside and press the x-ray button. The system recognizes the radiation, exposes, dates, and assigns a tooth number to the image, then stores and files it—automatically. And then the system moves on instantaneously to the next shot. All you do is reposition the sensor and cone, step outside, and press the button. It’s all done in 5 to 7 minutes. And retakes are a cinch. This is smart software. And it works just the same with bite-wings. 
I have to write a special note to all you doctors who regularly practice endodontic procedures or surgically place implants. Just an opinion from a humble hygienist, but let me say, if you don’t have a digital x-ray system by now, you are crazy! I mean it. You waste so much time with repeated shots, waiting for them to be developed. Calibrate the system, take the shots yourself, and see them on the screen above the patient, instantaneously! You will have more time with the patient, less interruption, and more accurate measurements. This is not a luxury tool; it is essential modern equipment! (Figure 3). 

A principal role of the hygienist is to prepare the x-rays for the doctor’s review and diagnosis. Consider what goes into this activity. We must check the x-ray images for integrity of image quality and positioning accuracy, and we also have a responsibility for bringing probable clinical problems to the dentist’s attention. Digital x-rays make review and diagnosis work so much easier. The images are displayed on a large computer monitor (15” to 18” LCD flat panels are best, but if you do choose a conventional CRT, don’t buy anything smaller than a 17” screen). If the brightness or contrast needs to be adjusted, this can be accomplished instantly.

What about making comparisons with x-rays from prior visits? No problem. The best digital x-ray systems store all the images for a given patient and a given tooth number one on top of the other. In this way you can ensure that the most recent x-ray is shot at the same angle and with the same brightness as before. This makes the doctor’s life easier and can lead to better diagnoses.
Do you need to enhance the image to view clinical conditions clearly? I already mentioned brightness and contrast adjustments. In addition, at least two of the manufacturers have developed special software tools that dramatically enhance the images at the click of a button, bringing abnormalities starkly into view. Examples are the ClearVu tool from DEXIS, and Schick has a similar capability. 
Many doctors question the clinical efficacy of digital x-ray images as compared with x-ray films. It is not my place to challenge them directly, although I have extensive experience in this area. The one fact I want to point out is that when the ADA awarded its prestigious Seal of Approval to the DEXIS digital x-ray system last year (the only ADA-accepted product for this category), it noted that four studies demonstrated the diagnostic quality of the DEXIS system to be substantially equivalent to that of conventional dental film. 

We all know how much time can be spent running around looking for lost patient files. The advances in practice management software from many companies have changed our lives permanently for the better in this regard. So, what about all that time spent running around looking for lost x-rays? No matter how good our filing systems are, we all lose images from time to time—isn’t that true? With digital x-ray systems you don’t lose images. They are all stored neatly by patient, arranged by date and tooth number. And, with several of the systems, you can also store panoramic images and intraoral and extraoral photographic images as well. Back them up to another storage medium overnight for safety. Select them from the central database (often located on the main network server), and there they are.

Have you ever been in the situation where the office was behind schedule in film developing and the patient had left before you realized you took a bad shot? It’s an awkward situation having to ask the patient to come back for a special appointment. This just doesn’t happen with digital x-ray.
How about printing digital x-rays? You might think why bother—aren’t we all striving for the paperless office? Do you know how many photocopiers were sold last year to large, supposedly paperless corporations by companies such as Xerox and Canon? I don’t know that answer, but I do believe that a truly paperless dental office is a myth; there are always going to be uses for paper. It’s a fact that most digital x-ray practices print copies of their x-rays. They use them as file copies (why I don’t know, but there you go), as referral documents, and—my favorite—as marketing tools.
Imagine you are sitting chairside with gloves and a mask on. You have just completed your treatment. As the patient is preparing to get out of the chair, you swivel round to your keyboard and select one of several fully prepared letter templates in your digital x-ray system. This letter automatically loads up the patient’s name and address. Into this you quickly drag and drop a digital photograph, a pre-treatment and posttreatment x-ray, and an intraoral photograph. Click on the print button and out pops a beautiful full-color treatment letter on high-gloss paper for the patient to take home. Does that deliver value to the patient or what? They are thrilled to have this take-home souvenir of your skillful work. It is there for friends and family to compliment. And the possibilities of creating other marketing tools are limited only by your imagination.
This technology is already being used everyday by thousands of dentists—it sets them and their practices apart. 

Hygienists are born teachers. We love to help, show, demonstrate, and explain. It’s in our nature. We sell the services of our practice by educating our patients. And we love it. So when we find a tool that allows us to explain things more straightforwardly to our patients, it is natural that we gravitate to wanting to use that tool more and more. It is difficult to educate using a piece of x-ray film. On the other hand, with a digital x-ray system and a good quality monitor (preferably a flat panel in front of the patient), you will have plenty to talk about. 

Case presentation is a great example. This is a very critical element of our hygiene work. We all know that improved case acceptance leads to improved practice revenues. Patients want to learn what is going on in their mouths with simple images and words. With a little educational information, they make their own decisions about treatment. The leading digital x-ray systems have presentation slide shows built right in, making it easy to view all the x-ray images in sequence.


Sometimes patients ask me about an area in their mouth that they see on the screen or perhaps an area we have been tracking together. Patients are interested in monitoring their oral health. It is so exciting when a patient becomes your partner. The dynamics of patient care change, and there is a significant en­hancement to the patient-provider relationship. Pa­tients will appreciate your professionalism all the more and will gladly recommend you to their friends and family. 

“Thank you for taking so much time to show me around,” says my new patient as we head into the operatory and she takes her seat in the chair. “You really have a great office, and I can just sense your enthusiasm and passion for what you do. I know I am in good hands.”

I smile. I can tell that another new patient is satisfied with having all her questions answered. When she leaves, she will take home information on all the work we will do today including, of course, that treatment summary letter with those x-ray and photographic images. When her family asks how it went with the new dentist, she will tell them and show them! And I have no doubt that they will be impressed.


Ms. Naba is a practicing hygienist, licensed in the state of New York. She has worked in multiple specialty and general practices, and as a consultant specializing in setting up new practices, OSHA trainings, and implementation of practice management systems. Ms. Naba was formerly director of operations for The New York Dental Forum, a continuing education organization for dentists in New York. She can be reached at