Dental professionals know that there are correlations between dental health and overall health, and they know that when they are providing dental care for their patients – they are also caring for more than just their teeth.

However, are there different ways to communicate this linkage so that patients understand?  The New York Times recently published an article on this topic (“Why Oral Hygiene Is Crucial to Your Overall Health”), and we thought if might be useful to pass along some of the specific examples that might arm a dental professional with new ways to explain this correlation with their patients.

Here are some examples as key takeaways from the article:

• One of the most well-known connections is between dental health and heart disease. Research has shown that people with gum disease may be more likely to have heart disease, as the bacteria in the mouth can travel through the bloodstream and contribute to inflammation in the arteries or spread to different organs. By maintaining good oral hygiene habits, patients can help reduce their risk of heart disease and keep their heart in top shape.
• Another surprising connection is between dental health and pregnancy outcomes. Pregnant women with gum disease may be more likely to give birth prematurely or have babies with low birth weights. By taking care of their teeth and gums during pregnancy, women can help give their babies a healthy start in life.
• Poor dental health can also contribute to respiratory infections, as the bacteria in the mouth can be breathed into the lungs. In addition, people with osteoporosis may be more likely to have tooth loss due to bone loss in the jaw. By maintaining good dental health, patients can help prevent these and other health issues.

Of course, even posting this article in waiting may be a valuable step as the patient can see the topic in the popular press.

Cephalometric radiographs are most commonly needed for orthodontic treatment.  However, they can also be used for TMJ assessment, sinus evaluation and trauma to the jaw or skull.  A cephalometric scan captures both lateral and poster-anterior (PA) images of the entire skull, and these scans are most commonly used as part of orthodontic treatment to measure relative movement of anatomical landmarks.

Important Overlooked Questions When Buying a Dental Pan Ceph or Cone Beam With Ceph X-Ray Machine

Typically, the way you can tell that any panoramic x-ray or dental cone beam machine can capture cephalometric x-rays is if the unit has an arm sticking out to the side.

The purpose of this arm is to create distance between the source of the x-ray and the anatomy so that the field of view presented in the image is larger.  This is similar to a flashlight that faces a wall.  As you move the flashlight away from the wall, the circle of light gets bigger.  The patient is positioned at the end of the arm to capture the cephalometric image.  The industry standard is that the midsagittal of the patient should be 5 ft from the x-ray source, so the ceph arm will be designed to achieve this.

A small but really important component of the the pan ceph is called the secondary collimator.  A collimator is a general term for an opening that only allows x-ray through that is going to hit the sensor, and therefore play a role in creating the desired radiograph.  Any x-ray energy that would not hit this sensor is blocked by the collimator, and therefore shielded from the patient.  All dental x-ray machines have a collimator.  

However, with a dental ceph machine, because the patient stands farther away from the source of the x-ray (at the end of the ceph arm), there is typically another collimator found at the end of the arm.  It will typically look like a vertical flange with a slit down the middle, and it will sit between the patient and the source of the x-ray.  

Typically, a key part of aligning the ceph involves making sure that the primary collimator (near the source of the x-ray) is “aligned” with the secondary collimator at the end of the ceph arm.  A poorly aligned secondary collimator can affect the resulting image because it may be blocking some of the required x-ray that the ceph sensor requires to take a good ceph radiograph.

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We had a great discussion with Dr. Smith (her name has been changed for privacy), and she had just left a practice in Illinois and moved to the southeast to start her own practice.  The office she is leasing had some old equipment, but she had started from scratch.  Not a single patient.

She put her head down and started working, and 3 months in, she was starting to make traction.

Until a pipe burst.

Generally, the damage could have been worse, but there was one casualty: the panoramic x-ray.

So now she had a decision:  she knew that implants would eventually become part of the practice.  However, she had hoped she could build the cash flow to a more comfortable level before making that leap to the cone beam system from the old pano.

However, now she had to decide – should she invest in the cone beam now or just focus on replacing the pano and then look to the cone beam later on.

Now, there are lots of options here.  Buy a used pano to bridge the gap until she’s ready for the cone beam.  Get a new pano and then trade it in toward a new cone beam when she’s ready.  There isn’t one right answer for the individual, because besides the financial pros and cons, every dental professional has to honestly assess their own risk tolerance. 

However, here is one framework to think about the finances.

If the office knows they need a panoramic x-ray, the question becomes whether the cone beam will generate incremental income vs the incremental cost.   

So, to run these numbers, the typical cone beam is going to be about $30,000 to $45,000 more expensive than a similar quality panoramic x-ray.  These numbers will be less if they went with refurbished equipment.

Let’s use the higher end of the range of $45,000 of incremental cost.  If you were to finance this over 5 years, it would be about $850 per month of incremental cost.

So just based on the numbers, the question becomes: would the cone beam enable more than $850 of incremental production per month for the dental professional?

However, that’s not the end of the analysis – because every individual’s risk tolerance is different.  Many would say that the probability of increasing production above that $850 mark is very high – and feel the cone beam is the right decision.  However, others may look at this and say “What if I can’t generate that production?” and feel that the implications are too severe for them, even if it’s a low probability.

The numbers should lead the way when deciding on a significant investment.  However, there’s not a single right answer for any dentist – and the variable not to overlook is the risk tolerance.

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The Health Policy Institute of the ADA released the snapshot of their Dental Practice Economic Outlook for the month of March.  Every month they conduct a survey of dental professionals to gather all kinds of different variables.  

One key takeaway is that dentists’ confidence in the recovery of their practices over the next 6 months reaches its highest point in almost a year.  However, this confidence is still quite a bit below it’s peak in early 2021.

See the report here.

Learn more about the Eva Select sensors from ImageWorks

According to the ADA, staffing issues were cited as the one of the most significant concerns among dentists in 2022.  The shortages have caused an estimated 11% reduction in dental practice capacity. In July 2022, 4 in 10 dental practices indicated they were recruiting or had recently recruited dental assistants (DA), and nearly the same share indicated they were recruiting dental hygienists (DH). Additionally in July 2022, about 1 in 3 dentists who did not have full schedules indicated that vacant staff positions were at least part of the problem.

This video is a short excerpt that reviews the 3 scientifically proven aspects that motivate staff.  We hope you find it useful.

At ImageWorks, we have been helping dental professionals make the most of their dental imaging systems for decades, and our dental panoramic x-rays and cone beam systems last a long time.  As a result, we have seen many second and third owners enjoy our systems for years.  However, over the years, we have seen many mistakes by buyers and sellers that in some cases result in the office spending more money than they expected. 

The price point of a used pano or cone beam system is typically enticing.  If you decide that the risk is worth the savings for your office, make sure you go in eyes wide open and ask about a commonly overlooked component in this transaction.

We already assume you will ask about the warranty coverage, the training, the support, the history of the unit, and whether parts are still available.  However, the one item that many times gets overlooked is the acquisition PC.

Most dental panoramic x-rays and cone beam systems require an acquisition PC.  This PC typically will not only control the equipment, but it will also be responsible for communicating with rest of the office network (usually via the office imaging software). 

For older pieces of equipment, this dual-role of the acquisition PC can become more challenging because it requires the appropriate hardware and software to run the older unit.  However, it also may need to be able to run current versions of your practice software.

Given this background, the obvious first question to ask is whether the unit comes with the PC that it was last used with.  We have come across situations where a doctor buys a used unit, and it shows up without a PC.  Then the doctor learns that they cannot just purchase a PC off the shelf that will run the unit – and they need to scramble to come up with a solution.

The second, less obvious concern is whether the PC being provided is a Windows 10 or 11 operating system (there would comparable iOS versions if you are a Mac office).  There are a few reasons why this may cause a concern. 

First, Windows 7 (or earlier) is technically not HIPPA compliant. 

Second, using a Windows 7 PC in your office may create additional integration concerns.  For instance, your practice management version may not be able to operate on Windows 7.  Alternatively, perhaps your practice management can work on Windows 7, but this would require all PCs in your office to be “downgraded” – because they all need to be at the same version. 

Third, it’s possible that the used unit you are purchasing can only operate on Windows 7, and attempting to use it with Windows 10 is either not possible, or would require new software from the manufacturer.

A used pano or cone beam system can be alluring based on the price point.  You just want to make sure you fully understand the risks.  If you would like to get our specialist’s opinion of a used unit you are considering – we would be happy to arm you with the right questions to ask.

A dental panoramic x-ray machine with cephalometric (sometimes referred to as a dental pan ceph machine) is an essential imaging tool for dentists.  This piece of equipment performs two main functions.

First, it operates as a traditional dental panoramic x-ray machine that creates a panoramic radiograph.  This is used by the dentist for general exams, as well as third molar, pediatric and extraoral bitewing exams. 

Second, it also allows the dental professional to perform frontal and lateral cephalometric exams.  These exams are typically used for orthodontic care.  However, they are also used for other evaluations like airway,  trauma and overall facial or oral development.

Many dental professionals understand the more obvious questions to ask when purchasing any large piece of equipment, like those having to do with support, training, warranty, etc.  However, at ImageWorks, we’ve been providing advanced dental digital x-ray solutions for thousands of offices, and we thought it would be worth sharing some commonly overlooked questions that are really important in selecting the right dental pan ceph x-ray machine. 

Cephalometric x-ray images are most commonly needed for orthodontic treatment.  However, they can also be used for TMJ assessment, sinus evaluation and trauma to the jaw or skull.  A cephalometric scan captures both lateral and poster-anterior (PA) images of the entire skull, and these scans are most commonly used as part of orthodontic treatment to measure relative movement of anatomical landmarks. 

A somewhat unique characteristic that many dental professionals look for in their cephalometric images is the ability to see soft tissue.  Specifically, they use the image to review the relationship a patient’s jaws and teeth have to their soft tissues and the entirety of their skull.

How does the pan ceph x-ray machine differ from a dental pan-only machine or a dental CBCT without ceph?

Most cephalometric x-ray machines are combined with traditional dental panoramic x-ray machines, so the machine you purchase will perform both functions.  Cephalometric capability can also typically be added to most dental cone beam machines.  Typically, the way you can tell that any panoramic x-ray or dental cone beam machine can capture cephalometric x-rays is if the unit has an arm sticking out to the side.

The purpose of this arm is to create distance between the source of the x-ray and the anatomy so that the field of view presented in the image is larger.  This is similar to a flashlight that faces a wall.  As you move the flashlight away from the wall, the circle of light gets bigger.  The patient is positioned at the end of the arm to capture the cephalometric image.  The industry standard is that the midsagittal of the patient should be 5 ft from the x-ray source, so the ceph arm will be designed to achieve this.

How good is the pan ceph sensor?

As with dental panoramic x-ray machines, not all systems have the same quality sensors, and the quality of the sensor is a big driver in determining the quality of the images that your machine will produce.  Most panoramic and cephalometric sensors today are CMOS design.  However, these CMOS sensors typically fall into two basic categories:  direct conversion sensors and indirect conversion sensors. 

The main difference is that direct conversion sensors use a more expensive material that reduces noise in the signal.  As a result, a direct conversion sensor typically is a more expensive component.  However, it creates clearer images. 

While the enhanced imaging of a direct conversion sensor has an impact with pan-only x-ray machines, it can be more pivotal for a ceph x-ray machine, because soft tissue landmarks are so important for orthodontic applications of cephalometric images.

Will it integrate with my software?

Currently almost all dental imaging hardware and software is very plug and play when it comes to integration.  Almost all dental pan ceph x-ray machines can communicate using the TWAIN standard, and almost all software platforms can accept images from TWAIN devices. 

However, one additional configuration that many offices like to have with a dental ceph x-ray machine is that they may have two different software platforms involved.  They may have their general imaging software, but they may also utilize orthodontic planning software (sometimes referred to as tracing software).  In these situations, they may value a system that can acquire the cephalometric images directly into their tracing program, while acquiring their panoramic images into their general imaging software.

Does the pan ceph equipment have one sensor or two?

In order for a dental ceph x-ray machine to also perform panoramic scans, the machine must be able to capture images in two different locations:  the panoramic scan is typically done when the patient is standing near the column (close to the x-ray source), and the cephalometric scan when the patient is standing at the end of the cephalometric arm (farther from the x-ray source). 

In each of these scenarios, a sensor must be located near the patient to capture the image.  This creates a challenge for a manufacturer, because typically the sensor is at the heart of the quality of the system, and therefore is one of the more expensive components – so having two sensors can make the system cost too high.

So dental manufacturers typically solve this problem in one of two ways:  either the equipment has a lower-resolution, cheaper sensor in both the panoramic image location and the cephalometric image location (two sensors), or it has a single higher-resolution sensor that can be moved between the different positions.  As technology has advanced, the mechanisms in single sensor platforms to move the sensor have become so easy to use and mistake-proof, this has become a common design to get the best of both worlds:  maximizing image quality while still being easy to use.

Are ceph images captured with a scan or with a single exposure?

Most dental cephalometric x-ray machines capture the cephalometric image by performing a quick scan: usually 6-10 seconds.  However, one variation of the two-sensor design mentioned above is to utilize a larger “flat-panel” style sensor at the end of the arm for cephalometric images.  The main advantage of this style is that instead of a scan, the cephalometric image is captured with a single exposure.

We hope you find this useful.  If you have any questions or would like to speak with a specialist to find the right fit for your practice, click below.  We would love to talk to you!