The aim of this study was to determine the prevalence of incidental findings (IFs) on digital dental panoramic radiographs (DPRs) of asymptomatic patients attending a general dental practice. This was a retrospective study of 6,252 consecutive digital (photostimulatable phosphor) DPRs of patients who visited a Canadian general dental practice for a complete new patient examination. The IFs were grouped into dental-related anomalies, radiopacities and radiopacities in the jaws, changes in the shape of the condyles, and other findings in the jaws, such as tonsilloliths and mucosal antral pseudocysts. Their prevalence was determined. Thirty-two percent of the DPRs showed at least 1 IF. The highest prevalence was found for dental-related anomalies (29% of all DPRs), of which impacted teeth were the most prevalent finding (24% of all DPRs), followed by idiopathic osteosclerosis (6% of all DPRs). A lower prevalence was noted for tonsilloliths (3%), and the prevalence of root tips, mucosal antral pseudocysts, and anomalies in condylar shape was approximately 1% each. The observed prevalence of 32.1% for IFs of any type underscores the need for a dental practitioner to review the entire DPR when a patient presents for an initial dental examination (or check-up) or for dental hygiene. Only a single IF (a central giant cell granuloma) provoked alarm, as it was initially considered malignant. Similarly, impacted teeth and suspected cysts need careful evaluation upon discovery to determine how they may be optimally managed.

This study reviews the two most important and frequently used systems of tomography used in dentistry today. These are the dental panoramic radiograph (DPR) and cone-beam computed tomography (CBCT). The importance of the DPR has been accentuated by the recent COVID-19 pandemic, as it does not produce an aerosol. Its clinical importance is derived from its panoramic display of the jaws and associated structures and should be examined for incidental findings that may portend a potentially serious outcome. An important recent spin-off of the DPR is the extra-oral bitewing, which can replace its traditional, uncomfortable and aerosol-generating intra-oral counterpart. Although much has been written about them, this paper reviews their essential attributes and limitations in clinical dentistry. Although attempts have been made to reproduce some of the attributes of CT in CBCT such as Hounsfield Units (HU) and improve the contrast resolution of the soft tissues, these remain elusive. Nevertheless, CBCT’s dataset should be appropriately reconstructed to fully display the clinical feature prompting its prescription. In certain cases, more than one mode of reconstruction is required.