A 3-year-old male has come for a routine dental check up. Intra-oral examination reveals good oral hygiene and open proximal contacts. During previous dental appointments, he was cooperative. Which radiographic assessment should be done for this patient?

The American Dental Association (ADA), the American Academy for Pediatric Dentistry (AAPD), the European Academy for Pediatric Dentistry (EAPD), and other organizations have published criteria that are meant to guide the dental professional in decision-making regarding appropriate radiographic imaging (Table 2-5). These guidelines clearly state that if the patient cannot cope with the procedure, one should attempt other strategies to handle the situation. The guidelines all acknowledge that, in some cases, radiographs are not possible, in which case, one should balance the benefit against the risk even more carefully. Sometimes it is better to postpone the radiographic exposure until the patient is older or better conditioned. The guidelines also clearly state that if there are no clinical signs of pathology, the need for a radiographic assessment is up to the professional’s judgment, and that these decisions have to be made on an individual patient basis. Radiographs are never to be used for economic and screening reasons since they involve a potential health risk for the patient. A 3-year-old with a sound dentition and open proximal contacts does not need a radiographic assessment. In contrast, for a 3-year-old with only 10 teeth visible in the mouth and no history of dental treatment, the dental professional should make a radiographic assessment. If a 4-year-old shows rampant decay, a radiographic assessment is certainly justifiable and indicated.