Reading your panoramic X-ray: what the dentist sees, and what you can spot

A panoramic X-ray shows every tooth, both jaws, the jaw joints and the lower part of the sinuses on one long image. Dentists call it an OPG (orthopantomogram) or a DPT. It is the X-ray we most often ask UK patients to send when they contact our Turkish dental clinic, because it gives a dentist in Turkey, or anywhere, an overall picture of the mouth before a full examination.

You do not need training to make sense of the basics. Once you know which way round the image goes and what the different shades mean, you will be able to spot your fillings, crowns, gaps and any implants, and understand what the dentist is pointing at when they explain your plan.

Getting your bearings

The first thing that confuses people is direction. Panoramic X-rays are displayed as if you are looking at the patient face to face. That means your right side is on the left of the picture. Many images carry a small "R" marker to confirm it.

The upper teeth run along the top half of the image and the lower teeth along the bottom half. The front teeth are in the middle. The wide, curved U-shape at the bottom is the lower jaw. At the far left and right edges you will usually see the rounded tops of the jaw joints just in front of the ears.

Dentists number teeth in quarters. In the system used in the UK and Türkiye, each quarter is numbered 1 to 4, starting with your upper right, then upper left, lower left and lower right. Within each quarter, teeth run from 1 (the central front tooth) to 8 (the wisdom tooth). So "tooth 36" is the lower left first molar. If your plan mentions tooth numbers, this is how to find them on the image.

What the shades mean

An X-ray is a shadow picture. Dense materials stop more X-rays and appear bright. Softer materials let more through and appear darker.

Implants are easy to recognise: a screw-shaped bright white post sitting in the bone with a crown on top. A root canal-treated tooth has a thin white line running down the inside of the root where the nerve used to be.

What you can spot yourself

With the image in front of you, try counting. An adult usually has 28 teeth, or 32 with all four wisdom teeth. Look for:

• gaps where teeth have been taken out, and whether the teeth either side have tipped into the space
• wisdom teeth lying sideways or buried in the bone
• crowns and bridges, which show as bright caps
• root canal fillings, as thin white lines inside roots
• implants, as white screws
• the general level of the bone between teeth, compared with where the necks of the teeth are

That last point is worth a closer look. In a healthy mouth, the bone sits just below where the enamel ends. If the bone line is well down the roots, especially if it varies a lot from tooth to tooth, that suggests bone has been lost through gum disease at some point. The NHS explains that long-standing gum disease can damage the bone that supports the teeth. An X-ray shows the result, not whether the disease is still active.

What the dentist looks for

A dentist reads an OPG in a set order so nothing is missed. Typically they check:

1. The bone. Height of bone around each tooth, any areas of bone loss, and the height of bone in gaps where implants might go.
2. Each tooth in turn. Large decay, cracks they can see, old fillings with gaps underneath, and how much healthy tooth is left.
3. The root tips. Dark areas that might mean infection, and the quality of any root canal fillings.
4. Old dental work. Crowns or bridges with open margins, overhanging fillings, failed root treatments, and the condition of any existing implants.
5. Key anatomy. The position of the sinuses in the upper jaw and the nerve canal in the lower jaw, both important for implant planning.
6. Everything else. The jaw joints, buried teeth, and any unusual shadows that need a closer look.

The UK selection criteria for dental radiography describe panoramic X-rays as useful for this kind of overall assessment, for example before planning extensive treatment, but not as a replacement for close-up X-rays of individual teeth when detail is needed.

Common things that look worrying but usually are not

Panoramic X-rays have a few quirks that make patients worry when they look at them for the first time. Most of these are normal parts of how the image is made:

• A pale, blurred band across the front teeth. This is the spine. The X-ray tube passes behind your neck during the scan, and the shadow of the spine falls over the middle of the image.
• "Ghost" shapes. Dense objects on one side, such as an earring, a hearing aid or the jaw itself, can cast a faint, blurred copy on the opposite side, higher up. Dentists know to ignore them.
• A curved dark line over the upper teeth. Usually the gap between the tongue and the roof of the mouth during the exposure.
• Teeth that look wider on one side. If your head was turned slightly, teeth on one side look broader and on the other narrower.
• A white line or shape on the lower jaw. The hyoid bone in the neck, or the outline of the soft palate and tongue, can show up as faint shapes.

If something looks odd and you are not sure, ask. It is far better to raise it than to worry quietly, and a dentist can usually tell you in seconds whether it is an artefact or something worth a closer look.

What a panoramic X-ray cannot show

An OPG is a broad overview, and it has known limits. Research comparing panoramic images with other X-rays has consistently found they miss a proportion of small decay between teeth and some infections at root tips. The main limits are:

• Small decay between back teeth. Bitewing X-rays are much better at this.
• Fine detail at the front. The front teeth are often blurred or narrowed, depending on how you stood.
• Bone width. An OPG is flat. It shows how tall the bone is, not how thick, so it cannot confirm whether an implant will fit.
• Exact measurements. The image is slightly stretched, and the amount varies across the picture, so measurements are approximate.
• Gums and soft tissue. Gum inflammation, mouth ulcers and early gum disease do not show.
• Tooth-coloured work. Some composite fillings and veneers are faint or invisible.

Using your OPG for a plan from us

At Precious Dental, a recent panoramic X-ray is the single most useful thing you can send for a free written plan. Our dentists use it to see which teeth look worth keeping, where bone looks sufficient for implants, and whether a full-arch approach might be more sensible than saving every tooth. You can send it by WhatsApp on +44 7575 589099 or through our form. We will reply with a written, itemised plan, and the final plan and price are confirmed after the 3D scan at the clinic, because the scan shows the bone width and nerve position that an OPG cannot. Our prices page explains how our pricing works.

Before you send it, have a look yourself using this guide. Note anything you are unsure about, such as a dark area at a root or a tooth you did not know was buried, and ask about it. It helps to understand your own mouth before anyone starts treating it.

Sources

1. College of General Dentistry (FGDP): Selection Criteria for Dental Radiography
2. NHS: X-ray
3. NHS: Gum disease
4. NHS: Tooth decay
5. PubMed: studies on the diagnostic accuracy of panoramic radiography

Checked October 2026. Where we give our own view as a clinic, we say so.