Reviewed by Dr. Manish Pandey, BDS, Dental Surgeon.
Bitewing vs periapical X-rays: both are small images taken inside the mouth, but they answer different clinical questions. A bitewing usually shows the crowns of upper and lower back teeth together and the bone between them. A periapical image shows an entire tooth, including its root tip and nearby bone. Your dentist chooses the view that fits your symptoms and examination; neither is automatically needed at every visit.
What is the difference between a bitewing and periapical X-ray?
A bitewing is made while you bite gently on a holder or sensor tab. It is particularly useful for looking between back teeth, where early decay can be hard to see directly, and for assessing the level of bone around those teeth. A periapical radiograph captures one or a few teeth from crown to root tip. It can help investigate a specific painful tooth, the area around a root, dental trauma, or treatment planning. These descriptions are about what each view can show—not a diagnosis from an image alone.
Which dental X-ray shows the root tip?
A periapical X-ray shows the root tip and surrounding bone. A standard bitewing is centered on tooth crowns and normally does not show the whole root. If pain seems to come from one tooth, the dentist may select a periapical view after taking a history and examining the mouth. If the main concern is possible decay between several back teeth, bitewings may be more informative.
Why might my dentist take both?
The images can complement one another. For example, a bitewing may help assess decay between neighboring teeth while a periapical view can examine the root and surrounding bone of one tooth that is tender. The decision depends on what is already known, previous images, symptoms, age, decay risk, and whether imaging is likely to change care. A clinical examination comes first; more images are not inherently better.
What happens during the appointment?
A small digital sensor or film is placed inside the mouth and the X-ray unit is positioned outside the cheek. The holder may feel awkward for a few seconds, especially if you have a strong gag reflex. Tell the dental team if you cannot comfortably hold the sensor, have a sore area, or think you may be pregnant. They can explain the reason for the proposed image and discuss suitable adjustments. The images are interpreted alongside the examination, not as a stand-alone verdict.
Are bitewing and periapical X-rays safe?
Dental radiography uses ionizing radiation, so the goal is to take only images that are clinically justified and to keep exposure as low as reasonably achievable while still obtaining a useful image. The American Dental Association and American Academy of Oral and Maxillofacial Radiology emphasize individualized selection rather than a fixed schedule for everyone. If you have recent images from another clinic, tell your dentist; they may be useful and could avoid unnecessary repeats. Read our separate guide on dental X-ray safety for broader context.
Questions worth asking your dentist
- What question will this image help answer?
- Do my earlier X-rays already show the area clearly?
- How will the result affect the treatment decision?
These questions support an informed discussion. They do not mean you should decline an indicated image when it is needed to diagnose a problem.
References
- American Dental Association and American Academy of Oral and Maxillofacial Radiology: 2026 recommendations for selection of dental radiographs.
- American Dental Association: X-rays (radiographs).
- International Atomic Energy Agency: Radiation protection in dental radiology.
Dental disclaimer: This article is general education, not a diagnosis or a substitute for an examination. A dentist should decide which image, if any, is appropriate for you.