Reading Your OPG X-Ray: What Dentists Look For in Results

An OPG X-ray (orthopantomogram) captures a complete panoramic view of both jaws, every tooth, the temporomandibular joints, and the surrounding bone in a single image. After the scan is taken, a dentist or radiologist reads the image systematically to identify cavities, bone loss, impacted teeth, cysts, tumors, fractures, and other abnormalities that affect oral and maxillofacial health. Understanding what your OPG X-ray results mean transforms the experience from a confusing medical image into an actionable roadmap for your dental care.

This guide explains what an OPG X-ray shows, how dentists and radiologists interpret the image step by step, common findings and what they mean, the difference between normal and abnormal results, key terms you will encounter in your OPG report, when additional imaging is required, and how DCDC delivers fast, accurate OPG reporting. Every section is medically reviewed by a diagnostic radiologist to ensure clinical accuracy.

What Does an OPG X-Ray Show?

An OPG X-ray shows the complete dental and maxillofacial anatomy in a single flat image, giving dentists and radiologists a broad diagnostic overview that no single intraoral X-ray can match. The panoramic format displays structures from one ear to the other, capturing every tooth from root tip to crown, the bone that supports them, and the critical anatomical landmarks surrounding the oral cavity.

Specifically, an OPG image reveals:

• All teeth in both jaws - including erupted teeth, developing teeth in children, and unerupted or impacted teeth hidden beneath the gum line
• Tooth roots and root canals - showing root length, shape, number of canals, and any signs of infection or resorption at the root tips
• Alveolar bone - the bone surrounding and supporting the teeth, revealing bone height, density, and any areas of destruction from periodontal disease
• The mandible and maxilla - the complete lower and upper jawbones, including the ramus, condyles, coronoid processes, and the body of the mandible
• Temporomandibular joints (TMJ) - the hinge joints on each side of the jaw, showing condylar shape, joint space, and signs of arthritis or erosion
• Maxillary sinuses - the air-filled cavities above the upper jaw, revealing sinusitis, polyps, mucous retention cysts, or tooth roots projecting into the sinus
• The inferior alveolar nerve canal - a critical structure running through the lower jaw, particularly important for implant planning and wisdom tooth extraction
• Dental restorations - fillings, crowns, bridges, implants, and root canal treatments, along with their condition and relationship to surrounding structures

"The OPG is the first image I examine for nearly every dental patient," says Dr. Osama Elzamzami, Head of Radiology at DCDC. "It provides the complete picture. I can see both jaws, every tooth, the joints, and the sinuses in one view. From there, I know exactly which areas need closer investigation."

Because the OPG is a two-dimensional projection of curved three-dimensional structures, some overlap and distortion are inherent in the image. Structures closer to the X-ray source appear magnified, and objects on opposite sides of the jaw may overlap. This is why radiologists are trained to account for these limitations when interpreting results, and why supplementary imaging such as CBCT scans may be recommended for complex cases requiring three-dimensional detail.

How Dentists Read an OPG Image

Dentists and radiologists do not simply glance at an OPG and draw conclusions. They follow a structured, systematic approach that ensures every anatomical region is evaluated and no finding is overlooked. This disciplined reading method is what separates a thorough radiological assessment from a cursory look at the image.

The standard systematic approach to reading an OPG includes the following steps:

• Overall image quality check: The radiologist first confirms that the OPG is properly exposed, correctly positioned, and free from motion blur or artifacts caused by metal jewelry or patient movement. A poor-quality image may need to be retaken before any diagnostic conclusions are drawn.
• Symmetry assessment: The left and right sides of the jaw should appear roughly symmetrical. Asymmetry in the mandibular ramus, condyles, or bone density may indicate pathology such as a tumor, fracture, or developmental abnormality on one side.
• Teeth evaluation (quadrant by quadrant): The dentist examines each tooth individually, moving systematically through all four quadrants - upper right, upper left, lower left, and lower right. For each tooth, the crown, root, and surrounding bone are assessed for cavities, fractures, root resorption, periapical lesions, and quality of existing restorations.
• Bone level assessment: The alveolar bone height around every tooth is evaluated. In a healthy mouth, bone reaches to within 1-2 mm of the cementoenamel junction (where the crown meets the root). Reduced bone height indicates periodontal disease, and the pattern of bone loss - whether horizontal (generalized) or vertical (localized) - guides the treatment plan.
• TMJ evaluation: Both temporomandibular joints are examined for condylar shape, size, and symmetry. The radiologist looks for flattening, erosion, osteophytes (bone spurs), or sclerosis that could indicate degenerative joint disease, arthritis, or previous trauma.
• Maxillary sinus review: The sinuses above the upper jaw are checked for opacification (clouding), mucosal thickening, polyps, retention cysts, and the proximity of upper tooth roots to the sinus floor - a critical consideration for extractions and implant placement.
• Nerve canal tracing: The inferior alveolar nerve canal in the lower jaw is traced from the mandibular foramen to the mental foramen to assess its relationship to the roots of the lower teeth, particularly the wisdom teeth. Close proximity between a tooth root and the nerve canal increases the risk of nerve damage during extraction.
• Pathology identification: Any abnormal radiolucencies (dark areas suggesting bone destruction, cysts, or tumors) and radiopacities (bright white areas suggesting calcifications, foreign bodies, or dense bone lesions) are documented, measured, and correlated with the patient's symptoms.

This systematic reading typically takes a trained radiologist three to five minutes. The findings are then documented in a formal written report that is sent to the referring dentist or provided directly to the patient. At DCDC, every OPG is read by a consultant radiologist, not a technician, ensuring the highest standard of diagnostic accuracy.

"I follow the same checklist for every single OPG I read," says Dr. Osama Elzamzami, Head of Radiology at DCDC. "Systematic reading is non-negotiable. If you jump straight to the area the patient is complaining about, you risk missing an incidental finding somewhere else on the image that could be far more significant."

Common Findings on OPG X-Rays

OPG X-rays reveal a wide range of dental and maxillofacial conditions. Some findings are expected and benign, while others require urgent attention. The following table summarizes the most common findings seen on OPG images, what they look like to a radiologist, and what they typically mean for the patient.

A patient story illustrates how OPG findings can change the course of treatment: A 42-year-old woman visited DCDC for a routine dental checkup with no specific complaints. Her dentist requested an OPG as part of the standard baseline assessment. The panoramic image revealed a well-defined radiolucent area measuring approximately 2 cm in diameter surrounding the crown of an impacted lower premolar that the patient never knew existed. The finding was consistent with a dentigerous cyst. Further evaluation with a CBCT scan confirmed the diagnosis, and the patient was referred to an oral surgeon for elective cyst removal before it could expand further and weaken the jawbone. Without the routine OPG, this silent, painless cyst could have grown undetected for years.

"This is exactly why we advocate for comprehensive panoramic imaging even in asymptomatic patients," says Dr. Osama Elzamzami, Head of Radiology at DCDC. "The most dangerous conditions are often the ones that cause no pain. The OPG catches them before they become emergencies."

Normal vs Abnormal OPG Results

Understanding the difference between normal and abnormal OPG results helps patients interpret their reports with greater confidence. While a radiologist provides the definitive reading, knowing what "normal" looks like on an OPG empowers patients to ask informed questions during their consultation.

What a Normal OPG Looks Like

A normal OPG image displays the following characteristics:

• Complete, intact teeth with no dark spots within the crowns or between teeth, indicating no cavities
• Healthy tooth roots that are fully formed, tapered, and surrounded by a thin dark line (the periodontal ligament space) and intact white bone
• Even alveolar bone levels reaching to within 1-2 mm of the cementoenamel junction (CEJ) around all teeth, with no areas of bone recession
• Symmetrical condyles at the TMJ joints with smooth, rounded surfaces and clear joint spaces
• Clear maxillary sinuses that appear dark (air-filled) with thin, uniform mucosal lining and no cloudiness or masses
• A visible inferior alveolar nerve canal running through the lower jaw with adequate distance from adjacent tooth roots
• No unexpected radiolucencies or radiopacities - no unexplained dark or bright white areas within the bone, sinuses, or soft tissues

Signs of Abnormal OPG Results

Abnormal OPG results include any deviation from the normal findings described above. Red flags that radiologists specifically watch for include:

• Dark areas (radiolucencies) within the jawbone that may represent cysts, tumors, abscesses, or areas of bone destruction
• Bright white masses (radiopacities) that could indicate calcified tumors, bone islands, or foreign bodies
• Significant bone loss around multiple teeth, indicating advanced periodontal disease
• Root shortening or irregularity suggesting resorption from orthodontic pressure, trauma, or adjacent pathology
• Asymmetry of the mandible or condyles that may point to a fracture, tumor, growth disorder, or degenerative joint disease
• Widened periodontal ligament spaces around a tooth, suggesting trauma, infection, or occlusal overloading
• Opacified sinuses indicating sinusitis or an oroantral communication (a connection between the mouth and sinus caused by extraction or infection)

It is important to understand that "abnormal" does not always mean "dangerous." Many OPG findings are incidental and benign. A small mucous retention cyst in the maxillary sinus, for example, is a very common finding that rarely requires any treatment. Your radiologist will clearly distinguish between clinically significant findings that need action and incidental findings that need only monitoring or no intervention at all.

Understanding OPG Reports: Key Terms

OPG reports are written by radiologists using standardized medical terminology. While these terms are precise and clinically necessary, they can be confusing for patients reading their results for the first time. Here are the most common terms you will encounter in an OPG report and what they mean in plain language.

• Radiolucent / Radiolucency: An area that appears dark on the X-ray because the X-ray beam passed through it easily. In the jaw, radiolucencies usually indicate bone destruction, cysts, abscesses, or tumors. A small radiolucency at a root tip, for example, typically means a periapical abscess or granuloma.
• Radiopaque / Radiopacity: An area that appears bright white on the X-ray because it blocked or absorbed the X-ray beam. Metal fillings, implants, and dense bone are radiopaque. Abnormal radiopacities within the jaw may represent calcified tumors, bone islands (dense bone nodules), or foreign bodies.
• Periapical pathology: Disease at the tip (apex) of a tooth root. On the OPG, this appears as a dark area at the end of the root and typically indicates that infection has spread from the tooth pulp into the surrounding bone. Treatment usually involves root canal therapy or extraction.
• Resorption (root resorption): The gradual dissolution of tooth root structure by the body. External resorption affects the outer root surface, while internal resorption affects the root canal from within. On the OPG, resorption appears as shortening, thinning, or irregular contour of the root.
• Horizontal bone loss: A uniform reduction in bone height around multiple teeth, typically caused by chronic periodontal (gum) disease. On the OPG, the bone level appears evenly reduced across an entire section of the jaw rather than localized to one tooth.
• Vertical (angular) bone loss: A localized defect where bone has been destroyed along one side of a tooth root, creating an angular or V-shaped pattern. This finding is more specific than horizontal bone loss and often requires targeted periodontal treatment.
• Impaction: A tooth that has failed to fully erupt into its normal position in the arch because it is blocked by bone, another tooth, or soft tissue. The OPG report will describe the type of impaction (mesioangular, distoangular, horizontal, or vertical) and its relationship to the inferior alveolar nerve canal.
• Well-defined vs ill-defined margins: These terms describe the border of a lesion within the bone. A well-defined margin (sharp, clear border) usually suggests a benign, slow-growing process such as a cyst. An ill-defined margin (irregular, fuzzy border) raises concern for a more aggressive process and warrants further investigation.
• Osteosclerosis: An area of increased bone density that appears brighter white than the surrounding bone on the OPG. It is usually a benign, incidental finding representing a localized area of dense bone, often found near the root tips of lower premolars or molars.

If your OPG report contains a term not listed above, ask your dentist or radiologist to explain it during your consultation. A clear understanding of your report ensures you can participate actively in treatment decisions and ask the right follow-up questions.

When Further Imaging Is Needed After OPG

The OPG is an excellent screening tool that provides a broad panoramic overview, but it is a two-dimensional image of three-dimensional structures. There are specific clinical situations where the OPG identifies a finding that requires further imaging for a definitive diagnosis or precise treatment planning. Knowing when additional imaging is necessary helps patients understand why their dentist or radiologist may recommend a follow-up scan.

Further imaging is typically recommended in the following scenarios:

• Dental implant planning: The OPG provides an initial overview of bone height and the location of vital structures such as the nerve canal and sinus floor. However, precise implant placement requires three-dimensional measurements of bone width and density that only a cone-beam CT (CBCT) scan can provide.
• Wisdom teeth close to the nerve canal: When the OPG shows a wisdom tooth root overlapping or in close contact with the inferior alveolar nerve canal, a CBCT is recommended to determine the exact spatial relationship between the two structures before surgical extraction, reducing the risk of nerve injury.
• Suspected jaw tumors or large cysts: A large radiolucency on the OPG with ill-defined borders or aggressive features warrants CBCT or medical CT scanning to assess the full extent of the lesion, its relationship to surrounding structures, and to guide surgical planning or biopsy.
• Complex root canal anatomy: When root canal retreatment is planned or the OPG suggests unusual root anatomy (extra canals, curved roots, calcified canals), a small-field-of-view CBCT centered on the affected tooth provides the three-dimensional detail the endodontist needs.
• TMJ evaluation requiring cross-sectional detail: While the OPG shows the condylar surface well, complex TMJ disorders may require MRI (for soft tissue disc assessment) or CBCT (for detailed bony anatomy) to reach a definitive diagnosis.
• Periapical detail not visible on OPG: When the OPG raises suspicion of a periapical lesion or root fracture but the overlapping structures prevent a definitive diagnosis, a targeted periapical intraoral X-ray or small-field CBCT provides the necessary resolution.

"The OPG answers the question of what is happening across the entire jaw," says Dr. Osama Elzamzami, Head of Radiology at DCDC. "When we find something that needs a closer look, we move to CBCT or MRI. The OPG tells us where to point the next camera."

At DCDC, all follow-up imaging - including CBCT, MRI, and CT scans - is available on-site under one roof, meaning patients do not need to travel to a separate facility or wait weeks for an appointment at another imaging center. The same consultant radiologist who read your OPG can coordinate additional imaging the same day when clinically indicated.

Getting Your OPG Results at DCDC

Doctors Clinic Diagnostic Center (DCDC) in Dubai Healthcare City provides end-to-end OPG X-ray services, from the scan itself to expert radiologist interpretation and same-day written reporting. DCDC is designed to give patients and referring clinicians fast, reliable, and thoroughly interpreted OPG results without unnecessary delays.

Here is what the OPG results process looks like at DCDC:

• Walk-in or scheduled scan: Patients can walk in during clinic hours or book an appointment in advance. No referral is needed for self-pay patients. The OPG scan itself takes under 15 seconds, with total time in the radiology suite under 5 minutes.
• Consultant radiologist review: Every OPG taken at DCDC is reviewed and reported by a consultant radiologist specializing in diagnostic imaging. This is not a technician reading or an automated report - it is a detailed assessment by a specialist who examines every structure on the image systematically.
• Same-day written report: The formal radiology report is typically completed within hours of the scan. In urgent cases, a verbal preliminary report can be communicated to the referring dentist within minutes. The written report includes a structured description of all findings, their clinical significance, and recommendations for any further imaging or follow-up.
• Digital image delivery: The high-resolution digital OPG image is available for electronic sharing with the patient's referring dentist, orthodontist, or oral surgeon. Patients can also receive a copy of their image and report for personal records.
• On-site follow-up imaging: If the OPG reveals a finding that requires further investigation with CBCT, CT, MRI, or ultrasound, all of these modalities are available at DCDC. Patients can often have supplementary imaging performed on the same visit, eliminating the need for multiple trips to different facilities.
• Insurance and self-pay options: DCDC accepts major Dubai insurance providers. Self-pay patients benefit from transparent pricing with no hidden fees. Insurance patients may need a referral from their dentist or GP to activate coverage.

Whether you are a patient seeking to understand a new OPG scan, a dentist looking for reliable outsourced reporting, or an oral surgeon needing both OPG and CBCT before a complex procedure, DCDC provides a streamlined experience from scan to specialist referral - all in one location in Dubai Healthcare City.

अक्सर पूछे जाने वाले प्रश्न

Final Thoughts

Understanding your OPG X-ray results does not require a medical degree, but it does require a qualified professional to interpret the image accurately. The OPG provides a uniquely comprehensive view of the entire oral and maxillofacial region in one scan, revealing conditions from common cavities and bone loss to hidden cysts and jaw joint disorders. By learning the basics of what the image shows, how dentists read it systematically, and what key report terms mean, patients can participate more actively in their treatment decisions and ask the right questions during consultations.

If you need an OPG X-ray with expert interpretation, Doctors Clinic Diagnostic Center in Dubai Healthcare City offers same-day digital OPG scanning with consultant radiologist reporting, walk-in availability, and on-site access to advanced imaging including CBCT, CT, and MRI when further investigation is needed. Explore our full range of OPG X-ray services or contact us to book your scan today.

लेखक

Dr. Osama Elzamzami

प्रोफाइल देखें

Diagnostic Radiology

MD, FRCR

Dr. Osama Elzamzami is Head of Radiology at DCDC Dubai Healthcare City, specializing in diagnostic imaging including X-ray, CT, MRI, OPG, and CBCT. He holds an MD and FRCR (Fellowship of the Royal College of Radiologists) and provides expert reporting for dental, maxillofacial, and general diagnostic imaging studies.

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