Can caries be accurately diagnosed using panoramic radiographs (PANs)? Why or why not?

• A. Yes; PANs provide the most detail
• B. No; bitewings are better because PANs distort and miss small lesions
• C. Yes; PANs are sufficient for all caries detection
• D. No; radiographs cannot detect caries at all

Answer: (B)

Panoramic radiographs give a broad view, but they sacrifice detail and accuracy for caries detection. The main issue is resolution and distortion: caries, especially early or small interproximal lesions, require seeing subtle radiolucencies at tight tooth contacts. PANs have lower spatial resolution and variable magnification across the image, and the teeth can overlap or be displayed along a curved focal trough. This makes small lesions easy to miss or misinterpret.

Bitewing radiographs, on the other hand, are oriented to the crowns and contact areas of adjacent teeth, providing higher resolution and better visualization of interproximal surfaces with less distortion. This makes bitewings significantly more reliable for detecting early or small caries than a panoramic view.

So, PANs are not sufficient on their own for accurate caries diagnosis; bitewings are the preferred method for detecting interproximal decay, with PANs serving a broader diagnostic role rather than a primary tool for caries detection.