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Ed Turner was staying in patient housing provided by Cancer Treatment Centers of America, feeling weak, tired and anxious about what he was facing. After years of remission from kidney cancer, the disease had returned, this time in his liver. The Elkton, Virginia, resident’s white blood cell count soared; he had an infection and felt too sick to even talk to family. When Cynthia Ingram, a registered nurse and animal therapy coordinator at CTCA, brought therapy dog Tori to visit Turner and his wife, Michelle, at their guest quarters, Turner was touched.
 

Trained Therapy Animals Boost the Moods of Cancer Patients

You know the importance of full mouth dental radiographs for your patients. However, the time it takes to get a diagnostic full mouth study is making you second guess this step.

If you want to ensure all patients get full mouth dental radiographs in a reasonable timeframe, and the bisecting angle technique makes you anxious, this article is for you. The subtle changes to the bisecting angle technique that will feel like “cheater codes” as well as this author’s approach to “bad radiographs” will be addressed.

These 2 things will help you and your team get consistently better radiographs faster. However, before we get to the “cheater codes” and “bad radiographs” we will start with a general overview of the 2 main intraoral dental radiology techniques: Intraoral Parallel Technique (IPT) and Bisecting Angle Technique (BAT).

The IPT is the same technique used to acquire diagnostic images for the rest of the body. The plate or sensor—

 will be used for both throughout the article—used to capture the image is positioned parallel to the target anatomy. The generator, also called the tube head, is positioned perpendicular to both the sensor and the patient.

The IPT is preferred as it allows for the most accurate image of the target anatomy with minimal distortion.

 If we could use this method for full mouth dental radiographs in our canine and feline patients it would be ideal. However, because of the absence of a vaulted palate and the presence of a mandibular symphysis, the sensor can only be placed parallel to the entire tooth for the mandibular molars and, in some patients, the most caudal mandibular premolars.

The anatomic differences between humans and veterinary patients means that the majority of our patient’steeth will require the BAT to obtain radiographs. The BAT is most commonly used in patients’mouths where the IPT cannot be used. However, it can be used for all teeth in patients’ mouths.

This is because the BAT is based on a geometric theorem: Cieszynski rule of isometry (

). This theory, coming from the geometric Law of Isometry, is applied to dental radiographs to obtain an accurate image when IPT cannot be used. The law has also been called the theory of equilateral triangles

, stating two triangles are equal if they have 2 equal angles and a shared side.

The reason for all this geometry is to ensure the image captured has the least amount of distortion. The other way to consider this is that BAT is a way to create an IPT when the sensor cannot be placed parallel to the entire tooth. Remember, the IPT has the tubehead directed perpendicular to BOTH the tooth and the sensor, which is not possible for most of our patient’s teeth. By bisecting the angle between the sensor and the tooth, this creates the angle to which the tubehead can be placed perpendicularly,similar to the IPT. While the BAT works for all teeth, the canine teeth given their curvature present a challenge. This article will first focus on the approach for imaging the majority of teeth and then will review the slight changes needed for imaging canine teeth.

Now that both intraoral dental radiography techniques have been reviewed, we can progress to the “cheater codes” to help improve your technique and speed.

The first way to simplify the BAT is to simplify the angles involved. Although many authors

 advise to place the sensor “as parallel as possible” to the tooth, it is this author’s recommendation and others

 that the sensor be placed perpendicular to the tooth. This small change in sensor positioning allows for a 90-degree angle between the tooth and sensor which is visually much simpler to bisect: 45 degrees. (

To ensure the sensor is perpendicular to the long axis of the maxillary teeth, the sensor should be placed parallel to the hard palate. For the mandibular teeth: using the patient’s tongue to fill the intermandibular space will give your sensor a flat surface to lay against that is perpendicular to the tooth roots. (

Positioning your patients in dorsal recumbency allows you and your team to complete the entire Comprehensive Oral Health Assessment and Treatment (COHAT) , including full mouth dental radiographs, without moving the patient or disconnecting any monitoring equipment. With the patient in dorsal recumbency, rotate their head 45°. By rotating their head and using the above simplification the bisecting angle will now be a vertical line which results in the tubehead angle being 0° or horizontally positioned. (

Once you get the correct angle for the first radiograph in the quadrant, do not change the angle of the patient, sensor or the tubehead. The only change to be made is to the move the sensor and tubehead either mesial or distal along that quadrant. This will save time by not rechecking any of the angles.

The biggest challenge to the bisecting angle simplification are the canine teeth. This is because while the rest of our patient’s dentition have similar angles between the crowns and roots, the canine teeth do not. (

Instead of using the angle of the crown for the canine tooth, the angle of the rostral mandible should be used. This is because the root of the canine tooth follows that curvature. (

) Canine teeth are a bit of an anatomical exception, given their crowns and roots do not have the same angle, you need to use the root angle to get the correct bisecting angle. 

Often a nondiagnostic radiograph, missing part of the tooth or inappropriate angle, is called 

. The radiograph is only bad if you do not then use it to help you get the diagnostic radiographs you want.

In this author's experience teaching dental radiography, most participants are quick to be critical of nondiagnostic radiographs. They often change patient, sensor and tubehead positioning or angle all at once. 

Instead, it is important to focus on the positives of the nondiagnostic radiograph, to determine what should not be changed. The main 2 things to focus on are whether the angle is correct and whether the teeth of interest are in the radiograph in their entirety. 

is a nondiagnostic image. It is nondiagnostic because the apex of the roots are not included in the image, however, the angle of the image is correct. Therefore, the only change that should be made is a sensor movement.

Once the sensor was moved further into the mouth, in a palatal direction, the entire root structure of right maxillary molars (109/110) are included in the image as well as the distal root of the maxillary fourth premolar (108). (

) The part of the sensor that could be seen outside of the mouth or beyond the teeth in image (a) corresponds to the black space in the dental radiograph in previous figure. It is important to line up the long side of the sensor with the cusp of the tooth/teeth to ensure the entire senor is used. This sensor placement is similar to collimating full body radiographs: ensuring 

 the target anatomy is within the radiograph.

Other times a “bad” radiograph may be caused by angles and not sensor placement. In those instances, the angle of the tube head may need to be corrected.

shows all the desired teeth are in the radiograph, however, the angle is very foreshortened, making this image nondiagnostic. Given that all desired teeth are included in the image, the sensor should 

be moved, instead the angle of the tube head should be corrected.

was very foreshortened, which fits with a small angle, almost parallel, between the tooth and the tube head. 

 shows a very large angle, almost perpendicular, between the tube head and the tooth, which resulted in the very elongated dental radiograph shown in 

, which demonstrates the second radiograph in the feline patient. Both tube head angles in the above figure failed to follow the angles outlines above for BAT.

To get the diagnostic image for this feline patient the tube head must be at an angle between that in Figure 11a and Figure 11b. 

 shows the correct angulation of the tube head and corresponding, diagnostic, dental radiograph (

). This feline 'patient' was placed in dorsal recumbency with the head titled at 45°, which resulted in a bisecting angle that is a vertical line and therefore the tube head angle should be horizontal. 

Evaluating the 'good' parts of your nondiagnostic dental radiographs will help you get to a diagnostic radiograph faster than focusing on what is 'bad' about it. This, other tips or 'cheater codes' will help decrease the time needed to take full mouth radiographs. As with any skill, this will take time and practice to learn this new way of obtaining and evaluating your dental radiographs.

, is a specialist in small animal dentistry and oral surgery. She began her career in small animal general practice and, although challenging at times, she gained a great deal of dentistry education. The more she learned, the more her passion for dentistry grew as well as a desire to become a specialist. While Thomson enjoys all aspects of clinical practice, she also very much enjoys providing continuing education for all veterinary professionals in small animal general practice. There is a huge demand for veterinary dentistry and oral care, and she wants to support general practice teams to provide the best care to their patients.

Altier B. Tips for mastering veterinary dental radiology. 

, January 19, 2021. Accessed February 27, 2025. 

https://www.dvm360.com/view/tips-for-mastering-veterinary-dental-radiography

Wigg’s Veterinary Dentistry: Principles and Practice. 2

Altier B. The ABCs of dental radiology: dental radiology demystified (Proceedings). 

. September 1, 2019. Accessed February 27, 2025. 

https://www.dvm360.com/view/abc-s-dental-radiology-dental-radiology-demystified-proceedings-pdf

Niemiec BA. Dental Radiology Series: Techniques for Intraoral Radiology. 

. August 14, 2015. Accessed February 27, 2025. 

https://todaysveterinarypractice.com/dentistry/practical-dentistry-dental-radiology-series-techniques-for-intraoral-radiology/

A veterinary dentistry expert shares tips for achieving full mouth images using 2 main techniques and 'cheater codes'

Clinical

How to get picture perfect dental radiographs in less time

blendVET's Believe and Belong in Veterinary Medicine at VMX 2025

Dozens of middle and high school students joined industry professionals in a day-long workshop at the 2025 Veterinary Meeting & Expo (VMX), presented by the North American Veterinary Community (NAVC), in Orlando, Florida. The event, “Believe and Belong in Veterinary Medicine,” was created by blendVET to encourage underrepresented students to pursue careers in veterinary medicine and provide support to get them started.

For the third year, the blendVET event was presented in partnership with NAVC as a hands-on experience to introduce pre-college students to the veterinary profession. "At NAVC, we are committed to creating pathways for young people from all backgrounds to discover and thrive in the field of veterinary medicine," Gene O'Neill, CEO of NAVC, said in a release. "Our partnership with blendVET enables us to provide students with hands-on learning experiences and mentorship in an industry that they may have never considered otherwise. Together, we are actively working to shape a more open and inclusive veterinary profession, and we're thrilled to offer these opportunities for the third year in a row at VMX, where we connect students directly with mentors and hands-on learning experiences."

Niccole Bruno, DVM, founder and CEO of blendVET, said she was thrilled to collaborate at VMX for a third year. "This year, we are proud to expand our offerings, providing tailored experiences for both new participants and returning blendVET students. It's particularly rewarding to see some of our scholars who have been with us throughout all 4 of our Florida events excitedly return to deepen their knowledge of the profession and strengthen their skills," Bruno said in a release.

In one room at VMX, first-time program participants received lessons in veterinary care as they rotated through stations. “It’s a baseline introduction into veterinary medicine,” Genine Ervin, DVM, chief operating officer of blendVET, said in a 

General practice, emergency medicine, zoological medicine, nutrition, dentistry, and surgery were among the covered topics. Activities included nail trimming, wound wrapping, and suturing. They students also got experience putting on personal protection equipment.

Returning student Catalina traveled from Puerto Rico to participate in this year’s event. She said her science teacher first informed her about the event, knowing that she was interested in becoming a veterinarian. Each of the few events she has attended offered different content, she noted. “It’s really fun, and I get to socialize and also learn new things,” Catalina said in a 

This year, a second room offered lessons in ophthalmology, clinical pathology, large animal medicine and forensic veterinary medicine to students returning to the program. At a more advanced level than the activities for first-time students, this experience provided various simulations including heartworm testing, cytology, rectal exams, phlebotomy, and bone identification.

blendVET presented the hands-on workshop to nearly 70 middle and high school students during the 2025 Veterinary Meeting & Expo.







Theresa Sullivan Barger

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