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  • Writer's pictureRahul Monga

Mastering Dental X-Ray Interpretation: A Guide for Internationally Trained Dentists

NDEB exam preparation courses and study material
Interpreting X-rays in board exams for internationally trained dentists typically involves assessing the dental and oral structures visible on the radiographs and making diagnoses or identifying abnormalities.

Around 15 years ago I visited my friend in India . He recently opened his practice and invited me for the prayer ceremony and party at his clinic.

While looking around at the equipment, interiors, instruments, consumable dental materials, suddenly I had this thought, and I asked him, "where is the dark room?". He gladly pointed his finger towards a dark brown table sitting in one corner of the room.

I was surprised. This table was the support of two alginate mixing bowls that were covered with a grey towel. I got curious, and asked, "what's in there?".

To my surprise, I was told that these bowls contain x-ray developer and fixer. X-ray film was held and opened under the towel and dipped blindly into developing solutions sequentially. I knew we could do better than this.

While we have overcame these infrastructural and technical challenges with the advent of digital radiography, the onus of precise radiographic 'interpretation' is still on the practicing dentist.


For internationally trained dentists seeking to practice in a new country, mastering the skill of interpreting dental X-rays is crucial. Dental X-rays serve as a universal diagnostic tool, providing valuable insights into patients’ oral health conditions.

In this blog post, i will provide internationally trained dentists with a comprehensive guide on how to interpret dental X-rays, helping you adapt to the radiographic practices of your new practice environment. This also includes dentists who are preparing certification and licensing exams for National Dental Examination Board Of Canada (NDEB), Australian Dental Council (ADC), National Board Of Dental Examinations (NBDE).

Exams such as Assessment Of Clinical Judgment ( ACJ) & Virtual OSCE requires intensive radiographic interpretation assessment.

1. Understanding Radiographic Practices:

• Familiarize yourself with the radiographic protocols and guidelines specific to the country or region where you will be practicing. Ensure compliance with local regulations and best practices for radiation safety.

• Learn about the types of dental X-rays commonly used in your new practice setting, such as periapical, bitewing, panoramic, and occlusal X-rays. Understand the specific purposes and areas each X-ray captures.

2. Anatomical Variations and Interpretation:

• Review and compare the anatomical variations in tooth and bone structures that may differ across patient populations. Adapt your understanding to the specific characteristics and presentations observed in your new practice environment.

• Recognize the appearance of different tooth structures, including enamel, dentin, pulp, and roots, on dental X-rays. Understand the variations and potential abnormalities that may be encountered.

3. Identifying Common Dental Pathologies:

Dental caries: Learn to recognize the signs of dental decay, including interproximal and occlusal caries. Adapt your knowledge to the prevalence and presentation of dental caries in your new patient population.

Periodontal disease: Identify radiographic signs of periodontal disease, such as bone loss, furcation involvement, and calculus deposits. Understand how the prevalence and severity of periodontal disease may differ in your new practice environment.

Endodontic conditions: Interpret periapical X-rays to detect periapical pathology, such as periapical abscesses, apical periodontitis, and root fractures. Adapt your understanding to variations in endodontic disease patterns.

4. Strategies for Effective Interpretation:

• Image quality assessment: Develop the skills to evaluate the quality of dental X-rays, including exposure, contrast, and positioning. Understand how variations in radiographic techniques may impact interpretation.

• Cultural and language considerations: Recognize the importance of effective communication with patients and colleagues, particularly when discussing X-ray findings and treatment plans. Adapt your communication style to ensure clear understanding and cultural sensitivity.

• Collaborative approaches: Emphasize the value of collaborating with local dental professionals, including oral and maxillofacial radiologists, to seek guidance and support when faced with complex cases or unfamiliar pathologies.


As an internationally trained dentist, mastering the art of interpreting dental X-rays is essential for successful integration into your new practice environment. This could be assessed when you appear for Assessment Of Fundamental Knowledge (AFK), Assessment Of Clinical Judgment (ACJ), ADC Written, Advanced Dental Admission Test ( ADAT), Or INBDE exams. By understanding the radiographic practices, adapting to anatomical variations, and familiarizing yourself with common pathologies specific to your patient population, you can provide accurate diagnoses and deliver optimal patient care. Continual learning and open communication with local dental professionals will help you refine your skills and excel in dental radiography interpretation.

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