A panorama picture provides a doctor with a good overview of the condition of your facial bones.

A simple rule of thumb is that wherever x-rays go through easily, a picture turns black, and wherever they are stopped the picture shows bright spots. First we will look at some normal panorama pictures, and you will soon be able to recognize your own face. Your face looks rolled out on the picture.

You can easily recognize the lower jaw, the jaw joints, which are round and regularly spaced when healthy, and there is also a clear joint cleft. Medical experts generally consider symmetrically occurring changes (changes on both sides) as „benevolent“, so if the change in the cleft or the form are symmetric, then this can be considered a variation within the norm, not a pathological change.

Let us forget about the joint for now and take a look at the lower jaw, you can recognize the teeth and if you take a good look, you can see a dark strip running almost the whole length of the lower jaw. Dark means that the x-rays go through, so this area has less bone – it contains a nerve in an hollow bone canal. This nerve gives the lower jaw feeling, and when the dentist gives you a shot, and your lip starts to feel „numb“, it is this nerve which goes „lame“. You can see where the nerve leaves the lower jaw, from this opening on it runs under the lower jaw and splits up into many small canals. You can recognize the teeth (shown here in blue), which are separated from the bone (shown here in black) by a very fine gap, the parodontal gap. The tooth also shows dark shadows (shown here in green), here there is less dentine, which is why the picture goes dark … this is the dental nerve.

The bone of the upper jaw which holds the teeth is built like the lower jaw. It borders on the maxillary sinuses, which border on the eye sockets. Since there is less bone here, the maxillary sinus is usually filled with air and the eye is filled with liquid, these areas are also dark. Every once in a while you can make out white lines, which are projections of the cheekbones, the cranium is shown spread out. It is also easy to recognize the nasal cavity and nasal septum.

An experienced doctor can tell a lot more from a panorama view. The structures described here enable a general overview. The contrast, clarity and demarcation of the structures in question are also analyzed, not just the structures themselves .

Now you can see a panorama picture of the „source“ of a toothache, the demarcation of the maxillary cavity is green, the tooth is marked in blue and a spot on the root tip is marked in red. Dark means that the x-rays go through more easily, as there is less bone there. The teeth have very large fillings: a dental nerve may have been damaged during filling, it began to rot and caused an inflammation at the tip of the root. The inflammation caused bone to recede – enabling x-rays to pass through more easily, the doctor sees a dark spot – it's that simple.

Here you can see a patient with parodontitis, usually the alveolar bone runs 2 mm below the enamel-cement line – the green line. Because the parodontitis was left untreated, bone has been receding for years, it is easy to see the horizontal direction of bone recession – the red line.

This patient has been missing side teeth for years, she came in with pains in the jaw joint. A little bit of the root is left, the front root has been filled up completely, the back root partially (root treatment). The jaw joint is irregularly spaced, the cleft narrowed and an irregular pattern can be seen in the gap. These are the classic signs of jaw arthrosis, the strain of chewing was not borne by the teeth but by the jaw. Over the years, this led to arthrosis.

Here you can see a shadowy maxillary sinus, meaning that the maxillary membrane, unlike the other side, is much thicker (shown in blue). This indicates an infection of the maxillary sinus, caused by molars (shown here in red). Molars often protrude into the maxillary sinus with their roots, or are very close, so if the dental nerve dies and this goes treated, then the inflammation in the bone (shown in green) may cause an infection of the maxillary sinus due the anatomical proximity.

As you see, an x-ray is a shadow play, as are many things in life!