Sir, we write with sighs of exasperation in response to two letters published in the journal. B. Qureshi (Incidental findings BDJ 2006; 201: 689) presented the case of a maxillary sinus 'polyp' identified by panoramic radiography, using this as a reminder to readers of the importance of 'thorough radiographic examination'. The maxillary sinus mucous retention cyst (erroneously called 'polyp') is an extremely common incidental finding that rarely, if ever, requires treatment. While we applaud Mr Qureshi for seeing the anomaly on the panoramic radiographs, we are concerned that his letter might be interpreted as a support for routine screening using panoramic radiography. In this particular case, identifying an asymptomatic and trivial condition did not help the patient and may have resulted in an unnecessary hospital referral.

In a letter in the same edition of the journal, K. Gündüz (Supernumerary molars BDJ 2006; 201: 688) describes a case of unerupted, asymptomatic, supernumerary molars on a panoramic radiograph taken as part of 'routine dental treatment'. While colleagues may have uttered 'Ooh! Fancy that!' upon reading this letter and seeing the radiograph, the case once again shows routine panoramic radiography identifying anomalies that do not justify treatment.

Radiography without adequate clinical indication ('Justification') is illegal under the Ionising Radiation (Medical Exposure) Regulations 2000. It is not only, however, an issue of radiation protection. What is often forgotten is that someone is paying for the unnecessary radiographs. These costs may increase if the consequence is an unnecessary hospital referral. There are ample scientific publications illustrating that routine panoramic radiography is not justifiable. The two cases described here may have the insidious effect of reinforcing erroneous beliefs about the value of radiographic screening. We refer readers to readily available and evidence-based guidance1,2 on this subject. A basic guideline is, however, that radiographs should be prescribed for patients individually on the basis of clinical signs and symptoms. In both the cases described above, had this approach been followed, no panoramic radiographs would have been taken and neither patient would have suffered as a consequence.