The College of General Dentistry's Selection Criteria for Dental Radiography sets UK bitewing intervals by caries risk. Adults at high risk have posterior bitewings every six months, at moderate risk every year, and at low risk approximately every two years. The shorter intervals run until no new or active lesions are apparent and the patient changes risk category.
The document was written by the Faculty of General Dental Practice (UK), which is now the College of General Dentistry. The current edition is the third, published in 2013 and updated in January 2018 to account for the Ionising Radiations Regulations 2017 and the Ionising Radiation (Medical Exposure) Regulations 2017. No later edition was found. It is free to view. The College's landing page asks you to sign in, and a College Subscriber account is free to register. The Care Quality Commission expects dental practices in England to comply with its recommendations. The last section sets the College's intervals beside the American Dental Association's.
How often does the College of General Dentistry recommend bitewings for adults, by caries risk?
The College's intervals by caries risk and age:
| Caries risk | Adults | Children |
|---|---|---|
| High | Six-monthly posterior bitewings, until no new or active lesions are apparent and the patient has entered another risk category | Six-monthly posterior bitewings, with the same condition |
| Moderate | Annual posterior bitewings, with the same condition | Annual posterior bitewings, with the same condition |
| Low | Approximately every two years; longer where there is explicit evidence of continuing low caries risk | Approximately every 12 to 18 months in the primary dentition and approximately every two years in the permanent dentition; longer where there is specific evidence of continuing low caries risk |
| Evidence grade | C | B |
For adults, the College recommends posterior bitewings every six months at high caries risk and every year at moderate risk. Both intervals run until no new or active lesions are apparent and the patient has entered another risk category. At low risk the interval is approximately every two years. A longer interval may be used where there is explicit evidence of continuing low caries risk.
Six months is the shortest interval. A footnote to the high-risk recommendation says bitewings should not be taken more frequently, and that you reassess caries risk before using that interval again. The same footnote says caries progresses at different rates in enamel and dentine, and that progression in adults may be slower than in children.
The adult intervals rest on expert opinion. The College finds comparatively little evidence on the diagnostic yield of radiographs for caries in adults, so it makes the same recommendations for adults as for children. All three adult recommendations are grade C. That grade means expert committee reports or opinion, with no directly applicable clinical studies of good quality.
For periodic bitewings, horizontal bitewings are the view of choice unless there is a clinical reason to reassess alveolar bone levels. For a new adult patient, the College asks for the fewest radiographs needed to show alveolar bone levels and caries. That will be some combination of periapical radiographs, horizontal bitewings and vertical bitewings.
What does it recommend for children and adolescents?
For children, the College recommends six-monthly posterior bitewings at high caries risk and annual bitewings at moderate risk. Both run until no new or active lesions are apparent and the child has entered another risk category. At low risk the interval depends on the dentition: approximately 12 to 18 months in the primary dentition and approximately two years in the permanent dentition.
These three child recommendations are grade B. That grade requires well-conducted clinical studies but no randomised clinical trials on the topic.
Expert opinion supports bitewings at the initial examination for all children at high caries risk. A child with little or no caries activity does not need bitewings at every recall appointment, though you still reconsider the child's caries risk.
The College also prints the EAPD guidelines for children as a valid alternative. They recommend less frequent bitewing examinations, use high and low risk with no moderate group, and set baseline examinations at given ages. The editors say they cannot judge definitively between the two approaches, and grade the EAPD recommendations C.
How is caries risk judged for this purpose?
The College expects a thorough clinical examination before any exposure to ionising radiation. That examination grades caries risk as high, moderate or low. For all ages, the College names past caries experience as by far the most important factor.
Appendix 2 of the document groups the factors under seven headings. These are some of the examples it lists for high caries risk:
| Factor group | Examples the College lists for high caries risk |
|---|---|
| Clinical evidence | New lesions, premature extractions, anterior caries or restorations, multiple restorations, no fissure sealants, fixed appliance orthodontics, partial dentures |
| Medical history | Medically compromised, xerostomia, long-term cariogenic medicine |
| Dietary habits | Frequent sugar intake |
| Use of fluoride | Drinking water not fluoridated, no fluoride supplements, no fluoride toothpaste |
| Plaque control | Infrequent, ineffective cleaning; poor manual control |
| Saliva | Low flow rate, low buffering capacity, high S. mutans and Lactobacillus counts |
| Social history | Socially deprived, high caries in siblings, low knowledge of dental disease, irregular attender, ready availability of snacks, low dental aspirations |
A patient who does not clearly fit high or low risk counts as moderate risk. The weight of each factor varies from patient to patient, and risk status can change over time.
Because patients move in and out of risk categories, the College calls routine radiographs taken solely because time has passed since the last examination not supportable. It asks you to reassess the interval for each new period. For a checklist that ties caries risk to recall frequency, the College points to NICE's 2004 guidance on dental recall intervals.
How does the UK guidance differ from the ADA's?
The American Dental Association revised its recommendations in January 2026 with the American Academy of Oral and Maxillofacial Radiology (AAOMR), in a consensus paper published in the Journal of the American Dental Association. The paper updates the 2012 ADA and FDA recommendations. The ADA calls it its first patient-selection recommendations in more than a decade. These are US recommendations, set here beside the College's for comparison.
For adults, the ADA gives a range for each risk group. A recall patient with clinical caries or at increased risk has posterior bitewings every 6 to 18 months. One with no clinical caries and not at increased risk has them every 24 to 36 months. The 2026 table repeats the 2012 adult intervals unchanged.
| Patient and risk | College of General Dentistry (UK, 3rd edition, updated 2018) | ADA and AAOMR (US, 2026) |
|---|---|---|
| Risk groups | Three: high, moderate, low | Two: clinical caries or increased risk; no clinical caries and not at increased risk |
| Adults at higher risk | Six-monthly at high risk; annual at moderate risk | Every 6 to 18 months |
| Adults at low risk | Approximately every two years; longer with explicit evidence of continuing low caries risk | Every 24 to 36 months |
| Children at higher risk | Six-monthly at high risk; annual at moderate risk | Primary or transitional dentition: every 6 to 12 months, if proximal surfaces cannot be examined visually or with a probe |
| Children at low risk | Approximately every 12 to 18 months in the primary dentition and approximately every two years in the permanent dentition | Primary or transitional dentition: every 12 to 24 months, if proximal surfaces cannot be examined visually or with a probe |
The College uses three risk groups with one interval each. The ADA uses two groups, each with a range. The ADA's 6 to 18 months at increased risk spans both the College's six-monthly high-risk interval and its annual moderate-risk interval. The College's low-risk interval of about two years sits at the short end of the ADA's 24 to 36 months. A longer interval may be used where there is explicit evidence of continuing low caries risk.
The College also attaches a stop condition to its high and moderate intervals: they run until no new or active lesions are apparent and the patient enters another risk category. It sets six-monthly as the most frequent interval at high risk. Neither body supports routine bitewings on a timetable without a clinical examination and a risk assessment. The ADA and AAOMR state that radiographic screening shall not be performed before the clinical examination.
For adolescents not at increased risk, the ADA gives 18 to 36 months. For adolescents at increased risk, the 2026 table gives 6 to 12 months if proximal surfaces cannot be examined visually or with a probe.
The sources on this page were checked on 23 September 2026.
The interval decides when the bitewing is taken. Take the two-minute reading test to see what you catch, what you miss, and what to work on first.
References
- Faculty of General Dental Practice (UK), now the College of General Dentistry. Selection Criteria for Dental Radiography. Horner K, Eaton KA, editors. 3rd edition, 2013, updated January 2018. Source (accessed 23 September 2026).
- College of General Dentistry. Selection Criteria for Dental Radiography. Web page, no date shown. Source (accessed 23 September 2026).
- College of General Dentistry. Standards & guidance. Web page, no date shown. Source (accessed 23 September 2026).
- American Dental Association and American Academy of Oral and Maxillofacial Radiology. Benavides E, et al. American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography: clinical recommendations. J Am Dent Assoc. 2026 Jan;157(1):20-35.e5. DOI (accessed 23 September 2026).
- American Dental Association. X-Rays/Radiographs. ADA Library, Oral Health Topics. Last updated 26 March 2026. Source (accessed 23 September 2026).
- American Dental Association. Versaci MB. New ADA recommendations confirm dental imaging most effectively used in moderation. ADA News, 5 January 2026. Source (accessed 23 September 2026).
- American Dental Association Council on Scientific Affairs and US Food and Drug Administration. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. Revised 2012. Source (accessed 23 September 2026).
Dr. Wael Mansour
Papilla helps dental students, dentists, and dental hygienists learn to read radiographs, one real case at a time, against outlines drawn by expert annotators.