Why Your PCP Ordered Dental Imaging for HRT Continuation
Your primary care physician almost certainly did not order a "dental ultrasound" to assess jaw bone density for hormone replacement therapy—this is not standard practice and represents either a miscommunication or an unusual clinical scenario that requires clarification with your provider.
Standard HRT Monitoring Does Not Include Dental Imaging
No guideline supports routine dental imaging for HRT continuation. Hormone replacement therapy monitoring typically involves assessment of cardiovascular risk, breast health, endometrial thickness (in women with a uterus), bone density via DXA scan of the hip and spine, and symptom control—not dental or jaw imaging. 1
Bone density assessment uses DXA, not dental imaging. When osteoporosis screening is indicated (which may be relevant for postmenopausal women on or considering HRT), the gold standard is dual-energy X-ray absorptiometry (DXA) of the lumbar spine and hip, not dental radiography or ultrasound. 1
Possible Explanations for the Order
If You Are Taking Bisphosphonates or Denosumab
Dental evaluation is required before starting bone medications. If your physician is considering or has prescribed bisphosphonates (alendronate, zoledronic acid) or denosumab for osteoporosis—which may be discussed alongside HRT—a comprehensive dental examination including panoramic radiography is mandatory before initiation to assess for infection, planned extractions, or other dental pathology that could lead to medication-related osteonecrosis of the jaw (MRONJ). 1
Panoramic radiograph (orthopantomogram) is the standard dental imaging. The appropriate dental imaging in this context is a panoramic X-ray of the jaws and teeth, not ultrasound. 1
If You Have X-Linked Hypophosphatemia or Metabolic Bone Disease
- Dental orthopantomogram is part of specialized metabolic bone disease monitoring. In rare metabolic conditions like X-linked hypophosphatemia, dental imaging at age 5 and in symptomatic adults is recommended because these conditions cause dental abscesses, delayed tooth eruption, and jaw abnormalities—but this would not be a routine reason to continue HRT. 1
If "Ultrasound" Was Misunderstood
Intraoral ultrasound is experimental, not clinical standard. Research has explored high-frequency intraoral ultrasound probes (25 MHz) for measuring gingival thickness, periodontal tissues, and jawbone density, but this remains investigational and is not used in routine practice for HRT decisions. 2, 3, 4
Trans-alveolar ultrasound (TAU) for jawbone density is research-only. A 2021 study validated a new ultrasound technique to detect bone-marrow defects in the jaw, but this technology is not FDA-approved or guideline-recommended for clinical decision-making about hormone therapy. 4
What You Should Do
Call your PCP's office immediately for clarification. Ask specifically: (1) What is the exact imaging study ordered? (2) Why is it required to continue HRT? (3) Are you being evaluated for osteoporosis treatment with bisphosphonates or denosumab? 1
Request the actual order and indication. There may be a documentation error, a miscommunication about the type of imaging (e.g., DXA scan vs. dental X-ray), or an unrelated clinical concern that was conflated with your HRT prescription. 1, 5
Do not proceed with imaging without understanding the indication. Radiographic examinations should only be performed when the expected information will change patient management, per the ALARA (as low as reasonably achievable) principle and justification requirements. 5
Common Pitfalls
Confusing DXA bone density scans with dental imaging. Patients and staff sometimes use imprecise language—"bone scan" could mean DXA of the hip/spine (appropriate for HRT monitoring) rather than jaw imaging. 1
Assuming all imaging is interchangeable. Dental panoramic radiographs, intraoral X-rays, CBCT, and ultrasound serve entirely different purposes and are not substitutes for one another. 1, 2
Failing to question unusual orders. If a test does not make clinical sense to you, it warrants direct discussion with your physician—errors in ordering do occur. 5