When you sit in our chair at Limitless Dental® in Jersey City and we take your x-rays, two sets of eyes review every image: mine, and Pearl AI, an FDA-cleared software trained on more than seven million dental x-rays that highlights what it sees in color directly on the screen so you can look at it with me. Patients ask about it constantly, so this post answers the questions you have been searching, with my actual workflow at our office and a straight answer on what Pearl AI is, what it catches, what it does not replace, and what I pay for it.
What is the AI that can read dental x-rays?
The AI we use at Limitless Dental® is called Pearl Second Opinion. It is an FDA-cleared software that reviews your bitewing, periapical, and panoramic x-rays the same moment we do and outlines what it detects in bright color directly on the image, including cavities, calculus, bone loss measured in millimeters, defective restoration margins, periapical lesions, impactions, and any existing crowns, fillings, root canals, or implants you already have (Pearl Health, manufacturer-published specifications, 2026). Pearl was trained on more than seven million verified dental x-ray images, which is what allows it to act as a second pair of eyes on every image we take. We were one of the early adopters in Jersey City. It is now part of every comprehensive exam in our office.
Are AI dental x-rays accurate?
Pearl Second Opinion is independently validated at 94 percent accuracy for detecting dental disease on x-rays and over 95 percent accuracy for identifying dental conditions overall, per Pearl’s published validation data (Pearl Health, 2026). In a clinical study referenced by the manufacturer, operator diagnostic accuracy improved from 82 percent to 98 percent when paired with the AI. In my own practice, I see the value most clearly on small interproximal cavities, the ones between two teeth that are easy to miss on a quick read of a bitewing. The AI catches them, lights them up, and gives you and me a clear visual to discuss together rather than me describing a shadow you cannot see.
Does AI replace the dentist who reads my x-rays?
No. The product is called Second Opinion for a reason. I read every x-ray. Pearl reads every x-ray. Then I put them side by side and decide what is actually clinically meaningful for you. The AI is not making your treatment plan. I am, with you, after I look at the image, your tissue, your bite, your history, your symptoms, and your goals. The AI is a check on me, the same way a radiologist serves as a second read on a hospital scan. If Pearl marks something I already saw, that is confirmation. If it marks something I did not see, I look again. If it marks something I disagree with based on what I am seeing clinically in your mouth, I tell you, and we move on. You are not being diagnosed by software.
How accurate is AI cavity detection compared to a dentist alone?
Dentists vary in how aggressively they read x-rays, which is a known issue in dentistry and one of the original reasons AI second-opinion tools exist. Pearl’s published clinical data shows operator diagnostic accuracy improving from 82 percent to 98 percent when paired with the software, and an average of 37 percent more disease identified per practice (Pearl Health, 2026). What I want you to take from those numbers is not that the AI is better than the dentist. It is that the dentist plus the AI together find more of what is actually there than either one alone. That is the entire premise of using it.
Should I trust the new AI tech my dentist is using?
Ask three questions before you trust any AI tool a dental office is using on your images. First, is it FDA-cleared? Pearl Second Opinion is, for both inside-the-mouth x-rays (bitewings, periapicals) and the full-jaw panoramic x-ray (Pearl Health, 2026). Second, does the dentist still review every image themselves, or are they outsourcing the read to the software? In our office I read every image, every time, and the AI is a check on me, not the other way around. Third, can you see the AI’s findings on the screen during your visit? At Limitless Dental® we pull the annotated image up on the monitor in the operatory and walk through it with you before any treatment is recommended. If those three answers are yes, the tool is being used the way it is supposed to be used.
What does Pearl AI actually highlight on my x-ray during a visit?
Pearl outlines up to 18 different findings per image, including incipient and progressed caries, calculus build-up under the gumline, bone loss measured in millimeters and ratios, periapical radiolucencies that can suggest infection at a root tip, widened periodontal ligament space, defective restoration margins on your existing fillings and crowns, impactions, and the location and condition of any restorations or implants already in your mouth (Pearl Health, 2026). When we pull your x-rays up on the chairside screen, you see all of that color-coded directly on the image. The cavity is outlined. The bone loss has a number on it. The old filling with a leaky margin is circled. You are not taking my word for it, and you are not squinting at a gray-on-gray image trying to figure out where I am pointing.
How much does Pearl AI cost the practice?
This question comes up because patients want to know if AI x-ray review is going to drive up the cost of their visit. At Limitless Dental® we pay roughly 300 dollars per month for the Pearl subscription. That cost is part of running the practice, the same way our CBCT 3D scanner, our digital impression scanners, and our in-house lab are. You are not billed extra for an AI second opinion on your x-rays. It is built into the standard of care we deliver at every comprehensive exam.
Is Pearl AI worth it for a patient like me?
If you have ever switched dentists and been told you suddenly have five cavities you did not know about, or the opposite, told you are perfect when you suspect something is wrong, you understand the value. An AI second opinion makes the diagnostic process less dependent on which day, which dentist, and which level of attention happened to be in the room. It does not change what is in your mouth. It changes how reliably we see it. For patients with anxiety about being over-treated or under-treated, this is one of the most concrete reassurances we can offer.
Is AI used to diagnose root canals or fillings?
Pearl can flag periapical radiolucencies, which are the dark areas at the tip of a root that often indicate the kind of infection that requires a root canal. It can also flag defective margins on existing fillings, which is what usually prompts a conversation about replacing a filling before it fails completely. The diagnosis is still mine. A periapical lesion on an x-ray is one piece of evidence. I also need your symptoms, a clinical exam, and sometimes a CBCT 3D scan before recommending root canal therapy. The AI does not make the treatment decision. It makes sure the finding does not get missed in the first place. If you want to understand what the CBCT adds to a 2D x-ray, we wrote about that here: CBCT Dental Scan: What It Shows Your Dentist.
What other technology does Limitless Dental® use alongside Pearl AI?
Pearl AI is one layer of how we read what is happening in your mouth. We also use low-radiation digital x-rays, CBCT 3D imaging for cases that need to see in three dimensions, digital impression scanners that replace messy impression trays, three in-house 3D printers and a milling unit for same-day restorations, and our in-house Limitless Lab so most of your case never leaves the building. Each one of those tools is in our office for the same reason Pearl is: a more accurate, faster, less guess-based visit for you. If you want to see how those pieces fit together, our General Dentistry page walks through what a comprehensive exam at our office actually looks like.
Will my insurance approve x-rays reviewed by AI?
Yes. Pearl Second Opinion does not change the codes we submit for your x-rays. The x-ray itself is what is billed, the same way it always has been. The AI review is a clinical workflow on our side and is not a separate charge on your statement. We bill bitewings as bitewings, periapicals as periapicals, and panoramic films as panoramic films. Most PPO plans process these immediately. If you do not have dental insurance and want to know your options for keeping costs predictable, our in-office Limitless Dental® Savings Plan covers exams, x-rays, cleanings, and discounts on most treatment for a flat annual fee. Ask our front desk about it when you call to schedule.
What should I expect when I sit down for an x-ray at Limitless Dental®?
A bitewing or periapical takes a few seconds per image. You bite gently on a small holder, we step out, and the image lands on the monitor in front of you within a moment. Pearl analyzes it the moment it is captured. By the time you have stopped biting on the holder, the annotated image is already on the screen. We pull it up, walk through what is there, answer questions, and decide together what, if anything, needs treatment. The whole process is meant to feel transparent, because it is. You see what I see. You see what the AI sees. Nothing is happening behind your back.
Frequently Asked Questions about Pearl AI x-ray review at your dental visit
Are AI dental x-rays accurate? Pearl Second Opinion is independently validated at 94 percent accuracy for detecting dental disease on x-rays and over 95 percent for identifying dental conditions overall, per Pearl’s published validation data. Operator accuracy improved from 82 to 98 percent when paired with the AI in clinical study.
What is the AI that can read dental x-rays? Pearl Second Opinion, an FDA-cleared software that analyzes bitewing, periapical, and panoramic x-rays and outlines findings in color directly on the image, including caries, calculus, bone loss, periapical radiolucencies, and defective restoration margins.
How much does Pearl AI cost? At Limitless Dental® we pay roughly 300 dollars per month for the Pearl subscription as part of our practice overhead. Patients are not billed separately for the AI second-opinion review.
Does AI read dental x-rays without a dentist? No. Pearl is a second-opinion tool. Dr. Nick Ciardiello reads every x-ray taken at Limitless Dental® and reviews the AI’s findings alongside his own clinical exam, your symptoms, and your history before any treatment is recommended.
Should I trust the AI tech my dentist is using? Ask three questions: Is it FDA-cleared? Does the dentist still personally review every image? Can you see the AI’s findings on the screen during your visit? If yes to all three, the tool is being used correctly.
Is Pearl AI worth it for patients? An AI second opinion makes diagnosis less dependent on which dentist or which day. It does not change what is in your mouth, it changes how reliably it is seen, which is most reassuring for patients worried about being over-treated or under-treated.
Is AI used to diagnose root canals? Pearl can flag periapical radiolucencies, which often indicate infection at a root tip and may suggest a root canal is needed. The diagnosis still belongs to the dentist, who confirms with symptoms, clinical exam, and sometimes a CBCT 3D scan.
Schedule your comprehensive exam with Pearl AI x-ray review
If you want to see your own x-rays reviewed this way, with the annotated image on the screen and the time to walk through what is actually there, call our front desk at (551) 525-8284 to schedule a comprehensive exam at Limitless Dental® in Jersey City. We will walk you through every finding, what it means, what is optional, what is urgent, and what is just being watched, so you leave with a clear understanding of your own mouth.
