Indiscriminate use of X-Rays is both Dangerous and Unethical; that is why The Academy of Pediatric Dentistry, which represents the oral health of infants, children, adolescents and those with special needs, took the initiative, with the direction from my research mentor at UCLA- Oral Radiologist Dr Stu White and my colleague Dr Art Nowak, Professor Emeritus from the University of Iowa, and others and engaged the FDA to develop safe guidelines for use of Dental X-rays back in 1987. Before that, there were none!
Everything we do in Medicine and Dentistry is based on risk assessment. Until there is a better way to early diagnose the most prevalent infectious disease that affects almost 1 in 2 kindergarteners (according to the 2000 US Surgeon General’s report), we still need to use X-Rays to detect early interproximal decay. Fortunately, with time, things change and improve. Those who have implemented high speed films, or even better, have gone green with digital hard sensors have reduced radiation exposure to an area smaller than the lid of a child’s sippy cup and the equivalent exposure of taking a one hour flight to Disneyland- 5 microsieverts, as published in the 2006 ADA publication Dental X-ray Examinations: Answers to Common Questions. By the way, a mammogram exposes you to 700 microsieverts as published in a March 15, 2011 Los Angeles Times Article: ”You’re being exposed to radiation — but it’s the amount that counts”. As times change, so must the guidelines.
So in 2004 the guidelines were updated. This past year 2012, again the guidelines were updated. These new guidelines can be found in the publication titled: “Dental Radiographic Examinations: Recommendations For Patient Selection and Limiting Radiation Exposure”
The development and progress of many oral conditions are associated with a patient’s age, stage of dental development, and vulnerability to known risk factors. Therefore the guidelines are presented within a matrix of common clinical and patient factors which may determine the types of radiographs that are commonly needed.
- Intraoral radiography is useful for the evaluation of dentoalveolar trauma. If the area of interest extends beyond the dentoalveolar complex, extraoral imaging may be indicated.
- Care should be taken to examine all radiographs for any evidence of caries, bone loss from periodontal disease, developmental anomalies and occult disease.
- Radiographic screening for the purpose of detecting disease before clinical examination should not be performed. A thorough clinical examination, consideration of the patient history, review of any prior radiographs, caries risk assessment and consideration of both the dental and the general health needs of the patient should precede radiographic examination.
You see, oral disease may develop in the absence of clinical symptoms such as pain and swelling. Since attempts to identify specific criteria that will accurately predict a high probability of finding interproximal carious lesions have not been successful for individuals, it was necessary to recommend time-based schedules for making radiographs intended primarily for the detection of dental caries. Each schedule provides a range of recommended intervals that are derived from the results of research into the rates at which interproximal caries progresses through tooth enamel. The recommendations also are modified by criteria that place an individual at an increased risk for dental caries. Professional judgment should be used to determine the optimum time for radiographic examination within the suggested interval.
For a New Patient Being Evaluated for Oral Diseases
Child (Primary Dentition)
An individualized radiographic examination consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be examined visually or with a probe is recommended. Patients without evidence of disease and with open proximal contacts may not require radiographic examination at this time.
Child (Transitional Dentition)
An individualized radiographic examination consisting of posterior bitewings with panoramic examination or posterior bitewings and selected periapical images is recommended.
Adolescent (Permanent Dentition)
An individualized radiographic examination consisting of posterior bitewings with panoramic examination or posterior bitewings and selected periapical images is recommended. A full mouth intraoral radiographic examination is preferred when the patient has clinical evidence of generalized oral disease or a history of extensive dental treatment.
Recall Patient with Clinical Caries or Increased Risk for Caries
Child (Primary and Transitional Dentition) and Adolescent (Permanent Dentition)
A posterior bitewing examination is recommended at 6 to 12 month intervals if proximal surfaces cannot be examined visually or with a probe.
Recall Patient without Clinical Caries or Risk for Caries
Child (Primary and Transitional Dentition)
A radiographic examination consisting of posterior bitewings is recommended at intervals of 12 to 24 months if proximal surfaces cannot be examined visually or with a probe.
Adolescent (Permanent Dentition)
A radiographic examination consisting of posterior bitewings is recommended at intervals of 18 to 36 months.
It is recommended that clinical judgment be used in determining the need for, and type of radiographic images necessary for, evaluation and/or monitoring in these circumstances. At Bay Area Pediatric Dental Wellness Group, we alert the consenting parent/guardian that:
“Based on the FDA X-Rays guidelines, X-rays are recommended for your child at this appointment. However, a decision to take X-rays will be made only after the doctor performs a clinical exam and reviews the patient’s cavity history, assessed risk, current health history and what was recommended at the last checkup. At that time, we will let you know whether or not x-rays should be taken.”
If you would like to read the updated guidelines, download the publication: “Dental Radiographic Examinations: Recommendations For Patient Selection and Limiting Radiation Exposure”
-Jonathon Everett Lee, DDS and Team HappyHealthyTeeth