Last week the conversation for many of us turned to dental radiographs thanks to the news media and medical research. Yale School of Public Health completed a study of over 15oo people and correlated their “remembered” exposure to x-rays with development of meningioma. My first reaction to this is to rebuke the study, so I went to get the details. The first thing to consider is that the exposure to dental radiographs and frequency was based on the patient’s memory, even of their childhood years, not on hard data where they scoured through old dental records. The next challenge is that the average age of the patients they included was 58. Our current technology for dental x-rays is far different; more sensitive film speeds or digital along with better equipment have dramatically reduced the exposure. Current dental radiographs expose the patient to 2-3 mrads for four bitewings and 10-20 mrads for a full set. The problem is that all of this information makes those of us who work in the dental profession feel better about radiographs, but what about our patients?
If I put on my patient hat, or move from being a dentist to a mom for a few minutes, I get how totally natural it is to ask some questions at the dental office after seeing or hearing about this study. In reality, wouldn’t you? Don’t we want proactive involved patients, who are interested in their health? Once I realized this I went from hoping no one had seen it or would ask us, to inviting the conversation. I also realized that the study did something powerful in my office: It opened a conversation on what we do and believe about dental radiographs. As a team we reviewed the ADA standards and recommendations and our own philosophy. This allows us to be on strong ground when we talk to patients who have questions.
In our office we do two things that are very important regarding dental x-rays. First, we follow all of the guidelines to maximize your safety using new, low radiation digital technology. Our equipment is checked and maintained and we will always use proper shielding. Second, we recommend using the ADA guidelines as a standard, but in an individual way based on what we know about dental health and the risk for cavities or gum disease. I am proud of both of these things and happy to share them with anyone.
So how often “should” we take x-rays. The word “should” implies there is a right and a wrong answer. I like to think of it as a “could”. We could set up a standard of annual bitewings and a full set every three years. The problem is that it may be too often for some patients and not often enough for others. The other challenge is deciding which films to take. Patients with bone loss from periodontal disease are better diagnosed with vertical bitewings, but we may need a panorex for the removal of wisdom teeth. Instead of defending a protocol, I diagnose the need for x-rays one patient at a time, with them, based on their needs.