Retakes Retakes are one of the most common causes of unnecessary patient radiation exposure (Monnin, 2021; Bhatti and Shaikh, 2020). They frequently result from improper patient positioning and processing technique (FDA, 2016; Monnin, 2021; Bhatti and Shaikh,2020; With dental radiographs in particular the most common causes were positioning errors, improper angulation, improper alignment and incorrect film placement (Ostrander, 2018). Every radiograph that is diagnostically unacceptable must be retaken. The retake may be necessitated either by poor radiographic exposure technique or by processing errors. To produce quality diagnostic images, the radiographer must have a thorough knowledge of the imaging methods used in dentistry, including paralleling, bisecting the angle, and bitewing and panoramic techniques. It is the responsibility of the radiographer to reduce patient exposure to radiation by maintaining high standards and being aware of the details required in the imaging chain. Receptor handling, placement, processing, and scanning must be meticulous and thorough for the production of quality radiographs. Machine and facility inspection All dental radiographic equipment, regardless of date of purchase or manufacturer, is subject to state and federal x-ray equipment inspections. States have various safety regulations and perform inspections on the basis of the type and use of radiation-generating equipment in the dental office, from intraoral machines to panoramic and other extraoral imaging equipment. Radiation inspectors evaluate the facility to ensure that proper warning signs are posted, correct safety procedures are in place, and all operating controls are placed outside of, or at an acceptable distance from, the patient area. Dental offices
must pass compliance tests that include exposure and timer reproducibility; safety checks for the level of scatter radiation for patients, operators, and other staff members; reading of the dosimetry reports of radiographers; inspection of the machine output; and a check of the construction materials in the general work area. All individuals who work with radiation should be required to review safety procedures on a routine basis, have thorough in-service trainings, and be required to take continuing education programs or courses (Lintag, et. al., 2019). Quality assurance Quality assurance programs have been established for dental radiography procedures. The term quality assurance refers to a plan of action to ensure that a dental office and its workers will produce consistent, high-quality images with minimal exposure risk to patients and dental professionals with training in compliance with state dental practice acts and regulations. (The American Dental Association, 2019). Staff members that have not utilized digital radiography for dental x-rays must receive training which is specific for this treatment modality as the radiographic technique differs from that of conventional radiography. Quality assurance protocols for dental radiography should be developed and implemented for: ● X-ray machines maintenance and compliance with state regulations.
● Image receptors. ● Film processing.
● Darkroom integrity. ● Patient shielding. ● Staff training and safety. (Royal College of Dental Surgeons of Ontario, 2021)
COMMON PATIENT QUESTIONS
How often do I need dental x-rays? The dentist determines the number, type, and frequency of x-rays based on the patient’s individual needs and oral condition. The type and frequency vary for each patient. The dentist will use guidelines established by the ADA to determine what x-rays are necessary. If and when x- rays are indicated, the dentist, the dental hygienist, or the dental assistant will take the appropriate safety measures to limit the patient’s radiation exposure during the x-ray examination. To keep the exposure as low as possible, he or she will provide protective shields, use fast film or digital x-ray sensors to capture the tooth image, and practice precise techniques to avoid retakes. Do dental x-rays cause cancer? For several reasons, the cancer risk from low levels of radiation such as dental x-rays is difficult to estimate. There are few studies demonstrating a risk at the low doses used in diagnostic imaging (Chauhan and Wilkins, 2019). Furthermore, estimates of cancer risk have been extrapolated from data gathered on populations such as Hiroshima and Nagasaki atomic bomb survivors, who have been exposed to high levels of radiation. Although there is an assumption that all levels of radiation increase the risk of cancer, some researchers argue that very low levels do not increase risk (United States Nuclear Regulatory Commission, 2017). The risk of developing cancer from dental x-rays is very low since the amount of radiation used is minimal (University of Florida, 2020). This being the case, the benefit of a properly prescribed and conducted dental x-ray examination is deemed to outweigh the risk. The risk is comparable to other risks of radiation exposure in daily life, such as cosmic radiation received during air travel or human-made radiation received from consumer products. Table 8 presents examples of common dental radiographic examinations and the amount of their respective radiation exposure, expressed in terms of the number of days required to be exposed to an equivalent amount of background radiation. This information provides a tangible comparison that can be used when discussing radiation risk with
Patients often address their questions about dental procedures to dental auxiliary personnel rather than the dentist. This is especially true of questions about radiographic procedures because the dental appointment often begins with a qualified staff member taking the prescribed radiographs. Dental professionals should encourage patients to ask questions about dental radiation exposure and be prepared to provide educated answers. Such conversations offer dental professionals the opportunity to open the lines of communication about the value of diagnostic images and the provision of optimal dental care. Providing examples that compare the risks of radiation exposure encountered in daily life with dental radiation exposures will foster understanding and encourage cooperation when radiographs are necessary. The ADA sponsors a website called MouthHealthy, which provides information for patients on a range of topics, including dental x-ray information. Dental professionals can refer their patients to this website (http://www. mouthhealthy.org/) for more information about dental treatment, including dental radiographic examinations (under A-Z Topics, X-Rays). Several common patient questions, along with appropriate clinician answers, are presented below. Are x-rays really necessary? Dental x-rays are an important diagnostic tool that allows the dentist to see changes in the teeth and bone and other conditions not visible by examining the mouth alone. Common conditions include tooth decay, gum disease, tooth infections, and missing or impacted teeth. The dentist uses this information to better diagnose and treat oral disease. In children, x-rays allow observation of tooth eruption, tooth decay, and jaw development. Early detection of any condition helps prevent further damage and typically reduces the cost of treatment. Before x-rays are taken, the dentist reviews the medical history, examinQ #24es the mouth, and determines whether x-rays are necessary, and if so, the type and number needed for diagnosis and treatment.
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