DCA05DR Dental Radiation Health, Safety, and Protection, 3rd Edition _______________________________
• Darkroom integrity. • Patient shielding. • Staff training and safety (Royal College of Dental Surgeons of Ontario, 2019). COMMON PATIENT QUESTIONS 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 ques- tions about dental radiation exposure and be prepared to provide educated answers. Such conversations offer dental professionals the opportunity to open the lines of communi- cation 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 spon- sors a website called MouthHealthy , which provides informa- tion 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 infor- mation about dental treatment, including dental radiographic examinations (under A-Z Topics, X-Rays). Several common patient questions, along with appropriate clinician answers, are presented in the following sections. 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. Com- mon 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, examines the mouth, and determines whether x-rays are necessary, and if so, the type and number needed for diagnosis and treatment. 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 condi- tion. 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 den- tist, 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, they 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 stud- ies demonstrating a risk at the low doses used in diagnostic imaging (Auvinen et al., 2022). 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. There is an assumption that all levels of radiation increase the risk of cancer. However, some researchers argue that very low levels of radiation do not increase the risk of cancer as public health data do not establish an absolute link between the occurrence of cancer secondary to exposure to low levels of radiation (U.S. Nuclear Regulatory Commission, 2020). 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 7 presents examples of com- mon 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 radia- tion risk with patients. For example, a set of four bitewing radiographs taken with rectangular collimation and either digital radiography or F-speed film is equal to approximately 0.6 days of background radiation in the United States. This puts the radiation risk in more concrete terms that the average dental patient can understand. DO DENTAL X-RAYS CAUSE BRAIN TUMORS? A study published in April 2012 reported an association between dental radiographs and an increased risk of meningi- oma, a benign form of brain tumor (Rundell, 2021). However, the results of this study are highly controversial as radiation from dental exams and x-rays has never been scientifically proven to increase the risk of the incidence of cancer (Lee & Choi, 2021; Auvinen et al., 2022; Rundell, 2021). One major weakness was the requirement that subjects recall their dental x-ray history over the course of their lifetimes, including when they were children. Recall data , as collected in this study, are known to be highly unreliable. In addition, bitewing x-rays, which include two to four views, were reported to put patients at a greater risk than full mouth x-rays, which involve up to 20 views, including two to four bitewings. This result appeared to defy logic. Also, because absorbed doses of radiation from dental x-rays have declined over the years, and because the aver- age patient had no idea of their absorbed doses and how they
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