Questions & Answers About Dental X-Rays Safety
The safety of dental xrays is an important topic that comes up frequently from patients at Smile Design Dentistry.
It is a great question and Dr. Corey Jensen and Dr. Brett Moore are always happy to have patients engaged in their health and asking questions. After all, it is your body and your health. You should feel free to ask your dentist any question regarding treatment recommendations (including dental x-rays) so you can make informed decisions along with your dentist when it comes to your health. Hopefully the following Q & A will provide you with a knowledge base to make good decisions the next time that dental x-rays are recommended for you!
Q: Why does my dentist recommend dental x-rays in the first place?
A: At Smile Design Dentistry dental x-rays will be recommended by Dr. Jensen and Dr. Moore as a diagnostic tool to aid in cavity detection, looking for oral pathology and to monitor the periodontal condition related to bone health. One of our dentists will also do a visual examination of your teeth but this only allows a superficial view where the x-rays allow them to see between your teeth and below the gum line where problems are more likely to occur. This is where dental x-rays take over. The picture produced by the x-ray will show the dentist if decay is forming in the teeth and will show if there are any infections to be concerned about that can happen below the gum line, possibly by the roots. X-rays are a critical tool that dentists use in the early detection of dental problems. A general rule of thumb is that the earlier you can catch a dental problem the less the pain and lower the cost will be to correct it.
Q; How often do I need to have dental x-rays taken?
A: Ok. Perhaps now you understand why a dentist needs x-rays but a great follow up question will be, “How often do I need to have dental x-rays taken?”. The answer to this question will depend on the needs of the individual. Dental x-rays, the same as any other dental treatment, is prescribed based on the needs of the individual.
There are several types of dental x-rays with general guidelines for frequency.
- Bitewing x-rays are x-rays of your premolar and molar teeth in the back of your mouth. Typically they are recommended to be taken once a year. If the patient has a history of very few dental problems they may be recommended once every two years. If the patient has a tendency to develop cavities frequently then bitewing x-rays may be recommended every six months.
- A full mouth set of dental x-rays, which are individual films of all your teeth typically are taken every 3-5 years depending on the individual’s needs.
- Sometimes, in lieu of a full mouth set of x-rays Dr. Jensen and Dr. Moore may recommend a panoramic x-ray, which is a full headshot. This is also usually on a 3-5 year schedule and is very beneficial for the patient who is considering orthodontics (braces) or wisdom teeth extractions. There are different indications for each of these two comprehensive xrays.
- One more common type if x-ray recommended is a periapical x-ray which is an x-ray of a single tooth. These are usually recommended if a patient enters with a complaint that a specific tooth is bothering them or as a follow up on treatment to make sure the area affected is doing well.
Hopefully that makes sense for the reasons that x-rays are prescribed and the frequency they are recommended to be taken.
Q: What is my risk in having x-rays taken? Can they be harmful?
A: As per The American Dental Association,, www.ada.org/2760.aspx the radiation you receive is scant. Using a millisievert (mSv) scale to measure doses, you could expect 0.038 from Bitewing X-rays, and 0.150 from a full mouth X-ray. Remember however, this is using conventional F-speed film. At Smile Design Dentistry we use only digital xrays which are a fraction of these older film techniques. Harvard medical have compared dental xrays to a chest x-ray which would be 100x greater or a chest CT which would be 1000 time greater.
Celeste Robb-Nicholson, M.D. published the article titled “A doctor talks about: Radiation risk from medical imaging” on Oct 1, 2010, which provides a handy chart. It shows that for “Imaging procedures and their approximate effective radiation doses: X-ray, panoramic dental 0.01”.
According to the World Nuclear Association, annual exposure to 100 mSv or greater carry a measurable, though small, increase in cancer risk. Below that level, it’s believed that your body’s cells are able to heal themselves from radiation. Dental x-rays are measured in microsieverts. Microsieverts are 1000 times smaller than millisieverts. Of course, a millisievert is 1/1000th of a sievert. The radiation from a dental x-ray is far, far below the threshold the World Nuclear Association uses to determine if there is a small risk of cancer. Another way to put it that may be easier for a layperson to understand is this. As a comparison, you would receive more radiation from a day in the sun than a dental x-ray. That in itself does not mean that you go and needlessly take x-rays. It just means that the danger of x-ray radiation is very, very low.
Q: If there is not much danger why does my dental provider leave the room when taking an x-ray?
A: A dental provider will leave the room when taking an x-ray because there is a six foot scatter zone for the radiation created by the x-ray. While most of the radiation from the x-ray is concentrated on a particular tooth or area of the mouth, a small amount of the radiation can scatter within a 6-foot radius. While the amount of radiation is very, very low it is the cumulative effect, over time that the dental provider wants to avoid since they will be taking x-rays for their patients over an entire career, perhaps 30 years or more. You may also have noticed that if you brought your child to see the dentist that the dental provider asked you to also step out of the room when x-rays are taken. That is also for your safety because, while the radiation is very, very small, your dental provider does not want anyone needlessly exposed to even a very small amount of radiation.
Q: How about a woman who is pregnant? Is it ok for her to have x-rays?
A: Out of an abundance of caution it is recommended that a pregnant woman not have dental x-rays. Mostly because the unborn fetus is very delicate and we do not want any scatter radiation, no matter how limited, to reach it. However, if you are pregnant and have an urgent dental issue, with proper shielding and protection for your baby an X-ray may be taken to help your dentist diagnosis the problem.
Q: What is the dental industry doing as a whole to make sure I don’t needlessly receive radiation from dental x-rays?
A: The dental industry has been very active in this arena. An entire transformation started in the late 1990s with the advent of digital x-rays. Back in the day an x-ray would be taken then processed in a dark room, complete with processing chemicals. The final product in this process was the x-ray image that would normally be stored in a patient’s chart. That all changed in the late 1990’s as dental practices became more computerized. Along with that computerization came digital x-rays. When a digital x-rays is taken it needs 75% less radiation than traditional x-rays to produce the image!
Also, it was determined through various studies that not everyone needs the same amount of exposure to an x-ray to produce an image. Through that research came the acronym “ALARA” or As Low As Reasonably Achievable. This is referring to the exposure time necessary to produce an image of diagnostic quality. Exposure time to the radiation producing x-ray is adjusted so that no more exposure than necessary is done. For instance, a child does not need the same exposure time as an adult to produce a diagnostic quality x-ray. Thus the exposure time for the x-ray unit is adjusted accordingly when taking a film for a child. We are proud at Smile Design Dentistry to have been one of the first dental offices to make this conversion at our family dental practice over 15 years ago. This means our patients have received 75% less radiation from dental x-rays than they would have with the older style film x-rays.
Q: Digital X-Rays sound like a real advancement in x-ray taking. Do they offer other advantages?
A: Yes! Digital x-rays offer many advantages over traditional x-rays beyond greatly reduced radiation exposure.
- Digital dental x-rays offer enhanced image quality. Clarity and detail are essential for a dentist to make a proper diagnosis. It may bring to light potential dental issues that would not have been caught on traditional x-rays.
- Since the image is digital it can be brought up on a computer screen immediately for the dentist to review with you. Again, since the image is digital it can be easily manipulated with color, contrast or light and dark to make the image even better.
- Digital x-rays are better for the environment, there is no need for paper files! No need for x-ray film! No need for x-ray developing solutions!
- Digital x-rays can be easily transferred to insurance companies, other referring dentists or to yourself. This can be done safely and securely electronically. No need for mailing materials.
- Unlike a human the computer never misfiles your x-rays in someone else’s chart. So they don’t get lost. Even in the event that your dentist’s computers crash there are multiple computer backups that happen so your information is never lost and can be easily restored.
- Finally, the ability to blow up an image on a computer screen makes them a wonderful tool for demonstrating and educating our patients about their dental conditions.
Q: So what is the bottom line regarding dental x-rays and radiation? Is it harmful?
A: The benefits of having dental x-rays taken far outweighs the risks. The ability of the dentist to be able to see between your teeth, below the gum line and the roots far outweigh the minimal exposure to radiation you will receive. Don’t be afraid if your dentist recommends x-rays. Your teeth will love you for it!
Q: Can I refuse dental x-rays?
A: Your refusing to have dental x-rays taken puts your dentist in a very precarious situation. The American Dental Association and the Minnesota Board of Dentistry require our doctors to maintain and treat all patients to a minimum standard of care. Routine dental x-rays are part of this standard of care and if a dentist willingly treats a patient without x-rays they are providing substandard care and putting themselves at risk for failure to diagnosis. If a patient refuses x-rays and later develops a dental problem that was missed because of this the dentist has now put themselves in a situation that might not be defendable. If a patient chooses not to have dental x-rays then the dentist has the option not to treat the patient and to dismiss the patient from their practice.
Q: Any closing thoughts from our doctors on “are dental X-rays safe?”
A: Dr. Jensen states: “At Smile Design Dentistry we want to provide the highest level of care available for all of our patients. We consider dental x-rays one of our most basic tools. We take them as we feel they are needed but also limit them as much as possible to avoid unnecessary radiation to our patients. We are proud of the fact that for the last 15+ years all of our x-rays have been taken digitally which allows us to reduce the radiation drastically.”
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Brian Denn is the Clinic Manager at Smile Design Dentistry in Plymouth, Minnesota. Brian has over 25 years of dental practice management involving making practices run smoother and patient experiences better. He also leads a dental practice managers group staying abreast of the latest dental practice management trends.