Can You Say No to Dental X-Rays? An Expert's Perspective

As a patient, you always have the option to continue with the recommended treatment. Even if you sign a form stating that you voluntarily refuse x-rays, no patient can consent to the dentist committing negligence. You simply cannot give up your right to receive appropriate care by signing an X-ray denial. If there is ongoing resistance, the doctor must determine when they will dismiss you from the office.

My dental hygienist recently congratulated me on the health of my teeth and gums. Then he said something that no doubt you too have heard while you were sitting in the dentist's chair: “Do I need bite X-rays every year?” The answer isn't always so simple. The American Dental Association (ADA) states that adults with no apparent dental problems do not need dental x-rays of any kind every year. Adults who take proper care of their teeth and have no symptoms of oral diseases or tooth decay can go two to three years between bite X-rays, according to the ADA.

Adults at high risk of tooth decay (such as those with a history of tooth decay) should receive tooth decay at least every 18 months and possibly more frequently, depending on the condition of their teeth and gums. The interval between x-rays is determined by the rate at which cavities develop. It usually takes about two years or more for cavities to penetrate the enamel of adult teeth. The pace is faster for children, so the recommended bite intervals are shorter for them.

However, children with properly spaced primary (baby) teeth without cavities don't need any dental x-rays. Older children with a low propensity for tooth decay may go 18 months to three years between each X-ray. People at higher risk may need them more often.X-rays help dentists see cavities, gum disease, the position of teeth that are still below the gumline, and other dental conditions that aren't visible to the naked eye. Other types of dental and orthodontic imaging, such as full mouth, full head, panographs, or 3D cone beam computed tomography, reveal more.

However, dentists tend to abuse them.Dr. Friedman, a dentist who advises Consumer Reports on dental issues, has been warning about the overuse of dental imaging since the 1970s. Other x-rays used for orthodontic treatments, wisdom tooth extraction and implants, such as cephalographs (lateral x-ray of the skull and jaws) or 3D computed tomography with a cone beam, are not routinely needed.A study found that while X-ray images increase orthodontists' confidence in their diagnoses and treatment plans, the vast majority of plans are made before they are seen. All x-rays can be harmful, although the radiation dose of bites is relatively low.

Of all the medical radiation patients receive, dental x-rays account for less than 3 percent.But radiation damage is cumulative. Each X-ray increases the risk of damage that can cause cancer. An unnecessary bite or other dental x-ray is unnecessary damage. Scintigraphy provides the same radiation dose as six traditional dental x-rays, and there is only limited evidence of greater diagnostic or treatment value than images with lower radiation.Although dental x-rays emit a relatively low dose of radiation compared to other medical images, a study involving more than 2,700 patients seemed to find an association with a higher risk of intracranial meningioma (the most common type of brain tumor) when exposure to X-ray radiation was greater than in the current era.

Patients with a tumor were twice as likely as patients without one to have had a bite X-ray.One limitation of the study is that its findings were based on patients' recall of dental x-rays, not on more objective medical data which are not available. However, the study is consistent with previous smaller studies that documented a higher risk of tumors associated with dental x-rays.While radiation should always be handled with care, choosing not to have dental x-rays can increase the risk of serious health problems such as gum disease, bone deterioration, tumors and jaw fractures which could otherwise go unnoticed until they are severe and untreatable.We have had so many advances in imaging technology that truthfully dental x-rays are quite safe. Radiation is one of the major risk factors that healthy adults claim when they choose not to have dental x-rays but in terms of overall health benefits, the risk of bodily harm from x-rays is extremely low.Some patients cite radiation as their cause for avoidance while others simply don't see dental x-rays as necessary for their oral and general health. Dental x-rays are used in children and adolescents to check the location of incoming permanent teeth, detect impacted or damaged teeth or help plan the placement of orthodontic appliances or extraction if necessary.However, dental x-rays are not only important for planning a healthy mouth in an adult but they are also essential for maintaining oral health and detecting serious problems before they become uncontrollable.

As with other x-rays, radiation used in dental x-rays always presents a slight risk of damaging tissue so they should be used sparingly.

Madison Bew
Madison Bew

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