ADA: New Guidelines for Dental X-Rays & Radiation Safety

For generations, the heavy lead apron has been a ubiquitous part of the dental X-ray experience. But that may be changing, as new guidelines from the American Dental Association (ADA) emphasize a more targeted and judicious approach to dental imaging, potentially minimizing radiation exposure for both patients and dental professionals.

Published in the Journal of the American Dental Association, the updated recommendations confirm that dental X-rays should be ordered only when clinically necessary. This means a one-size-fits-all approach to X-ray frequency is no longer recommended; the need for imaging will be determined on a case-by-case basis, considering individual patient dental health.

“This means that there is no ‘one size fits all’ when it comes to the interval between dental X-rays,” the ADA states on its website.

Shifting Safety Standards and the Lead Apron

The new guidelines build upon previous updates, including recommendations from 2024 that deemed thyroid collars and lead abdominal aprons unnecessary due to advancements in X-ray technology and optimized techniques. These earlier findings, supported by the American Academy of Oral and Maxillofacial Radiology (AAOMR), recognized that modern dental X-ray equipment delivers significantly lower levels of radiation.

“Dental X-rays are safe. In some cases, a dental X-ray delivers less radiation than a single day of the natural radiation we are all exposed to just by living in the world,” explained Dr. Erika Benavides, a clinical professor of periodontics and oral medicine at the University of Michigan School of Dentistry, and lead author of the guidelines. However, she emphasized the importance of adhering to the ALARA (As Low As Reasonably Achievable) principle, minimizing exposure over a patient’s lifetime by ordering X-rays only when clinically indicated.

A More Personalized Approach to Dental Imaging

The ADA’s recommendations stress that dentists should carefully consider a patient’s overall oral health, age, and any signs or symptoms of dental disease before ordering X-rays. This includes evaluating medical and dental histories, reviewing previous X-ray images, and conducting a thorough clinical examination.

The guidelines also advocate for shared decision-making between dentists and patients, encouraging open discussion about the need for X-rays and the benefits versus potential risks. This collaborative approach ensures patients are informed and actively involved in their care.

“Dental imaging is an important diagnostic tool that can help improve oral and overall health outcomes when used appropriately,” Dr. Benavides said. “You wouldn’t get an X-ray of another part of your body unless the doctor believed there was reason to order one after an examination. Similarly, dental X-rays should be ordered only after first examining the patient’s medical and dental histories, prior X-ray images and current clinical exam findings.”

Expanding the Scope of Recommendations

These updated guidelines represent the first time the ADA has addressed both traditional 2-D (planar) radiography and 3-D imaging, known as cone-beam computed tomography (CBCT). The recommendations provide specific guidance for utilizing these different imaging modalities in various clinical scenarios.

The guidelines also offer tailored recommendations for dental imaging in specialized areas such as endodontics (root canal treatment), orthodontics (braces), and oral and maxillofacial surgery, recognizing the unique imaging needs of each field.

Looking Ahead

The development of these recommendations involved an expert panel established by the ADA Council on Scientific Affairs and received endorsement from the AAOMR, highlighting a collaborative effort to advance best practices in dental imaging.

“These updated clinical recommendations honor what we have used and learned and chart a clear path forward for patient care and effective use of radiation in dentistry,” said Dr. Trishul Allareddy, immediate past president of the American Academy of Oral and Maxillofacial Radiology.

The shift towards a more personalized and targeted approach to dental X-rays reflects a growing emphasis on minimizing unnecessary radiation exposure while maintaining the diagnostic benefits of this essential tool for oral health.

Publication details: Erika Benavides et al, American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography, The Journal of the American Dental Association (2026). DOI: 10.1016/j.adaj.2025.10.013