Dental X-rays: New Guidelines Reduce Radiation & Apron Use

For many who regularly visit the dentist, the heavy lead apron is a familiar sight, draped across the body before dental X-rays are taken. However, that annual routine may be changing, according to newly released recommendations from the American Dental Association (ADA).

Published in the Journal of the American Dental Association, the updated guidelines emphasize that dental X-rays should be ordered only when there is a clear clinical need, aiming to minimize radiation exposure for both patients and dental professionals. This means the frequency of X-rays will be tailored to an individual’s oral health status, rather than a standardized annual schedule.

The ADA’s website clarifies that there is no “one size fits all” approach to determining how often dental X-rays should be taken. The recommendations represent a significant update to previous guidelines, last revised in 2012, and are the first to address both traditional two-dimensional (planar) X-rays and three-dimensional cone-beam computed tomography (CBCT) imaging.

the use of lead aprons themselves is being re-evaluated. The updated guidelines, and previous recommendations, suggest they may no longer be necessary in many cases due to the low levels of radiation used in modern dental imaging and advancements in technology.

“Dental radiography is safe,” explains Dr. Erika Benavides, D.D.S., Ph.D., clinical professor of periodontics and oral medicine at the University of Michigan School of Dentistry, and lead author of the guidelines. “In some situations, the radiation dose received is even lower than the natural exposure we are subjected to in a single day simply by living on the planet.”

Despite the safety of dental X-rays, Dr. Benavides stresses the importance of adhering to the ALARA (As Low As Reasonably Achievable) principle – a widely accepted standard in both dentistry, and medicine. This principle advocates for minimizing cumulative radiation exposure over a patient’s lifetime and ordering X-rays only when clinically justified.

The guidelines outline that dentists should consider a patient’s current oral health, age, and the presence of any signs or symptoms of dental issues, such as cavities or other diseases, before deciding to order an X-ray. A discussion with the patient about the need for the study is also encouraged, promoting a shared decision-making process.

Dental images remain a valuable diagnostic tool, Dr. Benavides emphasizes, contributing to improved oral and overall health when used appropriately. She draws a parallel to other areas of medicine, noting that X-rays of any body part are only performed when there is a valid clinical reason following a medical evaluation. Similarly, in dentistry, X-rays should be ordered after a thorough review of the patient’s medical and dental history, previous imaging, and the findings of a current clinical examination.

The recommendations also provide specific guidance on how to utilize X-rays in various clinical scenarios, including cases involving fractured teeth, root canals, implant planning, and jaw-related disorders.

Dr. Trishul Allareddy, immediate past president of the American Academy of Oral and Maxillofacial Radiology, notes that these updated recommendations reflect years of accumulated experience and offer clear guidance for providing safe and appropriate dental care while minimizing radiation exposure. The guidelines are endorsed by the American Academy of Oral and Maxillofacial Radiology.

These changes reflect a growing emphasis on personalized dental care and a commitment to minimizing unnecessary radiation exposure, ensuring that dental imaging is used as a targeted and effective diagnostic tool.