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ADA updates dental radiograph recommendations

The ADA, in collaboration with the Food and Drug Administration, has released updated recommendations for the prescription of dental radiographic examinations.

"Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure," which was last updated in 2004, should serve in conjunction with dentists' professional judgment on when it's appropriate to use diagnostic imaging. Radiographs can help dentists evaluate and diagnose many oral diseases, but the ADA also recommends that dentists weigh the benefits of taking dental radiographs against the risk of exposing a patient to X-rays, the effects of which can accumulate from multiple sources over time.

The dentist is in the best position to make this call since he or she knows the patient's health history and their vulnerability to oral disease.

 "We are encouraging dentists to look at the issue of selecting radiographic examinations for their patients on an individual basis, not as a one-size-fits-all," said Dr. Sharon Brooks, professor emeritus at the University of Michigan, who worked as a consultant with the ADA Council on Scientific Affairs to develop the new set of recommendations. "The guidelines are to help them make the decisions on the appropriate use."

It's important to have a concrete set of recommendations dentists can point to if patients have questions or concerns about the level of radiation they may be exposed to, Dr. Brooks said. The recommendations are intended to serve as a resource for the practitioner and are not intended to be standards of care, requirements or regulations.

The CSA and its consultants began working on updating the document about a year ago. It was then sent out for peer review to the American Academy of Oral and Maxillofacial Radiology; American Association of Endodontists; American Association of Orthodontists; American Academy of Periodontology; American Academy of Oral and Maxillofacial Pathology; American Academy of Pediatric Dentistry; American Association of Oral and Maxillofacial Surgeons; American College of Prosthodontists; American Association of Public Health Dentistry; and Academy of General Dentistry.

The nondental groups that were asked to review the recommendations included the FDA; National Council on Radiation Protection & Measurements; Conference of Radiation Control Program Directors; and American Association of Physicists in Medicine. Within the ADA, the recommendations were also sent for review to the councils on Dental Practice; Access, Prevention and Interprofessional Relations; Dental Education and Licensure; and Dental Benefit Programs.

Highlights from the updated document include:

• Removing a stronger recommendation for thyroid collar use for children, women of childbearing age and pregnant women. The strength of the recommendation is now the same for all patients.

• A new section that was not in the 2004 document, which expands upon the 2006 CSA report, "The Use of Dental Radiographs: Update and Recommendations."

• New topics that were not covered in the 2006 CSA report such as receptor selection, handheld X-ray units, technique charts and radiation risk communication.

• Changing the recommendation for shielding to be consistent with the National Council on Radiation Protection & Measurements.

To view the report in its entirety, visit www.ada.org/5160.aspx?currentTab=2.