Dental X-Rays: Are They Necessary And How Safe Are They?

When it comes to maintaining your dental health, regular check-ups are crucial. But have you ever wondered why your dentist strongly recommends taking x-rays during these visits? In this blog, we dive deeper into the importance of dental x-rays, why these seemingly routine images hold such a critical spot in modern dental care and what you need to know before your next visit to the dentist.

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Can a Dental Checkup Be Thorough Without X-Rays?

Dentists use x-rays to help diagnose disease and conditions in the oral cavity. But, they can only 'see' so much during your clinical exam without x-rays.

While a visual examination is a crucial part of any dental check-up, there are numerous conditions that simply can't be detected without the aid of x-rays. For instance, the dentist can only inspect three of the five tooth surfaces - the chewing (occlusal), the inner (lingual) and the outer (buccal) surface of the visible portion of the tooth. The dentist cannot, however, inspect the interproximal tooth surfaces (where the teeth touch), or the part of the tooth that is below the gumline. And cavities, infections, and other issues can develop beneath the surface of your teeth or within your gums - all areas that are not visible to the naked eye. X-rays provide a clear, detailed image of these hidden spots, allowing your dentist to spot potential problems early and treat them before they escalate. At Acton Smile Hub, our commitment to early detection of dental issues with x-rays allows us to spot problems like cavities, infections, and bone conditions before they become major concerns.

Moreover, dental x-rays reveal the condition of your jawbone, the positioning of your teeth, and can help in diagnosing diseases affecting the bones and tissues. Without them, your dental provider may miss significant issues such as gum disease, tumors or cysts that could adversely impact your oral health over time.

Finally, the condition of the existing restorations or treatments cannot be evaluated without x-rays, and it is a common occurrence for a pathology to be 'an accidental finding' on an x-ray image review since so many dental diseases and conditions are 'silent'.

Therefore, while a dental exam can proceed without x-rays, it would lack the comprehensive insight that these images provide, potentially resulting in undiagnosed and untreated dental issues.

Do All Patients Get the Same Set of X-Rays During Their Dental Appointments?

Not all dental visits result in the same set of x-rays for every patient. Instead, the necessity and type of X-rays are tailored to individual needs. Various factors, such as age, dentition (primary, adult, mixed, partial or complete edentulism), previous history, oral health status, and specific symptoms or concerns, guide the dentist's decision on which x-rays to prescribe. Some of the guidelines are listed below:

New Adult Patient with Permanent Dentition: If you're a new adult patient with a full set of permanent teeth, a full mouth intraoral radiographic exam (FMX) — which consists of 18 x-rays — is typically recommended if there's clinical evidence of cavities, oral disease, or a history of extensive dental treatments. Generally, an FMX is taken every 3-5 years. The approach is individualized, and for some, a combination of posterior bitewing and panoramic X-rays may be more suitable.
Recall Patients with Clinical Caries or Increased Risk for Caries: For patients who are already experiencing cavities or have a higher risk of developing them, a posterior bitewing exam along with selected periapical images is recommended every 6-12 months.
Recall Patients with No Clinical Caries and Not at Increased Risk for Caries: If you're a recall patient without any current cavities and not at increased risk of caries, a posterior bitewing exam is usually done every 18-36 months.

The chart below shows recommended frequency of bitewing x-rays for different patient groups. Bitewing x-rays capture images of the upper and lower back teeth in a single view which helps your dentist see how your teeth touch each other, check for cavities between teeth, and assess the height of the bone supporting the teeth.

Children, for instance, may require more frequent x-rays to monitor the growth and development of their teeth and jaws. Conversely, adults with good oral health and low risk of dental disease might not need X-rays as often.

The key takeaway is that dental x-rays are not a one-size-fits-all service. They are an essential diagnostic tool that dentists use judiciously, tailoring the type and frequency to each patient's unique needs, ultimately ensuring the best possible care. If you have any concerns or questions about the x-rays being recommended for you, discussing them with your dentist is always a good idea to understand the rationale and benefits.

Are There Official Guidelines for Prescribing Dental Radiographs?

When it comes to prescribing dental radiographs, dentists follow stringent guidelines to ensure patient safety while maximizing diagnostic benefits. Organizations like the American Dental Association (ADA) and the Food and Drug Administration (FDA) have jointly issued recommendations that guide dental practitioners. These guidelines are designed to help dentists make informed decisions on when and what type of radiographs are necessary.

The ADA recently released new guidance on the safety and regulatory aspects of radiography, which updates portions of the 2012 FDA/ADA recommendations for dental radiographic examination. These recommendations follow the ALARA principle, established in the ‘70s by the International Commission on Radiologic Protection. The ALARA acronym stands for 'As Low As Reasonably Achievable' and aims to minimize the radiation dose to the patient and the surroundings to a level as low as reasonably achievable and diagnostically acceptable. Based on these guidelines, your dentist will weigh the benefits of taking the radiographs against the risks of exposure to xrays, which is cumulative over time.

For instance, the recommendations emphasize that radiographs should not be a routine part of every dental visit but should be prescribed based on individual patient needs. Factors like the patient's dental history, age, risk factors for dental diseases, and current oral health are taken into account. This personalized approach ensures that the benefits of taking the radiographs outweigh the risks of radiation exposure.

The guidelines also specify particular scenarios warranting radiographic examinations. For example, new patients who have extensive dental treatments or symptoms of pain might need more comprehensive radiographs like panoramic or CBCT scans. Conversely, a patient with a consistent record of good oral health might require fewer x-rays.

It's important to note that these guidelines are periodically updated to incorporate the latest research and technology advancements in dental radiography. Dentists continuously keep up to date with these developments to provide the best care for their patients while adhering to safety standards.

Understanding the Health Implications of Radiation

Radiation is a form of energy, and while X-rays are incredibly useful for diagnosing and treating dental issues, the exposure to radiation must be carefully managed. It's natural to have concerns about how this exposure might affect your health.

Radiation exists all around us and comes from natural or artificial (man-made) sources. Radiation can be ionizing or non-ionizing. X-rays, including dental x-rays produce ionizing radiation.

X-rays work by passing low doses of radiation through the body to capture images of internal structures. In the dental world, these images help in identifying problems that aren’t always visible during a regular examination, such as cavities between teeth, bone loss, and infections. However, overexposure to radiation can have detrimental effects on your health. Ionizing radiation can cause alterations in the cell’s genetic material. The radiation energy can directly break the bonds of the cell’s DNA molecules. It can also damage the cell by creating unstable ions by means of breaking the water molecules in the cell.

Cells damaged by radiation can:

Repair back to health and normal function
Not repair or repair faulty and lead to alterations, such as mutations that can cause cancer
Die due to excessive damage, which can lead to organ death.

How radiation is delivered will impact the health outcomes. Radiation dose delivered over time is less harmful than the same dose delivered at once. Radiation dose delivered to a small area of the body is less impactful than a dose to the entire body. This is why dental professionals adhere to the ALARA principle mentioned previously. It means they take special care to minimize radiation exposure while still achieving the necessary diagnostic benefits.

The effects of Ionizing radiation are cumulative over time. This does not mean the radiation is stored in the body, it means that the biologic effects of radiation can accumulate and add up over a life span. While small doses, such as dental x-rays carry a very low risk, higher doses of radiation can be serious to your health.

Modern advancements in dental radiography, like digital x-rays, have significantly reduced the amount of radiation used. As a result, the health risks associated with dental x-rays have become even lower, making them a safe part of your dental care routine when used appropriately. Still, every precaution is taken to ensure that the benefits of having dental x-rays far outweigh any potential risks.

How Much Radiation Do Dental X-Rays Produce?

Radiation exposure from dental x-rays is considered minor in comparison to the total exposure from all other common sources including natural and manmade.

The National Council on Radiation Protection and Measurements (NCRP) estimates that the average annual radiation dose per person living in the U.S. is about 6.2 millisieverts mSV.

About one half (3.1 mSv) of our average yearly exposure comes from background radiation, and another 3.1 mSV is from man-made sources. More than half of the man-made exposure is due to computed tomography imaging. Overall, dental imaging accounts for less than 1 percent of the estimated collective annual effective dose received from medical imaging.

Source: Dental X-Ray Radiation Comparison, Today's RDH, August 2022,(https://www.todaysrdh.com/todays-rdh-x-ray-comparison-chart/)

It's important to note that the level of radiation from dental x-rays is considered safe, particularly with modern advancements in imaging technology and digital x-rays. While the radiation dose from dental x-rays is minimal, it’s still wise to minimize unnecessary exposure. This is why dentists are meticulous about prescribing x-rays only when necessary, based on individual risk factors and health status. For most patients, the benefits of early detection of dental issues far outweigh the minuscule risk associated with the radiation exposure from dental x-rays.

Digital vs. Traditional Film X-Rays: Which X-Rays Emit Less Radiation?

Digital x-rays have revolutionized dental imaging by significantly reducing the amount of radiation needed to produce clear images. In fact, digital x-rays expose patients to up to 80% less radiation compared to their traditional film counterparts. The dose from dental x-rays is minimal compared to other sources, and with our modern technology such as our digital dental x-rays in Acton, MA that exposure is even further reduced.

One of the main reasons digital x-rays emit less radiation is their design. Digital sensors are more sensitive to x-rays than film, which means they require less exposure time to capture an image. Additionally, digital x-rays can be enhanced and processed immediately on a computer, allowing dentists to get clearer images without the need for multiple exposures.

Moreover, digital radiography provides several other benefits beyond reduced radiation. These include immediate processing, the ability to enhance images for better diagnosis, digital storage and sharing capabilities, and environmental advantages due to the lack of chemical processing required by film x-rays. These benefits make digital x-rays not only safer but also more efficient and environmentally friendly.

In summary, the advantages of digital x-rays over traditional film x-rays are:

Reduction in radiation exposure: digital xrays produce 70-80% lower radiation doses than traditional film xrays
Better diagnostics: digital x-rays have higher resolution and produce a clearer image that can be enlarged, zoomed in and adjusted for brightness and contrast
Ease of manipulation: digital files are easier to archive and transfer when needed
Less time consuming: a digital x-ray is almost instantaneous while it takes some time to develop a traditional film xray
Environmentally friendly: digital xrays eliminate the environmental burden of chemicals used to develop film x-rays.

When Do I Need a Dental CBCT?

Dental Cone Beam Computed Tomography (CBCT) is a cutting-edge imaging technology that has transformed the way dental professionals diagnose and treat a variety of conditions. Unlike standard 2D x-rays, CBCT provides a 3D view of the teeth, bones, soft tissues, and nerve pathways. While 2D imaging is sufficient for routine dental care, it has its disadvantages such inadequate capture of fine anatomical details, overlapping structures, distortion and reduced sharpness.

The comprehensive view provided by CBCT is invaluable for accurately planning complex dental procedures, such as implant placements, assessment of the position of unerupted or impacted teeth, and evaluation of jaw pathology. The CT scanner rotates around the patient’s head producing up to 600 images in less than a minute. The software then reconstructs a three-dimensional image with great detail for some of the intricate dental procedures in the fields of oral and maxillofacial surgery, orthodontics and endodontics. This precision allows for more accurate diagnoses and better treatment outcomes.

Indications for a dental CBCT include but are not limited to:

In summary, CBCT is an indispensable tool in modern dentistry, offering unparalleled detail and accuracy when dealing with complex surgical procedures, diagnosing hard-to-see conditions, or planning intricate restorations. There is no current guidelines on how often patients should be exposed to CBCT, and depending on the field of view (FOV), the radiation exposure can range between 0.05-0.1 mSV. In general, a CBCT is not prescribed routinely and dentists should practice their clinical judgment when recommending one.

Is it True That the Lead Apron Used During Dental X-rays Is No Longer Necessary?

For years, the lead apron has been a staple in dental offices, assuring patients of its protective qualities during x-rays. However, recent findings have sparked discussions over whether this seemingly essential piece of equipment is still necessary.

The American Dental Association (ADA) has weighed in on this debate. Its new guidance published in February 2024 in the Journal of the American Dental Association (JADA), no longer recommends thyroid collars and other shields such as lead aprons for any dental imaging procedure. The rationale behind this recommendation is that the shield can block the primary x-ray beam which may result in more x-rays needed to be taken. In addition, according to the experts, protection of radiation scatter from the targeted area is not accomplished by these shields.

Despite this recent recommendation, states have individual radiation safety protocols and until these are amended, you will not see big changes in your dental office.

Knowing When It's Ok to Skip Dental X-Rays

Despite the fact dental xrays are considered safe, there will be clinical situations when routine x-rays may not be necessary or advisable. Some examples include:

Pregnancy, especially in the first trimester
Young children, specifically before the eruption of the first permanent molars
Recent dental x-rays, usually when taken within the last year
Low risk of dental disease, typically patients with no previous cavities or dental restorations
When alternate diagnostic methods may be sufficient.

You should communicate openly with your dental provider about any potential concerns you may have. Your dentist can provide tailored advice based on your unique situation, dental history, current oral health and risk factors.

Final Thoughts on The Importance of Dental X-Rays in Modern Dentistry

To summarize, dental x-rays are safe and effective tool in dental diagnosis. They are an essential tool in modern dentistry, providing critical information that can't always be detected through a visual exam alone.

While it's natural to have concerns about radiation, the benefits of early detection and accurate diagnosis often outweigh the minimal exposure. Individual needs and official guidelines help determine the necessity and frequency of these radiographs, ensuring that you receive personalized care.

Digital advancements have also made the process safer and more efficient than ever before. This leap in technology ensures that the benefits of x-rays are maximized while minimizing any associated risks.

Understanding when and why x-rays are needed empowers you to take an active role in your dental health, ultimately leading to better outcomes and a brighter smile.

The dental staff at Acton Smile Hub has been trained to provide safe practices when exposing xrays and to use best clinical judgement when recommending them. While every precaution is taken to minimize risk, our use of modern technology ensures that we provide the safest dental x-rays for our patients in Acton, MA. Regardless, you should always bring up any concerns you may have around this topic. It's important for dentists and patients to have open discussions about dental treatment options and the necessity of x-rays, and make informed decisions together.

Curious about dental x-rays?

We understand that you may have questions about their necessity or radiation exposure. Our goal is to provide you with the most accurate and up-to-date information, and to assure you that our advanced digital technology makes them safer than ever before.

If you're a resident of Acton, MA, or a nearby community like Concord or Maynard, we are here to provide expert answers to your questions and a safe dental x-ray experience at our Acton dental office.

For more questions or to book your visit, give us a call or schedule a dental appointment online with Dr. Tufa. We are here to help you get the comprehensive care you deserve!

Heni Tufa Post Author

Dr. Tufa is a general dentist in Acton, MA who is also an Invisalign Provider and certified Botox dentist.

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