There has been some “chatter” regarding the recent Reader’s Digest Article on overuse of x-rays in all aspects of the medical profession. I felt that it would be beneficial to clarify what the x-rays show, the value they bring, the rationale behind the decision and the legal implication of not taking the x-ray.
As you know this magazine is popular especially in the senior community. Dental x-rays have extremely low radiation levels associated with them. In comparison a complete set of dental x-ray is about 5 micro-severts and a flight from New York to Los Angeles is 40. This is also the same amount of radiation that you would get from the environment spending 1 day outside. Please refer to the chart below. The digital x-rays we use are the third and fourth from the bottom.
Dental X-rays give us the ability to see things that we would completely miss on inspection or examination of the mouth. The reason is that they show the differential changes in the density of the hard tissue. Bone levels around the teeth and soft, decalcified areas of teeth (cavities) show up on x-rays where they can appear invisible on visual inspection. The panoramic xray that goes around the head give us the ability to see pathology in the jaws, sinus position, the nerve position in the lower jaw, impacted teeth and many other variations of normal. These are critical when considering missing the diagnosis of a lesion or other pathological problem.
The frequency that we order x-rays is determined by the patient we are treating. Many times seniors who are on many medications who have very dry mouths will have x-rays taken much more frequently than a healthy adult. Patients who have dry mouths are at risk of developing cavities at a significantly higher rate. If we wait too long the cavity can enter into the nerve of the tooth leading to an infected tooth requiring more extensive root canals or even extraction. Those who have periodontal disease loose bone and sometimes it is necessary to take x-rays on a more frequent basis to keep record of the health of the boney tissue. I could go on and on, but dental x-rays are hugely important to the overall accurate diagnosis and treatment of our dental patients.
Let’s consider a scenario: There is a patient who is in our dental chair for a cleaning and it is her first time at our office. Upon inspection of her teeth and mouth it appears that she is healthy. She is concerned about the risk of developing cancer from dental x-rays. She read the article in the Readers Digest and she was adamant that she just wanted her teeth cleaned. Let’s say that we cleaned her teeth and did what she asked us to do. Now about 1 year later she appears back in our office with a swelling in her jaw and says that she is having pain and now allows us to take the panoramic x-ray because now she knows there is a problem. Upon inspection of the x-ray we see an area of pathology. She is referred to an oral surgeon and it is biopsied and discovered that it is cancerous. When she takes this to her attorney she decides to sue you. In court you are asked by the plaintiff’s attorney why did you not take the panoramic x-ray of this patient at the initial visit? You answer that she didn’t want one and then the attorney asks what the standard of care is. You then respond that it is to have a full set of x-rays but she denied this. You are guilty!!!! It doesn’t matter what the patient wants, the critical point is that if it is the standard of care we in the profession are obligated to do so or the patient and the professional are at risk.
My point is that the level of radiation is so low (according to the table) that the benefits far outweigh the risks of exposure. Please trust your dentist that they have your best interest in mind. If you have not been to the dentist make an appointment to reduce your risk of disease. Take control of your health and live your life as full as possible. Even if you believe the health of your teeth are beyond repair, your dentist will help work with you to achieve your best. It is a well-known fact that the condition of the mouth is a reflection of the body’s overall health.
Reader’s Digest Article on x-ray and the rational for taking x-rays
If you have questions or comments please let me know so that I can constantly improve the information that I pass along to the readership. The office’s address is 15055 22 mile, Shelby Township, MI 48315
Our phone number is (586)247-3500 or email at DrAntolak @ TheGentleDentist.com.