Radiation protection of patients in dental radiology

» Can I promote a good radiation protection practice in dentistry?

Yes.

The most effective way to reduce dose in dental radiography is to avoid unnecessary X-ray examinations by justification. Routine dental X-ray examination for all patients is not justified In addition, the patient dose for each X-ray examination should be optimized so that it is As Low As Reasonably Achievable (ALARA) and consistent with producing the required image quality. It is important that the equipment is subject to formal acceptance testing, routine quality control (see the picture below) undergoes proper maintenance, and has all the standard dose reduction features.

» Should patients and carers wear lead aprons and personal protective devices during a dental radiographic procedure?

With well-designed and optimized equipment and procedures there is no need for routine use of lead aprons for the patient in dental radiology. 
Lead aprons may provide some protection in the case of the vertex occlusal examination, and may be prudent in the case of vertex occlusal examinations in a patient who is, or may be, pregnant. 

The use of a lead apron may reassure patients that every effort is being made to ensure their safety, and may reduce the amount of time that needs to be taken to reassure them. Certainly a lead apron should be provided for any patient who requests one. It may also be advisable to consider using them on a cautionary basis where equipment and/or technique have not been verified by a radiation protection specialist, and where they will not otherwise interfere with the examination. Thyroid collars should be used in the few examinations where the thyroid may be in the main beam.

Lead aprons should be provided for a person who is required to support a patient during the radiographic procedure (i.e., a comforter or carer). Assisting adults should be positioned so that all parts of their body are out of the main beam.

» What are the recommendations and safety measures for children undergoing dental radiography?

Many actions are similar to those recommended in adult procedures. Although radiation exposure arising from dental radiology is low, a child may undergo many repeated procedures during childhood and adolescence. Therefore, the accumulated effect of the radiation exposure should be taken into consideration. The salivary and the thyroid glands are among the organs at risk in dental radiology. The salivaries are often within the primary beam, while the thyroid receives dose mainly due to scattered radiation  Since the thyroid is one of the most radiosensitive organs in children, it may be necessary to consider shielding it from time to time; useful guidance in this regard is available in European Guidelines on Radiation Protection in Dental Radiology published by European Commission.

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