Radiation protection of patients in dental radiology

Frequently asked questions by the health professionals

» Can I promote a good radiation protection practice in dentistry? 
» Should patients and carers wear lead aprons and personal protective devices during a dental radiographic procedure? 
» What are the recommendations and safety measures for children.

» 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 rare case of the vertex occlusal examination, especially in a patient who is, or may be, pregnant. On the other hand, 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 all examinations where the thyroid may be exposed to the main beam or to a considerable amount of scatter radiation.

Lead aprons must 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.

Read more:

• UNITED NATIONS scientific committee on the effects of atomic radiation, Sources and effects of ionizing radiation, UNSCEAR Report Volume 1, New York, USA (2000). 
• INTERNATIONAL ATOMIC ENERGY AGENCY, Radiological protection for medical exposure to ionizing radiation, Safety Guide, RS-G-1.5, IAEA, Vienna (2002). 
• European Commission, European Guidelines on Radiation Protection in Dental Radiology, RP 136, Luxembourg (2004). 
• Haute Autorité de Santé. Guide des indications et des procedures des examens radiologiques en odontostomatologie (2006). (accessed 29 August 2009) 
• SEDENTEXCT. Radiation Protection; Cone Beam CT for Dental and Maxillofacial Radiology. Provisional Guidelines (v1.1 May 2009). (accessed 18/8/09)) 
• Espelid, I., Mejàre, I., Weerheijm, K., EAPD., European Association of Paediatric Dentistry guidelines for the use of radiographs in children. European Journal of Paediatric Dentistry 4 (2003) 40-48. 
• Harris, D., Buser, D., Dula, K., Gröndahl, K., Jacobs, R., Lekholm, U., Nakielny, R., van, Steenberghe, D., van, der, Stelt, P., E.A.O. Guidelines for the use of diagnostic imaging in implant dentistry. Clinical Oral Implants Research 13 (2002) 566-570. 
• Isaacson, K.G., Thom, A.R., Horner, K., Whaites, E., Orthodontic Radiographs. Guidelines for the use of radiographs in orthodontics. British Orthodontic Society: London, (2008). 
• Pendlebury, M.E., Horner, K., Eaton, K.A., (eds). Selection Criteria for Dental Radiography. Faculty of General Dental Practitioners (UK) Royal College of Surgeons of England, London, (2004). 
• Lecomber, A.R., Faulkner, k., Dose reduction in panoramic radiography. Dentomaxillofac Radiol. 22 (1993)69-73. 
• American Academy on Pediatric Dentistry ad hoc Committee on Pedodontic Radiology: American Academy on Pediatric Dentistry Council on Clinical Affairs. Guideline on prescribing dental radiographs for infants, children, adolescents, and persons with special health care needs. Pediatric Dentistry 30 (7 Suppl): 236-7 2008. 
• LOOE, H.K. et al., Radiation exposure to children in intraoral dental radiology, Rad. Prot. Dosim. 121 (2006) 461-465. 
• WAGNER et al. Exposure of the pregnant patient to diagnostic radiations: A Guide to Medical Management, 2nd Edition, Publisher: Medical Physics Publishing, Madison, (WI 1997). 
• NATIONAL RADIOLOGICAL PROTECTION BOARD, Radiation exposure of the UK population, Review NRPB R263, Chilton, UK (1993). 
• NATIONAL COMMISSION FOR RADIATION PROTECTION, Implementation of the principle as low as reasonable achievable (ALARA) for medical and dental personnel, NCRP Report 107, NCRP (1990). 
• AUSTRALIAN RADIATION PROTECTION AND NUCLEAR SAFETY AGENCY, Radiation Protection in Dentistry, Code of Practice and Safety Guide, RPS 10, Canberra, Australia (2005).