Are Xrays (radiographs) really needed?

[Zzzdentist]

That's a question that pops up every now and then.

"Do I really need to have these xrays taken?"

The answer usually is yes! Xrays (radiographs) are essential to help diagnose dental problems such as abscesses, root anatomy, and cavities. They aren't just taken for the fun of it, or just because it's a part of a routine.

The main fear people have with xrays is their safety. With dental xrays, the dose of radiation used is quite low and brief. With high speed films and digital radiography, the dose is even lower than in the past.

People may not realize it, but they are exposed to radiation every day. Just walking around outside exposed to the sun or flying in an airplane subjects you to solar radiation. DECT 6.0 cordless phones emit a certain level of radiation inside homes as do GMRS two-way radios do outside.

With all this ambient radiation, we each want to reduce our exposure of course. The human body is quite resilient and is able to deal with low doses of radiation. In fact, radiation is used in healthcare to kill cancerous tissue while leaving healthy tissue intact.

In the case of dental xrays, they allow the dentist to see areas of the teeth and jaws that simply cannot be examined by visual examination alone. The hidden, curved root might pose an issue during an extraction or root canal, and not realizing it through an xray can compromise the outcome of the treatment. That small cavity hidden underneath an old filling or at the contact between teeth can progress to a huge cavity. Xrays are also critical for medicolegal documentation.

By using a lead apron with a thyroid shield, what minimal scatter radiation there is effectively is blocked from entering the rest of the body.

With pregnant patients, the dental team often may forgo taking xrays or give the patient an option of declining them. In reality, the lead apron shields the developing fetus so there should be no concerns. If a pregnant woman requires emergency dental treatment, an xray should be the least of her concerns. I don't think a pregnant woman would decline a medical xray if it was critical to diagnosing a medical health issue.

Info from American Pregnancy.org

Dental offices should be assessing each patient as to whether they require xrays and what xrays they need. For a long term patient who has excellent oral hygiene and is a regular visitor who experiences low to no cavities, their xray frequency can be set to a longer interval than some one say who experiences cavities more often.

[whistlinghill]

funny thing is, some patients will say "no i don't need it", and the moment the dentist asks for them they change the "NO" to a "YES".

Another thing is, how would you explain to patients the need for a complete probing / intraoral soft tissue assessment? The College of Dental Hygienists of Ontario states that we must do an update at least once every year. I don't think once a year is very much to ask from a patient. Probing is just as important as getting radiographs taken on an annual basis (or longer). Many patients will listen to your calling of numbers 1,2,3,4,5, etc........ but numbers are quickly forgotten....... i know visuals always prompt head noddings, but are they hearing us? Je ne sais pas.

[Zzzdentist]

funny thing is, some patients will say "no i don't need it", and the moment the dentist asks for them they change the "NO" to a "YES".

That's weird hey? I guess they don't want to go against what the dentist requests.

Another thing is, how would you explain to patients the need for a complete probing / intraoral soft tissue assessment? The College of Dental Hygienists of Ontario states that we must do an update at least once every year. I don't think once a year is very much to ask from a patient. Probing is just as important as getting radiographs taken on an annual basis (or longer). Many patients will listen to your calling of numbers 1,2,3,4,5, etc........ but numbers are quickly forgotten....... i know visuals always prompt head noddings, but are they hearing us? Je ne sais pas.

I somehow missed your posting here! With every new patient exam, I do a full periodontal probing and assessment as part of the complete exam. For recalls I will then do posterior probings as long as their periodontal health in the anterior area is normal and they don't have active, moderate periodontal disease. The next recall will be just the posteriors again, and on the next recall I do a full probing.

With patients that have more severe periodontal issues, they get sent and monitored at the periodontist who usually sends us a perio probing report with their findings. Ones with generalized moderate pockets, I will do full probings about once a year with just posterior probings at 6 months. It really depends on how their first probings are, and whether I feel it's best to monitor their pockets on a more frequent basis.

After the exam, I usually will go over the perio chart with the patient and review how the areas are doing over time, and show them what the numbers mean and where the problem areas are. Most people are quite receptive to this actually and find it interesting that they've never had it done before. They can see the problem areas, and I can then motivate them to floss more since they can see the problem areas start in between the teeth.

I honestly can't understand why some dentists don't take regular periodontal readings. How else can you monitor a person's periodontal health? Xrays will show a bit, but it's too easy to miss a developing problem without probings.

[whistlinghill]

Normally if someone comes in with healthy readings, i am still okay with doing it once yearly. With periodontal cases i will do spot probing everytime they come in for hygiene appointment. I will also evaluate on areas of bleeding because bleeding as we know it is not good sign.

I have actually worked with a handful of doctors who only do periodontal chartings during initial exams and never after. Hygienist can easily put their license at stake if they don't do periodontal updates a least once a year, Isn't there protocol in the Royal college of dental surgeons for the same thing?

[Zzzdentist]

I have actually worked with a handful of doctors who only do periodontal chartings during initial exams and never after. Hygienist can easily put their license at stake if they don't do periodontal updates a least once a year, Isn't there protocol in the Royal college of dental surgeons for the same thing?

Eeee.... I cringe when I hear about dentists doing that. I used to work with a dentist who rarely ever did perio probings. You would see chartings from like 5-7 years ago and nothing since...

I didn't realize that it was a protocol in Ontario for hygienists to update probings. That's quite interesting as I don't think there's anything like that in place for Alberta. I actually don't think Alberta dentists are a part of the Royal College of Dental Surgeons of Ontario so really I can't say whether there is or not. They don't have jurisdiction over here.

No one likes doing perio probings, but of course they are essential. It's like not taking xrays. You just miss out too much information that's critical to a patient's health and treatment plan. Personally, I think it borders on neglect not to do them regularly, but really patients don't have a clue what's going on half the time. One of the things I hope with this website is to raise people's dental education so they understand what's going on and what's being missed.

I just figure "What would I like to have done and checked if I were the patient in the chair?" Would I like the dentist to check the status of my gums and know if there are any problem spots? Ignorance certainly can be bliss, but I think patients deserve more than just a cursorary cavity check. Perio probings will never be a "money centre," but the information and motivation that they can provide is invaluable I think in practice.

[atlantadentalcenter]

but really patients don't have a clue what's going on half the time. One of the things I hope with this website is to raise people's dental education so they understand what's going on and what's being missed.

I think that's half the problem and you're right for putting up a site to educate people on this. If you went up and asked 10 random people I'm betting they all wouldn't know half of what's recommended to be checked on their teeth once each year or sooner. I'm sure they would say cavities but I don't think most of them would even think about gums or any of the other things. But not because it's not important to them, they just don't know.