There's a reason why dentists and dental technicians leave the surgery and sit behind lead shields when exposing patients to Roentgens - they'll mess with our stardust bodies.
'We are stardust - we are golden
We are billion year old carbon
And we got to get ourselves back to the garden…'
Thanks Joni M.
52
I'm sorry I didn't see this article sooner. I'd like to relate a few items on a less technical, more anecdotal basis. I had an uncle who was a dentist (graduated N.Y.U. Dental in the late 1930's). I, as his nephew, was treated for free for 40 years. I never knew the cost of dentistry! Sometimes he had me "work off" some of my dental "debt": mowing his lawn; helping to move his daughter (my cousin) from one apartment to another; pick up work at the dental lab en route to his office, and the like. More fun than work for my favorite uncle. His work was considered excellent by other dentists I saw subsequent to his retirement. And crowns that lasted over twenty years! As to radiographs, he told me that after having practiced dentistry over a life-time, he came to the conclusion that there was no safe level of radiation, notwithstanding more recent lower dosages and "faster" film. He had a good sense of humor. I once mentioned later in life that my teeth were beginning to wear down (I inherited bad genes from my Mother, but Father had the best teeth). He told me that if I didn't want my teeth to wear down, don't eat. He was active in the First District (N.Y.) Dental Society, kept up with the latest advances, and believed in continuing dental education. He volunteered in N.Y.'s Hospital for Joint Diseases' dental clinic every other Tuesday morning for many years as pro bono publico work. Pardon my paean to my late uncle.
227
Its an easy 250 for my dentist. He says its to check for cavities and usually pushes it every 6 months, all types of xraysmandatory at least once every 3 years. Most his patients get them yearly. I still think it is overkill unless there is an underlying reason why. Since he was out of network anyway I have to pony up the difference and since I have had no cavities as an adult I have stopped going to see him. It is a put off.
94
That's padding your bill. A dentist who does that to all his patients is unethical and is going to kill some of them. There is a specific rate of cancers that occur per number of xray exposures. This fool is killing a few of his patients.
97
If you change dentists or move, be sure to ask for a copy of your dental X-rays to ensure that you don't repeat them.
92
I firmly believe that dentists are widely "requiring" x-rays because they can charge for them! And make money from them! Even more money, actually, as the dental industry has seen at least, if not bigger, price increases and profitability than medical health care.
137
I walked out of one dentist's office because they've insisted on x-rays prior to cleaning. I cajoled another to get a cleaning, but that didn't last after the first cleaning. At 79 years of age with a set of great teeth without any significant dental work all my life, I have given up on dental hygiene appointments. Each of three dental offices insisted -- said they wouldn't work on me unless I had x-rays. Now, I am doing self-care. I asked the Oregon Dental Association about this in an email; and, never got a reply. This is NUTS!
350
When will there be national dental insurance? Dentists are extremely expensive, unregulated and they rip you off because they can. Unemployed people cannot get past a job interview if they have brown decaying teeth or missing teeth. This is a national economic crisis.
159
You can often get free or next to free dental care at either a dental school or at low income dental clinics. Just search in Google for one near you.
16
not easy for most people.
28
My policy is if during your visual exam of my mouth you see something suspicious take an x-ray of that spot. Otherwise no x-rays. I've had a kidney transplant and my risk for cancer is high enough without more xray fishing expeditions.
71
What is not mentioned in this article is dentists make lots of money in by administering these x rays, so it's a way to generate significant profits for their practice.
No dentist will admit it, but patient profits (by means of insurance billings) is a guiding factor in how many dental offices operate.
No dentist will admit it, but patient profits (by means of insurance billings) is a guiding factor in how many dental offices operate.
164
Perfect example of the disaster we euphemistically refer to as FEE For SERVICE
57
The most outrageous thing is that, with most dentists, you're not even allowed to decline x-rays in order to get a cleaning, even if you're willing to sign a release absolving them from responsibility should a problem go undetected! Dental malpractice insurance has taken our choice away from us, as I discovered during a frank conversation with my local dentist. Now, I travel 2 hours each way twice a year to get a cleaning from a holistic dentist who is willing to do it without x-rays, and it's well worth the trip. There are enough carcinogens out there without having to have another one shoved down our throats.
120
My wife has her teeth cleaned twice a year because that was what her dentist recommended. The other day she went for her semiannual cleaning and the technician told her that she had to have a full set of X-rays before her scheduled cleaning, a new protocol. My wife walked out of the office rather than submit.
She then inquired of the dentist I use and was told that a full set of X-rays was required before a cleaning. She is now 0 for 2. Many of the commenters believe this is a scam. Another possibility is that some dental health agency or insurance company may be requiring this.
It seems that refusal to submit to X-rays shuts you out of dental care in this small town of Sandpoint, Idaho. Does anyone have suggestions as to what to do?
She then inquired of the dentist I use and was told that a full set of X-rays was required before a cleaning. She is now 0 for 2. Many of the commenters believe this is a scam. Another possibility is that some dental health agency or insurance company may be requiring this.
It seems that refusal to submit to X-rays shuts you out of dental care in this small town of Sandpoint, Idaho. Does anyone have suggestions as to what to do?
122
You might be able to transfer x-rays from past dentists. They can send them to you on the internet. Sadly, dentistry has become just another scam, especially in areas with a shortage.
47
Assume you do not have dental coverage? If you do, check with your insurer. Even if you don't, I'd call and ask a benefits person about this requirement.
13
It IS a scam!
The incentives to milk patients, to pick their pockets, in the criminal FEE 4 SERVICE business model.
Doctors stopped being medical practitioners MANYyears ago. They see themselves, increasingly, as Free Marketers, in a FEE-- 4 -- SERVICE B U S I N E S S.
The incentives to milk patients, to pick their pockets, in the criminal FEE 4 SERVICE business model.
Doctors stopped being medical practitioners MANYyears ago. They see themselves, increasingly, as Free Marketers, in a FEE-- 4 -- SERVICE B U S I N E S S.
52
Would someone please explain to me how exposure to diagnostic x-rays is cumulative? An x-ray is an energetic photon, Once it strikes something, it is gone. Now, that interaction may leave cellular damage in its wake, but it's not like the photon is going to hang around and cause additional damage.
Further, any damage caused in a cell will either result in a cancerous mutation or it will not. Since all cells die and are replaced at regular intervals, it would seem that if any mutation is not cancer causing then your own body will take care of it. There will be nothing to accumulate.
Now it may be that each dose of x-ray energy has a small percentage of carcinogenic effect that can multiply itself with subsequent exposures, but that is a function of statistical probabilities, not the strict effect of cumulative exposure.
Further, any damage caused in a cell will either result in a cancerous mutation or it will not. Since all cells die and are replaced at regular intervals, it would seem that if any mutation is not cancer causing then your own body will take care of it. There will be nothing to accumulate.
Now it may be that each dose of x-ray energy has a small percentage of carcinogenic effect that can multiply itself with subsequent exposures, but that is a function of statistical probabilities, not the strict effect of cumulative exposure.
3
The release of free radicals does the damage.
15
Could a physician reply here? This comment makes sense but I'm not a physician. I have a relative who has a recurrence of cancer but has had a lifetime of radiation exposure and is facing restricted treatment options as a result. My relative's doctor also speaks of "cumulative" radiation exposure.
13
There are a few reasons. First, your body has multiple safeguards against cancer. Most people need multiple mutations to pile up in a single cell to get cancer. Each dose of radiation (or mutations from other causes) has a risk of "breaking" one or more of these safeguards. The more of these safeguards that are broken, the greater the risk that the next mutation you get will be the one that tips you over to cancer. Second, cells are replaced through division - if a mutation does not cause cancer and is not immediately repaired, it will stick around and be present in all progeny of the mutated cell. Finally, while it is true that the dice have no memory, the more times you roll the dice, the greater the chance that at least one of those rolls will come up "snake eyes".
61
One advantage to routine x-rays is history. Dentists can exam and take notes on problems, but x-rays provides the clear information of changes over years. Some dental problems (root decay, internal tooth decay) are slow and progressive over years so x-rays help show the changes dentists can miss with just exams. It's cheap insurance.
12
Don't recall every having them but when my long time dentist retired the new one insisted on doing them with no better explanation than they were recommended by the Am. Dental Assoc. but was murky on how frequently. Reluctantly said ok on the theory that I had not had any in a while and it was a new dentist. Still not convinced a) fluoride touthpaste since Crest first came out; b) no cavities on baby teeth; and c) all of 2 cavities on adult teeth back ca. 1955. Now my wife was another story.
7
Aren't digital X-rays much safer because they deliver much less radiation?
12
I don't have a problem with annual x-rays, because they are a diagnostic tool to identify cavities or other issues can be missed by the dentist's exam. But if the dentist does not carefully review the x-ray , they are useless. I have had two dentists who missed early x-ray evidence of tooth decay, then when the x-rays were repeated a year later, it was too late to save the teeth. I lost three teeth, 10 years apart, due to overlooked x-ray evidence. Implants cost thousands, only part of which is covered by dental insurance. Let the buyer beware.
25
I always ask:
How old is your x-ray machine?
How much radiation does it use per exposure?
When was the last time it was serviced and calibrated?
I ask this not only of my dentist, but of any other provider who needs to take an x-ray. It's best to ask in advance of your appointment since many providers don't have that information easily accessable. But the answers matter.
If you ask that same question at airport security, you'll never get an answer, unfortunately. But you can ask to be searched by hand, provided you have an extra hour or more available.
How old is your x-ray machine?
How much radiation does it use per exposure?
When was the last time it was serviced and calibrated?
I ask this not only of my dentist, but of any other provider who needs to take an x-ray. It's best to ask in advance of your appointment since many providers don't have that information easily accessable. But the answers matter.
If you ask that same question at airport security, you'll never get an answer, unfortunately. But you can ask to be searched by hand, provided you have an extra hour or more available.
34
The age of the X-Ray machine is not an issue. They are either accurately calibrated or not.
The amount of radiation used per exposure varies depending upon the body part to be imaged, the type of imaging system (Digital, Computed or Film), the system speed of the detector and the technique selected by the person performing the exam.
Servicing and calibration are fairly standard and are required by law.
The most important variable is the person doing your exam and that does vary based upon where the exam is done.
In a Hospital and most Radiology Clinics it will be performed by a Radiologic Technologist who has completed a training program to include supervised clinical practice, taken a national exam and receive regular continuing education. The most common is the American Registry of Radiologic Technologists (ARRT). It takes as long to train a Registered Technologist as it does to train a Registered Nurse. Most states require Licensure.
In private Doctor's offices and many clinics the exams are done by Nurses who have completed some training to do X-Rays and are allowed to perform a limited selection of exams. In some states others perform exams as well.
Studies have shown that exams performed in facilities with Registered Technologists tend to use lower doses of radiation compared to the exams being performed by less well trained individuals. Full Disclosure, I am a Registered Radiologic Technologist and have been for over 30 years.
The amount of radiation used per exposure varies depending upon the body part to be imaged, the type of imaging system (Digital, Computed or Film), the system speed of the detector and the technique selected by the person performing the exam.
Servicing and calibration are fairly standard and are required by law.
The most important variable is the person doing your exam and that does vary based upon where the exam is done.
In a Hospital and most Radiology Clinics it will be performed by a Radiologic Technologist who has completed a training program to include supervised clinical practice, taken a national exam and receive regular continuing education. The most common is the American Registry of Radiologic Technologists (ARRT). It takes as long to train a Registered Technologist as it does to train a Registered Nurse. Most states require Licensure.
In private Doctor's offices and many clinics the exams are done by Nurses who have completed some training to do X-Rays and are allowed to perform a limited selection of exams. In some states others perform exams as well.
Studies have shown that exams performed in facilities with Registered Technologists tend to use lower doses of radiation compared to the exams being performed by less well trained individuals. Full Disclosure, I am a Registered Radiologic Technologist and have been for over 30 years.
33
@David Gregory You are referring, then, to RNs who have Associate degrees, and not, by a long chalk, comparing RDTs with RNs who have obtained Bachelor, Masters, and Ph.Ds.
7
I teach dental radiography. A radiograph is needed to diagnose and evaluate oral disease, including, but not limited to cavities. Radiographs should only be taken after an exam - and then as needed. The ADA has guidelines that should be followed. The dentist and patient can modify these based on the patient's individual history and situation. A lead apron with thyroid collar should always be used for all radiographs!! Have an open conversation with your doctor and discuss!
49
I switched dentists six or seven years ago. The new dentist insisted on doing a full-mouth series and refused treatment without it--and also insists on a repeat full series every five years and bitewings every 12 months. (She gave me a detailed explanation of her rationale, which I don't recall.) I don't like it, but I changed dentists because my old one was way too expensive and preoccupied with cosmetic dentistry. I like the new dentist and think she's good (came highly recommended by many friends) except for her X-ray policy. What is one to do?
13
1 full set of xrays every 5 years and bitewings every year is very standard
18
People should be more concerned about toxic Mercury in their mouths than X-rays.
7
After I refused x-rays repeatedly for my young children the pediatric dentist told me that he could not continue seeing my children because periodic x-rays are part of his plan of care and in line with the ADA. Sorry, I was not buying it. I know the machines were expensive and they need to be utilized and turned into revenue. But not at my children's expense.
85
Wait until you go see a dentist who routinely takes post-op X-rays after he did a new crown or filling, it is a "common" practice now especially at the bigger dental chain clinics. They said it's for "quality control" but for me it's an overkill.
28
Its to make sure you don't have any gap that could cause severe sensitivity or leaks for cavities and cause to replace the crown later
12
He has to pay for that x-ray machine he invested in.
17
My teeth are very close together except at the very front. I also get a new cavity every half decade or so, probably because of a 1950s pre-fluoride childhood. I have lots of crowns so we do digital bitewings every 18 to 24 months and of course more X-rays when something happens like recently breaking a tooth on a pistachio shell - my bad - and needing a crown. The important takeaway here is that the need for X-rays varies amongst patients.
I do envy people with great teeth. I've been able to keep mine but at a major financial cost.
I do envy people with great teeth. I've been able to keep mine but at a major financial cost.
15
It is long past time when the ADA should require cumulative dosimeters, which stay with the patient for his/her lifetime, and thus should travel with the patient who sees a succession of dentists over a lifetime. Patients also get numerous other X-rays, none of which are recorded for dosage in a cumulative individual record. I also wonder why dentists are not required to have X-ray machine inspection reports and histories posted on the walls where the machines are installed. Their bland assertions that the machines are inherently low-dose is suspect at best. Dentists have no training in such physics and other techie analysis. A friend from years ago who calibrated X-ray machines said some are wildly out of specs. Dentists make significant money from doing X-rays, and are quite aggressive at pricing.
43
Hi Jay, I am a hygienist in a small practice in NJ. The State of NJ does do routine x-ray machine surveys. Our inspector is also very good at coming up with the absolute lowest dosage of radiation needed for the specific digital system that we have. Her number was lower than the range recommended by the company. I hope that other states are as regulated as we are, it helps both the patient and the health care provider.
30
I am 53, have all my teeth, never had a cavity. I see my dentist every 6 months, and he does the bitewing every 3 years, I'm comfortable with that.
12
My dentist has plenty of expensive modern equipment, but uses it in moderation. My only beef is that when I see a specialist, they scorn the X-rays my dentist sends them and insist on taking their own.
28
Say NO! It is important to ssk questions but we always have the right to say no.
20
My hygienist routinely took 4 bite wing XRays, 2 on each side of my mouth. I have a small mouth, so each pair of XRays was almost identical. After a show down, I finally persuaded her to take just 1 bite wing of each side.
16
A reasoned article about the perils of side effects of procedures deemed excessive. One must also consider foul play here, the unfair enrichment of any operator by subjecting a patient to unnecessary tests, just because he/she has the equipment at hand. This abuse is not unique to dentists but to any and all professionals greedy enough to make an extra buck, irrespective of the objective (helping the patient)...instead of a self-serving proposition. Bedside manners do include hot only professional empathy but honesty in it's dealings.
17
That seems particularly relevant to chiropractors, and even more relevant to their penchant for doing Xrays on children. Maybe not all are charlatans, but glorified physical therapists seems like a generous label.
9
No, not all Chiropractors are charlatans. And how does Chiropractic bashing relate to dentistry? I am tired of ignorance about chiropractors. Sure, some are charlatans. So are many doctors and dentists. There has been a deliberate disinformation campaign against Chiropractors by the AMA and other medical associations for years. Chiropractic is a non-invasive, non-device, non-pharmaceutical method of healthcare. Wouldn't want that to interfere w/ exorbitant profits from surgery, devices and drugs. If it weren't for my chiropractor I'd be crippled.
13
I had a TIA (Mini-Stroke) because the Chiropractor twisted my neck and injured my artery in the neck at the base of my skull. I had lost use of my one hand, one eye and balance. So much for stupid chiropractors.
22
I don't have all of the pertinent information about this particular case (I assume, neither does anyone else posting here). However, if a new patient walked into your office with a history of multiple dental restorations, some evidence of periodontal disease, maybe a wisdom tooth or two that are still present (or if they're unsure if they ever had them removed)/or a complaint of any clicking or popping of the jaw joint, then all of those x-rays are not only justifiable, they're absolutely indicated. Now, on subsequent visits, it may only be necessary to take a bitewing or two, every X often, but even that depends on the risk/compliance of the patient.
13
This article and the comments are pretty shocking to me. I refuse dental x-rays all the time. I have my teeth cleaned every 6 months, and allow x-rays if a problem requires them. Roughly every 2 to 5 years. Otherwise, I just say no, and have never felt pressured. (I'm not sure why they even bother to ask.) If I did, I'd find a new dentist.
Of course, it may be easier for me to say no and have it accepted than for those who get cavities. Knock on wood, I'm approaching 60 and have never had one.
Of course, it may be easier for me to say no and have it accepted than for those who get cavities. Knock on wood, I'm approaching 60 and have never had one.
27
Unless the questioner had clear and extensive signs of dental disease, this is outrageously inappropriate. This dental is draining your wallet but more importantly, increasing your risks of oral cancer.
It ought to be malpractice, but the dentists are very good at shielding themselves from the serious consequences of their money grubbing.
It ought to be malpractice, but the dentists are very good at shielding themselves from the serious consequences of their money grubbing.
16
Patients should not automatically acquiesce. Too many doctors are cavalier about the radiation from diagnostic tests -- particularly CT scans and x-rays. It boils down to two motivating factors: diagnostic overkill and greed.
33
I will not allow my dental office to take x-rays unless there's a specific problem. The last time I visited her office, I asked the Dental Assistant why dental x-rays are so expensive. She confessed that she had no idea. One Hygienist I know told me that her boss (dentist) won't see patients who don't allow him to do a full mouth set of x-rays.
17
I'm convinced that my thyroid cancer occurred because of the number of dental x-rays I received in my life. I have no proof, but I think researchers should study it retroactively.
35
Everyone should insist that the thyroid shield collar be used. I have to remind my dentist every single time.
31
You always wonder when the technician runs the equipment safe in a separate room especially when x-rays used to be given without the protective bib over the chest and around the neck ...Fortunately my current dentist limits scans to a handful of every 2 years or so, certainly not 22!
7
I have wondered about this. Some of these dentists are x-ray crazy. They set up the x-rays and run like crazy out of the room only to return when they hear that buzz.
Pretty soon I expect my jaw to take on a glow.
Pretty soon I expect my jaw to take on a glow.
14
Dentists buy these expensive machines. They gotta pay for it somehow. How? by offering unnecessary x-rays and imaging and then billing the patient or the insurance company.
It's a scam. don't fall for it.
It's a scam. don't fall for it.
29
For the past ten years I've been going to a university dental clinic here in New York City and have never had a single cavity in all that time. But when I went there recently for what I thought would be a routine dental cleaning, the dental student told me that he wanted to take four bitewing X-rays. It was an evening appointment and I was a bit drowsy, so I did not object. After he took the X-rays, I said, "Weren't you supposed to cover me with a lead apron?" "Oh, it's okay," he replied. "Because I only took four."
And when I asked the supervising dental instructor about the danger of having four bitewing X-rays without the protection of a lead apron, he dismissed it by telling me that I'd be subject to more radiation on flight from New York to San Francisco.
And when I asked the supervising dental instructor about the danger of having four bitewing X-rays without the protection of a lead apron, he dismissed it by telling me that I'd be subject to more radiation on flight from New York to San Francisco.
14
I've never liked the answer that because you are exposed to radiation elsewhere, you should not worry about any additional. Radiation is cumulative in the body and we should limit it wherever possible. Excess radiation does lead to cancer.
49
Use of lead aprons, with specific exceptions, is becoming outdated. Take your chances.
http://www.oregon.gov/dentistry/docs/RHS%20-%20Lead%20Aprons%20-%20Infor...
2
Wow. I've always had healthy teeth but my dentist has done bite-wings x-rays every 6 months on me since I was adolescent. I never thought to question it. What a scam. I feel greatly disturbed.
42
I've recently began getting dental work done that has been ignored since my early 40s. I'm now 67. I lost several teeth in a motor vehicle accident in my mid-30. I've been wearing the same partial plates since I was 41. I simply didn't have money to go to the dentist and no insurance to go either. But now I do so now I go. I also have osteoporosis. I anticipated that this would be a more invasive renovation and treatment and take longer. I researched to find out what is available before I selected my dentist. Just in case I sound totally prepared, nope, I wasn't. At least, though, I was a bit ahead of the game when my upper plate broke and I had to have it fixed or survive on pureed foods. The dentist who fixed my plate was kind enough to refer me to a dentist who does the extensive renovations I will need.
I have had 2 panoramic xray and a ct for bone. That is it. I am now recovering from my first first bone implant on my upper jaw. I will probably need another in the same areas but I am doing everything I can to minimize that I will. I will also have another bone implant on my lower jaw in either 6 months or a year. It takes 4-6 months to evaluate how well each implant has taken. My mouth must be in perfect health for the implants needed to build the bridges. I need a completely healthy mouth to start the treatment for my osteoporosis. So 2 years and about $18,000. But if all of this works, I will be better off until I die. The women in my family die in their mid-90s.
I have had 2 panoramic xray and a ct for bone. That is it. I am now recovering from my first first bone implant on my upper jaw. I will probably need another in the same areas but I am doing everything I can to minimize that I will. I will also have another bone implant on my lower jaw in either 6 months or a year. It takes 4-6 months to evaluate how well each implant has taken. My mouth must be in perfect health for the implants needed to build the bridges. I need a completely healthy mouth to start the treatment for my osteoporosis. So 2 years and about $18,000. But if all of this works, I will be better off until I die. The women in my family die in their mid-90s.
8
I wish there'd been some kind of disclaimer in the article to the effect of - not everyone's dental history or risk for decay and periodontal disease is the same.
For one person to have a full mouth series of periapical xrays periodically might be appropriate while for another might be excessive. Factors might be the patient's age, his dental hygiene, his record of routine care, his prior treatment etc. One size does not fit all.
For one person to have a full mouth series of periapical xrays periodically might be appropriate while for another might be excessive. Factors might be the patient's age, his dental hygiene, his record of routine care, his prior treatment etc. One size does not fit all.
15
Therein lies the rub with private practice dentists. I currently use the faculty practice of a local dental university as my dentist. They charge the same as a dentist but staffed by teaching professionals, not motivated by greed. X-rays are commonly used as a profit center. At one time, I had a lengthy commute and tried a dentist closer to work. He told me all my "old" fillings should be replaced with gold and that I needed a full series of Xrays. I ripped off my "cocktail napkin" and informed him I was reporting him to the Dental Board (which I did). He ran after me, begging me not to do that and to reconsider. The waiting room was full of little old ladies, who certainly had plenty of "old" fillings...
15
so x-rays are a "profit center." Really? How do you figure that to be the case?
4
When you have insurance of any kind, it is within the dentist's best financial interest to milk it and use it as far as they knowingly can.
25
So then, dentists just routinely operate only according to their financial interests?
8
Yep!
12
My dentist recently sold his practice and the new dentist, whose office is very fancy, wanted bitewings plus a full set of x-rays. I allowed the bitewings because it has been a couple of years since i last had them, but I declined the full mouth series. Interestingly, the full mouth x-rays (about $200) are completely covered by my insurance, and the fact that the dentist dropped this request without explaining why they were needed told me a lot. I am not a cash cow, especially when unnecessary tests carry risks. Buyer beware.
31
As with any test in medicine/dentistry, X rays should not be taken without cause.
Here are some important points regarding radiation and cancer risk:
1.) Induction of cancer from X rays is stochastic effect, not deterministic (i.e. it is "by chance" not "assured")
2.) We use a "linear no threshold model" to estimate the risk of cancer in medical imaging. It is NOT proven that low dose X rays like these result in increased risk of cancer; it is interpolated from atomic bomb studies.
3.) Dental X rays result in a relative radiation dose (0.005 mSv) equivalent to being alive for about 1 day. A chest X-ray, for comparison, is equivalent to being alive for about 10 days (0.1 mSv), A CT scan of the abdomen and pelvis is equivalent to being alive for about 3 years (10 mSv).
4.) The risk of radiation exposure should be weighed against diagnostic risk before ordering a study.
~ Your friendly neighborhood Radiologist
Here are some important points regarding radiation and cancer risk:
1.) Induction of cancer from X rays is stochastic effect, not deterministic (i.e. it is "by chance" not "assured")
2.) We use a "linear no threshold model" to estimate the risk of cancer in medical imaging. It is NOT proven that low dose X rays like these result in increased risk of cancer; it is interpolated from atomic bomb studies.
3.) Dental X rays result in a relative radiation dose (0.005 mSv) equivalent to being alive for about 1 day. A chest X-ray, for comparison, is equivalent to being alive for about 10 days (0.1 mSv), A CT scan of the abdomen and pelvis is equivalent to being alive for about 3 years (10 mSv).
4.) The risk of radiation exposure should be weighed against diagnostic risk before ordering a study.
~ Your friendly neighborhood Radiologist
39
Dr. ?, Why are the dental x-rays so expensive? You know all about the cancer risk but I'd like to know why one x-ray costs over $20.00.
6
Hm, let's see here. An x-ray machine costs about $100,000. An office costs about $700,000. A dental degree costs about $450,000. Then you have to factor in the staff that have to be paid, as well as all of the other joys of operating a dental practice like paying malpractice insurance and business taxes (like medical device taxes). It adds up.
Delivering dental is expensive.
Delivering dental is expensive.
14
$20 is hardly expensive for any diagnostic imaging. As stated above, digital x-rays are very expensive. Most dentists have to purchase their own digital imaging equipment as opposed to medicine where you often visit a separate imaging center. Furthermore, you really don't "see" the costs of medical imaging because insurance often picks up the tab. If you looked at your EOB for medical imaging, suddenly dental x-rays wouldn't be "so expensive."
4
It's actually not difficult to avoid unnecessary x-rays. You just say 'No.' It's your mouth. It's worked every time for me.
If a dentist REQUIRES x-rays every year, he's just told me he's not the right dentist for me.
On the other hand, my dentist is into preventative care and if she suggests an x-ray, I've learned it's usually for a good reason, and then I will comply.
If a dentist REQUIRES x-rays every year, he's just told me he's not the right dentist for me.
On the other hand, my dentist is into preventative care and if she suggests an x-ray, I've learned it's usually for a good reason, and then I will comply.
37
We live in a very litigious society. Say your dentist did not take a full mouth series of radiographs and missed a lesion. That lesion expanded in size. Turns out the lesion is actually a ameloblastoma and now half your jaw has to be removed. You hire a lawyer and your lawyer asks the dentist, "So doctor, why did you not take a full set of x-rays?"
It is not a good reason but it is the society we live in.
It is not a good reason but it is the society we live in.
8
Are you advocating overthrow of the government?
2
The fact of the matter is, he would be protected if he documented the conversation properly. My dentist makes me sign a form saying I declined such and such treatment.
Fact is, the only thing certain in life is death and taxes. We will all die of something. It does not make sense to have your doctor do, for instance, an MRI or CT scan on your whole body yearly. Too much cost, and you will find too many incidental findings, notwithstanding the radiation.
Fact is, the only thing certain in life is death and taxes. We will all die of something. It does not make sense to have your doctor do, for instance, an MRI or CT scan on your whole body yearly. Too much cost, and you will find too many incidental findings, notwithstanding the radiation.
12
This subject, overall is indicative of the "lazy medicine" ubiquitous to the medical profession in the US. Sometimes profit driven, but always a matter of "that's our policy". The word "policy" is just another word for "now I am going to stop thinking". Ever had a colonoscopy? They give you the same dose of mien to drink to clean you out, whether you are a 150 lb vegetarian, or a 250 lb meat eater. Lazy medicine. Think about you own health in this way, and avoid policy, ask questions, and when in doubt, don't.
12
Frequency of x-rays?
It should be based on the signs/symptoms of the patient AND their risk for tooth decay or implant disease. Tooth/implant assessment includes diagnostic x-rays HOWEVER should be based on the individual needs and risks (and this is coming from a dental professional). It's possible X-rays may be taken out of "habit" versus necessity.
Are you at high risk?
Top 5 Risk Factors
1. An bacterial imbalance/infection in the oral cavity that results in prolonged periods of acidic pH. If you've had a cavity recently, research indicates you're at higher risk for a future cavity.
2. Dry Mouth - often from medications (puts you at extreme risk!)
3. Poor Oral Hygiene (too much plaque) or wrong self care. If you don't like to floss, use something else (waterpik, interdental brush)
4. Acidic or Sugary Foods/Drinks. Frequency of snacking or drinking
5. Braces, Oral Appliances
Are you at risk for tooth decay? Ask your dentist or dental hygienist about how to reduce risk factors and restore oral balance, which may include therapeutic agents. The goal is to outweigh the risk factors. Is your dental professional assessing your risk? Mention CAMBRA - they should know what you're talking about.
The British Dental Journal recently published (2017) a systematic review on "timing and frequency of bitewings" - after reviewing 13 guidelines, authors concluded guidelines are varied and the dental profession should come to a consensus.
It should be based on the signs/symptoms of the patient AND their risk for tooth decay or implant disease. Tooth/implant assessment includes diagnostic x-rays HOWEVER should be based on the individual needs and risks (and this is coming from a dental professional). It's possible X-rays may be taken out of "habit" versus necessity.
Are you at high risk?
Top 5 Risk Factors
1. An bacterial imbalance/infection in the oral cavity that results in prolonged periods of acidic pH. If you've had a cavity recently, research indicates you're at higher risk for a future cavity.
2. Dry Mouth - often from medications (puts you at extreme risk!)
3. Poor Oral Hygiene (too much plaque) or wrong self care. If you don't like to floss, use something else (waterpik, interdental brush)
4. Acidic or Sugary Foods/Drinks. Frequency of snacking or drinking
5. Braces, Oral Appliances
Are you at risk for tooth decay? Ask your dentist or dental hygienist about how to reduce risk factors and restore oral balance, which may include therapeutic agents. The goal is to outweigh the risk factors. Is your dental professional assessing your risk? Mention CAMBRA - they should know what you're talking about.
The British Dental Journal recently published (2017) a systematic review on "timing and frequency of bitewings" - after reviewing 13 guidelines, authors concluded guidelines are varied and the dental profession should come to a consensus.
14
So many negative, distrustful comments against dentists.
Radiographs are a necessary diagnostic tool and should be used judiciously. However, in our increasing litigious society, it is very likely that any over usage of radiographs is due to a defensive mentality of not wishing to be sued because of neglect, oversight or malpractice. If a dentist is unable to diagnose an abscess because the patient refuses x-rays, who is then responsible, the Dentist!!! How would you feel if you were that patient.
The solution is to ask questions of your dentist and always obtain copies for your own records.
Radiographs are a necessary diagnostic tool and should be used judiciously. However, in our increasing litigious society, it is very likely that any over usage of radiographs is due to a defensive mentality of not wishing to be sued because of neglect, oversight or malpractice. If a dentist is unable to diagnose an abscess because the patient refuses x-rays, who is then responsible, the Dentist!!! How would you feel if you were that patient.
The solution is to ask questions of your dentist and always obtain copies for your own records.
6
The dentist is not responsible if the patient just says no to X-rays.
7
"My new dentist gave me 22 X-rays yesterday.."
AKA Chronic remunerative Dentistry.
AKA Chronic remunerative Dentistry.
8
This article brings up a point that has severely damaged the credibility of dentists: the "upsell". They treat you like ignorant children and then get testy when you question their procedures. They find imaginary problems to be treated with expensive solutions. The hygienist sets you up with oohs and aahs and snide comments about how your teeth are about to fall out. Then the dentist comes in and confirms SOME of the hygienist's "findings" and recommends further X-rays or a procedure and then slips out of the room. This all happens while your mouth is stuffed with appliances and you are unable to talk. Now the hard sell begins with the hygienist scheduling when, not if, these procedures are to be done. If you demur, the hygienist follows you out to the lobby where the cashier/clerk (in medical garb) berates you with more scare tactics to get you to schedule. You pay your $300 for cleaning and X-ray (outrageous) and escape to your home where messages await you from the dentist's office excoriating your lack of judgement for not buying into this scam.
As one retired dentist put it to me: "People aren't getting cavities like they used to so we have to come up with something to make money".
As one retired dentist put it to me: "People aren't getting cavities like they used to so we have to come up with something to make money".
94
If this is your experience with your dentist, you need to find a new one. The closest I ever came to dental coercion came from my old dentist, who looked longingly at my slightly crooked front tooth and suggested an implant. Since I never have anything to smile about, he was the first person to notice it. That discussion didn't go any further.
35
Paul, I actually laughed out loud.
13
I go for a cleaning every six months. the Hygienist asks me each time if she can take bite wing x-rays. It's a sales pitch plain and simple. I have no insurance so this costs comes out of my pocket. This practice annoys the hell out of me and I believe unecessary.
22
I am 69 years old and have had basal cell carcinomas removed from my upper and lower lips - nowhere else - over the last several years. While I can't say a lifetime of dental x-rays is at fault, I never allow x-rays - not just dental, but any kind of x-rays - unless I am having a problem for which some kind of intervention is contemplated, and the x-rays will help the provider in determining or refining the intervention.
16
The Eyes and Thyroid Gland are both very sensitive to ionizing radiation and are commonly exposed during Medical and Dental exams of the head or neck to either direct or indirect (scatter) radiation.
As a Radiologic Technologist who performs Medical X-Ray and CT exams, you have a right to know that any exam is necessary, is done by qualified personnel and that best practices are being used to minimize the radiation dose. It is your body and health.
Determining what exams are appropriate is the responsibility of the Doctor, Dentist or other Practitioner ordering the exam, but as patient or parent you have a right to know why they are being done and if there are reasonable alternatives. No Doctor or Dentist I have ever met has a problem with answering patient concerns and options regarding care.
Make sure the person performing any Diagnostic X-Rays or CT Exam is restricting exposure to only the area necessary for the exam and that appropriate shielding is being used. Who performs these exams varies by state and the same is true of the training, certification, continuing education and licensing for both Medical and Dental exams. Many times Medical X-Rays done outside Hospitals are being done by minimally trained people (Nurses or a Medical Assistants) who do not always use the lowest dose, smallest exposure area or best shielding practices possible. The training for a Medical Radiologic Technologist is as long as for a Registered Nurse.
Be careful- it is your body.
As a Radiologic Technologist who performs Medical X-Ray and CT exams, you have a right to know that any exam is necessary, is done by qualified personnel and that best practices are being used to minimize the radiation dose. It is your body and health.
Determining what exams are appropriate is the responsibility of the Doctor, Dentist or other Practitioner ordering the exam, but as patient or parent you have a right to know why they are being done and if there are reasonable alternatives. No Doctor or Dentist I have ever met has a problem with answering patient concerns and options regarding care.
Make sure the person performing any Diagnostic X-Rays or CT Exam is restricting exposure to only the area necessary for the exam and that appropriate shielding is being used. Who performs these exams varies by state and the same is true of the training, certification, continuing education and licensing for both Medical and Dental exams. Many times Medical X-Rays done outside Hospitals are being done by minimally trained people (Nurses or a Medical Assistants) who do not always use the lowest dose, smallest exposure area or best shielding practices possible. The training for a Medical Radiologic Technologist is as long as for a Registered Nurse.
Be careful- it is your body.
24
It's all about making MONEY.
7
I guarantee that the commenters here who feel that they should be able to decide what services they want or are willing to take their chances and refuse necessary diagnostic radiographs would be the first ones to holler loudly if something was missed as a result. No patient can give consent for the dentist to be negligent. Many offices have a policy that states if a patient refuses to have the necessary radiographs, the patient will be dismissed from the practice. And rightly so. Why on earth would you go to a dentist expecting excellent care and then refuse to allow him or her to provide it? A dentist working on a patient without the proper diagnostics is like a surgeon doing an operation with one hand tied behind his back.
4
@ EGS I'm not at all sure about your point. My new dentist took a *video* of a single tooth (#12, not too far back) plus used bitewings and a visual exam to diagnose a crack and prescribe a crown. My old dentist would have taken the x-ray for diagnostic and insurance purposes, and shown me the crack in a mirror. No video necessary.
5
you sound like exactly the wrong kind of person to be involved with others health decisions...
6
Your dentist does this because you have dental insurance and he/she can make more money by doing x-rays and then charging your insurance for the unnecessary work. Don't allow it. It's unnecessary exposure to radiation which has been studied and should not be considered benign.
10
A pediatric dentist's staff threatened me that they'd refuse to treat my child if I declined x-rays that were not called for by findings from examination, but based only upon their assumptions and self-imposed schedule. No worries. We won't ever darken their doorstep again.
15
To all those being forced to get regular dental x-rays: look into getting your care at a school of dentistry. I do, and their policy is that they request x-rays only when they find something on examination that they wish to investigate. They do not demand x-rays on some schedule or connected with cleanings, ever.
12
Standards have changed in Dental Education and there is a trend towards less x-rays. Digital radiography offers less radiation as well.
It is interesting to note, the photo shows the digital bite wing radiographs of a child that has several carious lesions on several primary molars. If these lesions are not treated the child could end up with a potentially severe infection that could also affect the adult teeth.
There are a great many ethical dentists in this country. Shop around and find a dentist who reads literature, keeps up with the latest standards and attends continuing education on a regular basis.
It is interesting to note, the photo shows the digital bite wing radiographs of a child that has several carious lesions on several primary molars. If these lesions are not treated the child could end up with a potentially severe infection that could also affect the adult teeth.
There are a great many ethical dentists in this country. Shop around and find a dentist who reads literature, keeps up with the latest standards and attends continuing education on a regular basis.
8
"While dental X-rays account for less than 3 percent of all the radiation that Americans get through medical imaging, every effort should be made to minimize their use."
Is this an average number? Is it a lifetime number? Annually? I would like more information about this.
Is this an average number? Is it a lifetime number? Annually? I would like more information about this.
3
Agree that many DMD's are too casual and aggressive with imaging. They simply start firing away with little discussion with the patient.
I refused exactly what the patient in the article complained about. I told my dentist to xray if they thought there was a specific issue. They "pouted", but that at least stopped them.
There is no "safe" level of radiation. Radiation is a lifelong, cumulative risk factor for malignancy. And don't forget, with dental xrays you are getting a focal (peri-oral) dose of radiation.
Patients should say "no!" more often.
I refused exactly what the patient in the article complained about. I told my dentist to xray if they thought there was a specific issue. They "pouted", but that at least stopped them.
There is no "safe" level of radiation. Radiation is a lifelong, cumulative risk factor for malignancy. And don't forget, with dental xrays you are getting a focal (peri-oral) dose of radiation.
Patients should say "no!" more often.
14
As a practicing dentist I routinely take different types of digital radiographs which have significantly less radiation than the old films. I could care less how much revenue X-rays bring to my business. They are for diagnosis of disease! The ignorance of some of the comments in this thread are unbelievable! Misinformed people who don't understand real science!!
13
Just say, "why?". What would you do differently with the test results? And, most importantly, say NO!
22
Good advice. I went to a TMJ specialist who gave me a cone-beam CT scan. When he wanted to give me another a year later I asked if the results would make any difference to the treatment. He looked annoyed and dropped the subject. We had the same conversation every visit thereafter until I decided to forget about treatment.
4
Take your X-rays (they are yours) and run as fast as you can to another dentist.
I had one dentist who would file my teeth every time I visited - my previously perfect lower set are now crooked. The profession has a fair share of scoundrels who know every trick to squeeze a $ out of dental plans. After bouncing around, I was fortunate to find an academic practice who are a credit to their profession.
I had one dentist who would file my teeth every time I visited - my previously perfect lower set are now crooked. The profession has a fair share of scoundrels who know every trick to squeeze a $ out of dental plans. After bouncing around, I was fortunate to find an academic practice who are a credit to their profession.
29
This is a stupid and uninformed article. Digital radiographs have much less radiation than film and thus article doesn't discuss that. There is also radiation everywhere- you should stop eating bananas since they have radiation too! Added to that, the amount of litigation and money-grubbing lawyers that live to sue, we gave to take these films to protect us!
5
There are consulting groups that go to dental practices to teach them how to monetize their practice. In other words, how to fleece insurance companies and patients as much as possible.
59
This guy seems to be running up his billing; hope you have insurance to cover the x-rays, and limit how much he will get reimbursed. Unless you have some issue, no need to have that many x-rays, and not needed every visit, maybe every two or three years to check on areas not able to be seen or visually inspected.
13
Don't hesitate to question your dentist and ask why the X-rays are needed and if they can work without them. I've had my children's dentist ask to do X-rays and have refused any X-rays period so far. The kids are now 6 and 8 and no negative impacts of saying no to the X-rays.
Bottom line - it's about you and your lifetime exposure to X-rays. As biologists know, and doctors and dentists often seem not to acknowledge, there is NO safe level of X-rays.
Bottom line - it's about you and your lifetime exposure to X-rays. As biologists know, and doctors and dentists often seem not to acknowledge, there is NO safe level of X-rays.
19
I recently had a mother of 2 in my office recently that remind me of you. I felt a stick when cleaning between teeth 28 and 29. She had Refused X-rays for her children up until I told her I am feeling a stick here and we need to get a film. She agreed to one X-ray. There were 5 visa le cavities on the one film I took so needless to say she let me take more film to check the rest of the teeth. Between her two children there were 27 fillings that were needed and Her 12 year old is receiving 2 root canals on permanent molars which could have been prevented and treated with simple fillings if X-rays had been taken. X-rays let is see places we can't and small cavities are easily treated... but with out treatment they become root canals or even worse there is no treatment and the tooth needs to be extracted. I would take the X-rays rather than the possibility of having decay in mouth that can lead to tooth loss and on top of that also contributes to strokes and heart attacks, but that's just an educated decision. Your poor children! Hope you have a better outcome than my patients.
8
Please note that there's a scanner based on infrared that can detect cavities between the teeth, great for children and pregnant women, no radiation involved, soft rubber head, very user friendly, you may check with your dentist, the scanner is called " Cari-Vu"
13
As a doctorally prepared RN of 35 years, I will only have dental x-rays after they have done a thorough examination, and are suspicious of something. I then have a conversation about what is the worst that can happen if I don't have an x-ray. If we decide together that I need one, I have lead shielding for my body AND my thyroid (which many dentists don't even offer, but I demand). Bottom line, if you don't eat sweets, brush, floss, don't overuse whitening agents, or crunch hard items, then your teeth should last. Prevention is key.
55
Twenty-five years ago, I had a six-month checkup while pregnant. As the x-ray tech started to do the routine x-rays, before the exam, I told her I didn't want x-rays this time. The dentist and x-ray tech argued with me for about ten minutes that it wouldn't harm my baby. I got up and left. Needless to say, I have since found a dentist who listens to my concerns and works around them. While x-rays have proven to be very beneficial in helping to diagnose dental issues, they aren't harmless. Dentists need to allow the patient to make the final decision about their own body.
22
Two years ago I told my dentist that I no longer wanted dental X-rays unless I had a problem. He unhappily agreed. My reason is simple. Routine X-rays, which I have had for decades, have never detected anything wrong. So I decided that I'd save money and take my chances. Based on my experience the odds are real good that I'll be just fine.
42
I have never had a cavity. A few years ago when I was looking for a new dentist, I called nearly a dozen dental offices to ask about their policy on x-rays. I was happy to get a full set of x-rays because I was a new patient, but wanted to keep the twice annual x-rays to a minimum. ALL of the practices I called required that I get annual x-rays or else they would not take me on as a patient. One very reasonable dentist actually called me back personally and told me that it is always my right to refuse a procedure. Needless to say, she is my new dentist. And every couple of years when she asks to do a few bite wings, I always say yes.
107
I'd get my previous X-rays sent to the new dentist. The person didn't say this is the first time ever going to a dentist, so presumably there is a record that can be transferred. I just left my dentist because he and his staff were nagging and rude about me not wanting x-rays every six months. X-rays and other records should follow the patient.
13
There is no mention as to the type of X-rays being done. Are they traditional or the new digital X-rays, which require far less radiation. You can not compare apples to oranges. Nor can you see well between teeth or bone level under the gums without X-rays. There can not be a determination as to what is overkill until you consider a lot more factors than 'the dentist took a full-set of X-rays".
8
"My new dentist gave me 22 X-rays yesterday.."
You need to find a new dentist - he is just trying to pay off that machine using your mouth.
You need to find a new dentist - he is just trying to pay off that machine using your mouth.
341
...or his new Porsche....
27
As a practicing UK dentist, that is a lot of X-rays. We take bite wings for all new patients and every two years for most, can be 6 monthly to 3 years though, based on disease experience.
Panoramics are not indicated for diagnosis of caries or periodontal disease because they are tomograms and sample a slice of tissue. Useful if you are looking for other lesions. CBCT is almost never indicated unless you need 3D visualisation to plans surgery for tumours or implant placement. It should be noted that modern digital X-ray capture has hugely reduced dosage compared to film. We use the principle of ALARA; as low as reasonably achievable
Panoramics are not indicated for diagnosis of caries or periodontal disease because they are tomograms and sample a slice of tissue. Useful if you are looking for other lesions. CBCT is almost never indicated unless you need 3D visualisation to plans surgery for tumours or implant placement. It should be noted that modern digital X-ray capture has hugely reduced dosage compared to film. We use the principle of ALARA; as low as reasonably achievable
22
You don't know that without hearing something about the person's dental history.
2
If there was a chance your leg was broken, would you choose not to have it Xrayed? I agree that a Panoramic Xray, a set of bitewings, AND a full mouth series is "overkill" The bitewings are necessary to look for decay between the teeth that will not be visible until it's too late. The panoramic shows much more than just the teeth; it provides valuable information about the maxillary sinuses, tooth positioning and other bone abnormalities. It is also used to plan treatment for full and partial dentures, braces, extractions and implants. It can also be used as baseline data in case any problems happen in the future.
Dental x-rays have come a long way since I began practicing Dental Hygiene in 1984.
Dental x-rays have come a long way since I began practicing Dental Hygiene in 1984.
18
If there was "a chance my leg was broken" I would have symptoms.
What is being talked about here is asymptomatic screening. Or, as we say in the medical field, "a fishing expedition".
Digital or non digital, xrays involve radiation. Radiation is a lifelong,cumulative risk. It's non-sensical that people worry about small, unproven risks for cancer, then seemingly ignore a well known risk-radiation.
What is being talked about here is asymptomatic screening. Or, as we say in the medical field, "a fishing expedition".
Digital or non digital, xrays involve radiation. Radiation is a lifelong,cumulative risk. It's non-sensical that people worry about small, unproven risks for cancer, then seemingly ignore a well known risk-radiation.
17
My dentist seems to base his xray procedure on how often my dental insurance will pay for the xrays, rather than need. As soon as I make an annual appointment, his technician is attempting to give me the "standard" office procedure of many xrays, because my insurance pays for it every 12 months. When I protested and objected, I got a long speech about how there is minimal insignificant radiation. I now avoid going to the dentist every year because of this. I only go once every two years, unless I have a particular problem. It's all about money, with complete disregard for the patient's wishes.
287
X-rays are so prevalent these days...it's hard to make the recommended appointment for a cleaning twice a year without being surprised with a dental x-ray prior to a cleaning. Dentists say it's standard once a year. You have to be very clear with your dentist and their reception staff that you do not want them done.
94
I made an appointment for a cleaning and was quite clear that a cleaning was all I wanted and no x-rays. I was having money problems and I simply could not afford the whole shebang and since I've always had excellent dental health I wasn't terribly worried about it. I got to the appointment, was sitting in the chair and informed that they would not clean my teeth without xrays. I got up, walked out and never returned.
100
I just say no, it is my body and I am responsible.
12
When are dentists going to receive the same scrutiny as doctors? Dentists own the dental equipment and interpret the X-rays themselves, pocketing all the money. With doctors, usually one doctor orders the X-rays, a different facility obtains the images, and a different person interprets. Although to some, that might sound like a way to increase costs, it is less conflict of interest. At the last dental visit, I got 21 X-rays without the dentist examining my mouth beforehand. The tech did not stabilize the machine and it bounced around during image taking so that some images were blurry. And then the dentist didn't even scan all the pictures. Then they offered to see me in 3 months for another dental visit because insurance covered it, not because I needed it.
189
Who owns the facility that obtains the images? Does the doctor give you a choice of who interprets the X-rays? Check who owns the imaging centers, how many are the doctors who send patients to them?
6
If they offer you visits every 3 months, you have periodontal disease, which means if you want to keep your teeth, you should probably go, but that's none of my business. :) good luck with that
9
Dental x-rays aren't just taken for caries detection. A full-mouth series is taken when a patient has periodontal (gum) disease that is associated with bone loss and a Panorex is recommended every five years to screen for jaw bone pathology. Dental cysts, metastatic cancers, infections, and other bone pathology in the jaw can be asymptomatic and are often first detected by a Panorex. I recall a case where a dentist relying only on a periapical film mistakenly diagnosed a patient with a periapical abscess. A Panorex clarified a jaw tumor was present.
There is also the issue of the diffusion of change into practice. Some practitioners get stuck in the rut of doing whatever they learned as dental students rather than adapting to changes reported in the dental scientific literature. Dental opioid and antibiotic prescription habits are an example where the dental profession is trying to change ingrained habits.
There is also the issue of the diffusion of change into practice. Some practitioners get stuck in the rut of doing whatever they learned as dental students rather than adapting to changes reported in the dental scientific literature. Dental opioid and antibiotic prescription habits are an example where the dental profession is trying to change ingrained habits.
30
In Tucson, AZ, I have encountered several dental practices that REFUSE to keep you as a patient if you refuse xrays they mandate you take every 6-18 months. I have left a practice for this reason. I even offered to sign a waiver of liability if their concern was a lawsuit and that was not good enough. I believe these mandated xrays are to increase the profits of dental practices. This is wrong as dental care is incredibly important for good health. The patient, not the doctor, should be able to decide what services they want or not. I wish there was legislation to stop dentists from being able to dictate xrays and throw away patients who do not want to comply.
296
Same here. And another dentist wanted to charge me $35 to giv me back my own records from a prior dentist. When I refused he held my records and the dental board backed him up despite a statute prohibiting the practice. Finally found a dentist who doesn't do this.
17
If it is not illegal, it is unethical.
Good reason to leave a practice. As the article says, the dentist must be able to justify why x-rays are needed.
Good reason to leave a practice. As the article says, the dentist must be able to justify why x-rays are needed.
17
It's important to note that the digital x-rays now standard at nearly all dental offices deliver much less radiation than the film-based x-rays of old.
48
Dental X-rays are a con. 22 dental xrays are fraud. Get your money back. And don't allow this again. I haven't had a cavity or problem for 25 years, and they still want me to get xrayed every year. As if.
129
This article, while valuable, does not mention the use of lead collars and/or aprons to protect patients from unwanted radiation while dental x-rays are being taken. The thyroid gland is highly sensitive to the cancer-causing effects of radiation, and children are especially vulnerable. The use of a lead collar should be standard, and if it isn't offered, it should be requested (or demanded). The "Image Gently" campaign has no doubt helped keep many children from receiving unnecessary radiation, but it has to contend with both entrenched practice -- "we've always done it this way" -- and mercenary considerations, since some providers may be reluctant to forgo procedures they can bill for.
73
I had this same thought peter. Thyroid cancer is on the rise and although not proven, it isn't a huge leap to assume it could come from dental ex rays we've all been getting all these years. After i had my thyroid removed due to cancer, i started telling my dentist to limit his use of ex rays to only when absolutely necessary and also i always insist on the collar. He has respected my wishes, and i always get a clean report on my dental health.
I don't know why the neck collar isn't routine.
I don't know why the neck collar isn't routine.
17
Unnecessary x-rays should be avoided, if only for reasons of cost. Radiation is another matter. While the risk of cancer from radiation at high doses has been well established, as by data from Hiroshima survivors, the dangers at the low doses of diagnostic x-rays (dental, CT, etc.) have not. They are assumed to be present on the basis of extrapolation from the high dose data. There is even evidence of a benefit from low dose radiation (though not to the point of recommending radiation for this reason). This is in the academic literature. See http://jnm.snmjournals.org/content/58/1/1.abstract .
7
Herb's comment cites an article by Siegel et al. from the Journal of Nuclear Medicine which, among other things, attacks the most basic principle of radiation protection, namely "ALARA" -- that radiation doses should be kept "as low as reasonably achievable." ALARA has been practiced the world over for many decades. Siegel suggests instead that low dose radiation is beneficial, an indication that he is a believer in the doctrine of "hormesis," which posits that radiation in low to moderate doses is not only not harmful, it is positively beneficial to health. This is a fringe view, rejected by the NRC, EPA, National Conference on Radiation Protection, International Commission on Radiation Protection, National Academies of Science, etc. Most professionals in the field, here and abroad consider "hormesis" to be quackery and pseudoscience. The hormesis true believers argue that all these groups are corrupt: they know that radiation is good for you, but have conspired for 70 years, ever since Hermann Muller's Nobel Prize lecture in 1946, to conceal this fact, in order to protect their jobs and funding. The founder of the hormesis movement, the late T. J. Luckey, thought that Americans were afflicted with a serious radiation deficiency, causing vast numbers of cancers annually, which could be remedied by using nuclear waste to create "radiation spas" where people could go to be zapped. -- Peter Crane, Counsel for Special Projects, U.S. Nuclear Regulatory Commission (retired)
45
If we forget about the hormesis aspect, I hope it will be admitted that the claim of risk from diagnostic x-ray procedures is based on an extrapolation, not direct evidence. Technically speaking, it depends on the linear no-threshold theory, which has not been demonstrated to be true. One needn’t be a crackpot to question longstanding policies like ALARA. The real bottom line is that x-ray procedures that have a clear diagnostic value for management of the patient should not be shunned because of the radiation. As can be seen, this is a controversial area. The New York Times would do well to explore it. I don’t intend to belabor the matter.
5
This is quite ridiculous. The benefits of low dose radiation is an idea from the East Bloc. In fact, some mineral waters sold in Hungary for instance, contained low amounts of radioisotopes. The idea is that you can 'train' your cells to become more efficient at repair (during DNA replication). This is absurd.
6
Two things have to be changed from the dental practices. One, excess X-ray usage. Second, amalgam dental filings, constant mercury poisoning that most of the people are unaware. Replacing to the safe treatment, you need to go to the special dentist that practices replacement. You need lots of vitamin C to excrete mercury from the body after the treatment. (Dr. Jonathan Landsman)
15
The process of extracting intact amalgam fillings from the mouth releases far more mercury vs. just leaving them there until they fail or fall out. But even then, you aren't going to start suffering from heavy metal poisoning. Which is good, because while there ARE treatments for heavy metal poisoning, Vitamin C isn't one of them. (Though I suppose receiving Vitamin C you don't need to "treat" heavy metal poisoning you don't have makes some sort of twisted sense.)
39
The evidence for the continued and ongoing safety of amalgam fillings around the world is without question. The FDA and all major health monitors world-wide have constantly affirmed the safety of this type of filling.
You can't point to a single serious study that suggests any causal effects from having amalgam fillings in your mouth.
This constant fear-mongering of this topic and other topics such as vaccines is shameful and dangerous.
You can't point to a single serious study that suggests any causal effects from having amalgam fillings in your mouth.
This constant fear-mongering of this topic and other topics such as vaccines is shameful and dangerous.
69
I haven't had an amalgam filling in at least 20 years and probably more than that. I still have some in my mouth and they're durable, although not lovely.
11
In Costa Rica, where dental care is highly professional and very affordable, dental x-rays are the exception rather than the rule. In the absence of a demonstrated need, they simply aren't done. In my own experience, I have had one set of bitewing x-rays in twelve years and recently my dentist declared my dental health to be well within expectations.
On the other hand, my wife, who is undergoing a double dental implant following an unsuccessful root canal, has had several (as you might expect).
On the other hand, my wife, who is undergoing a double dental implant following an unsuccessful root canal, has had several (as you might expect).
34
You can decline the x-rays, too. My dentist always asks and I say "no" unless I have a tooth issue. He respects my decision and never berates me .
38
You are lucky. I've been to two dentists who have told me that if I don't get them, not to come back.
46
It seems that if you are visiting a new dentist, the dentist will want initial x-rays. How do they know what's hidden in there? When my long-time dentist wanted to do x-rays every year, I just said no, and he was fine with that. Newly on Medicare, I need to find a new dentist covered under my plan and I am expecting x-rays! I will really miss my current excellent dentist and his nice staff.
7
I went to the same dental practice for almost 20 years. In all that time I never had a cavity. Nevertheless, when I wanted to get a cleaning without an annual set of xrays they said no. I walked out without having anything done and haven't been to a dentist since then. I've occasionally called dental offices to ask what the policy is on xrays and they all seem to insist on doing them annually. Having been blessed with a very good set of choppers I've decided to just take my chances.
15
Dentists in the US scam patients into unnecessary Xrays to jack up the bill. Dentists in our small town won't see you unless you have a full set of Xrays. My husband was told he needed a root canal; he didn't . I was told my another Dentist that she wanted to remove a crown due to bacteria in the tooth, at a cost of $1200. I didn't have the procedure and years later there's no problem with the tooth.. We now have dental work done in Mexico, without Xrays. Cost for a cleaning is $35.
157
Dental treatment without X-rays is considered negligent care. So good luck with that.
18
Lord. Please don't go to Mexico for medical care of any kind (including dental). It's one of the more dangerous foreign places to seek care.
3
How did you go about finding a dentist in Mexico?
4