Page 10 - GP FALL 2009

An EBD Approach to Radiography in the Dental Practice

by Analia Veitz-Keenan, DDS, Silvia Spivakovsky, DDS, Kay-Tiong Oen, DDS, MAGD

n this year’s spring issue of GP, we 1980. Among other findings, the nat- it is very important to help students
described that when properly used, urally-occurring amounts of radia- with decisions that will impact their
IEvidence Based Dentistry (EBD) is tion (such as primordial radionu- practices in the future.
an effective method for evaluating and clides that have been present in the We independently performed an
judging issues in the practice of den- rocks and minerals of the earth’s electronic database search (Example:
tistry. We defined the EBD methodol- crust since it was formed and cosmic PubMed, Trip database, and Google
ogy. In this article, we will apply the radionuclides, which are produced by Scholar) and evaluated each article
principles of EBD to study the risks interactions of atoms in the atmos- for inclusion criteria in our review.
related to dental radiography. phere with cosmic rays) have Recent articles from 1998 up to 2008
In 1990, the International changed little in the past two were selected. More than 200 articles
Commission on Radiological decades. However, a key finding in were reviewed and critically
Protection (ICRP) determined that the report is that there has been a appraised. American and interna-
“effective dose” was the preferred unit dramatic increase in the amount of tional guidelines, statements, recom-
of measure for comparing risks from radiation from medical imaging pro- mendations, systematic reviews and
different radiographic exposures. cedures, including computed tomog- individual articles were included if
Thus “effective raphy (CT) and they dealt with selection criteria,
dose” was created cardiac nuclear diagnostic yield, sensitivity and
to provide a dose All x-ray exposures should be medicine exami- specificity for the different modali-
quantity related to clinically justifiable and nations. 3 ties. 19 articles were selected to sup-
the probability of lead to a positive benefit for In 2007, ICRP port and develop a practical under-
health detriment the patient. revised its esti- standing of selection criteria in den-
from exposure to mate of radio- tal radiographs based on the best
low doses of ioniz- sensitivity in tis- available evidence.
ing radiation. 1 sues including those in the maxillo- The criteria were used to evaluate
In 2004, ADA and FDA published facial region and changed its recom- the potential benefits and to compare
Guidelines for Selection of Dental mendation for calculating the effec- the different techniques for dental
Radiographs. The guidelines were tive dose. In support of this revision, radiographs - for the accurate diagno-
developed to serve as an adjunct to an article entitled “Patient Risk sis of periodontal diseases, dental
the dentist’s professional judgment Related to Common Dental caries, endodontic treatments and
on how to best use diagnostic imaging Radiographic Examination” was periapical lesions, implant place-
for each patient. “Radiographs can published in the September 2008 ments, as well as the reduction of ion-
help the dental practitioner evaluate issue of JADA. 4 In this article, the ized radiation. Studies selected also
and definitively diagnose many oral authors concluded, “If one uses the analyzed the differences between
diseases and conditions. However, revised recommendations for calcu- periapicals, bitewings, panoramic x-
the dentist must weigh the benefits of lating effective dose, the dental radi- rays, digital x-rays, and the benefits
taking dental radiographs against ographic procedures we evaluated in of using the rectangular collimation.
the risk of exposing a patient to x- this study are 32 percent to 422 per- Inclusion criteria for selected articles
rays, the long term effects which cent riskier than previously were the beneficial use of dental radi-
accumulate from multiple sources thought.” They emphasized the ographs and the harm of abusing
over time.” A dentist, with the knowl- importance of the dentist’s critical them. After this extensive review, we
edge of the patient’s role in determin- divided the results to better under-
health history and On average, we’re now ing each patient’s stand the purpose and the application
risks to oral disease, subjected to six times the individual radi- of the selection criteria and we
is in the best position ographic needs. arrived at some conclusions.
to make this judg- amount of radiation All these new
ment. It is funda- that we were subjected to findings conflict The Implementation of the
mental to radiation back in 1980. with the common ALARA Principle
protection that all x- belief we have ALARA, which is an acronym for “As
ray exposures should held and followed Low As Reasonably Achievable”, is
be clinically justifiable and lead to a up to now that the amount of radia- an integral component of the NCRP
positive benefit for the patient. 2 tion from dentistry was negligible. Guidelines for Radiation Protection
The National Commission on Our work at New York University issued on December 2003. 5
Radiological Protection (NCRP) College of Dentistry (NYUCD) was to Implementing this principle will pro-
Report No. 160 of 2006 described an select and appraise articles to sup- vide a safer practice for the environ-
increase in the average radiation port and develop a practical under- ment, considerably reduce radiation
exposure of the population in the US. standing of selection criteria in den- exposure to the patients, and will
On average, we are now subjected to tal radiographs based on the “best produce more diagnostic radi-
six times the amount of radiation available evidence” that can be ographs. The principles incorporat-
than we were subjected to back in implemented at NYUCD. As faculty, ed in ALARA are:

www.nysagd.org | Fall 2009 | GP 10