Page 11 - GP FALL 2009

1) Exposures are clinically justi- which radiographs are taken regard- harder to justify as digital radiogra-
fied and determined by a clinical less of the presence or absence of phy becomes more widely available”. 9
examination. clinical signs and symptoms. No Another important issue is the
2) Optimization of the technique radiographs should be taken unless radiographic recording of the edentu-
is applied to minimize exposure to clinical examination has been per- lous areas. There is little evidence to
the patient, using the fastest films formed and history reviewed. support radiographic exposure of
compatible with the diagnostic task, “Routine” radiography is an unac- edentulous areas in search of occult
collimation of the beam to reduce ion- ceptable practice. 7 pathoses in an asymptomatic
ized radiation, and patient. Studies have shown that
the use of lead aprons basing selection criteria on clinical
and thyroid shields. All these new findings conflict with the evaluations for asymptomatic
3) Dose limitations common belief we have held and followed patients, combined with selected
are applied to ensure up to now that the amount of radiation periapical radiographs for sympto-
that no one is exposed from dentistry was negligible. matic patients, can result in a 43
to an unacceptably percent reduction in the number of
high risk. radiographs without a clinically con-
4) The exposure to dental radi- sequential increase in the rate of
ographs is justified if they supply Radiographic Recommendations undiagnosed diseases . 10
beneficial clinical information. Bitewings and selected periapicals
Prescriptions without the knowledge seem to be the best choice for diagno- Radiographs and Medical
of the patient’s history and examina- sis as they can provide accurate Considerations
tion should not be made. details for the most common dental The use of radiographs during preg-
conditions such as periodontal dis- nancy was also considered in the
Full Mouth Series ease, caries detection, and the evalu- review. The ADA reinforces that dur-
For new patients, the clinical assess- ation of pulpal activity and periapi- ing pregnancy, it is very important to
ment of their dental needs is of pri- cal conditions. prevent and to treat dental infection
mary importance. The number and For the diagnosis of caries, bitewing to avoid consequences to the fetus.
type of radiographs needed will be radiographs appeared superior to Dental radiographs can be taken
based on the evaluation of the clini- panoramic radiographs for the detec- with an apron with thyroid collar if
cal signs and symptoms present. tion of dental caries overall, with supe- they are needed for treatment. 2
After reviewing numerous articles, rior sensitivity for proximal caries. 8 The anatomic position of the thy-
the evidence supports that a full For the diagnosis of periodontal roid gland is an important concern in
mouth series of dental radiographs is disease, the use of panoramic radi- the decision of taking dental radi-
not always necessary for every new ographs is not recommended due to ographs. Panoramic radiographs do
patient. However, this does not imply the overlapping resolution and the not protect the thyroid gland because
that the use of all full mouth series low contrast. Furthermore, literature of the inability to use the thyroid collar
has been eliminated. The results states that, “Contrary to the outcome during exposure. The literature sug-
suggest that it is better to start with expected from the guideline, the need gests that intra-oral techniques expose
fewer radiographs and to add more to supplement panoramic radi- the gland to less radiation and to use
as needed depending on the outcome ographs with intra-oral exposures panoramic radiographs only when
of the individual clinical and risk will nearly always result in a greater they are really needed, especially in
assessment of each patient. radiation dose than that arising from children and adolescents. Compared
The review of a patient’s medical periapical radiography of all the with intra-oral techniques, panoramic
and clinical history should include a affected teeth. This applies even radiography has a reduced diagnostic
thorough examination, review of any more to heavily restored and caries accuracy for the common dental
prior radiographs, pathologies such as caries, periodontal
and caries and peri- The implementation of our findings is not bone loss, and periapical pathologies. 11
odontal risk assess- to reduce radiographic exposure to Lastly, everyone is concerned
ments. Consideration about more radiation exposure in
for both the dental decrease quality of healthcare but to mini- dental patients with a history of
and general health mize the required exposure to protect our head and neck radiation therapy.
needs of the patient patients from the cumulative effects of the The ADA Council on Scientific
must precede any radiation. Affairs and European Union
radiological expo- Commission Guidelines suggest that
sure. 6 When radi- patients undergoing radiation ther-
ographs are prescribed, intra-oral prone dentitions. Since periapical apy are at a high risk to develop den-
radiographs should be considered radiographs also have much better tal diseases and should receive the
foremost due to their better resolu- image quality and will identify three appropriate diagnostic radiographs
tion and lower radiation. 7 times as many periodontal bone as needed. 7,8
Many of the articles questioned defects, it is difficult to justify the
the practice of “routine x-rays“ that use of panoramic radiographs for Conclusion
were not individualized to the investigation of periodontal disease. The take home message for dental
patient. A “routine” or “screening” Thus the panoramic-plus-periapicals practice is reduce the exposure to
examination is defined as one in approach is likely to become even unnecessary radiation.

www.nysagd.org | Fall 2009 | GP 11