Editorial - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Editorial

Diagnostic Dental Radiology - Benefit Or Hazard?

Each year many people are exposed to diagnostic dental X-rays. It is not surprising therefore, that the possible dangers associated with such exposures create a great deal of discussion between the dentist and patient regarding the use and need for X-rays as a diagnostic aid.
The harmful nature of the large amount of X-rays have been well known for many years. However, for the small amount of radiation received from dental radiographic examinations establishing a relationship between the risk and future hazards remain elusive. For over 35 years international health organizations have been trying to determine how many cancers and genetic defects, if any, are a result of the small amount of radiation used for diagnostic purposes. Numerous research efforts have been aimed at determining if there is a real danger. Since the levels of exposure to ionizing radiation are so small, determining the effects at these levels are currently beyond mankind's capabilities.
It has been postulated that small amount of dental X-rays pose about as much probability of causing cancer as smoking one cigarette. Cigarettes are causing 30% of the cancers and 25% of the heart disease in the United States. Cigarettes are a known carcinogen. Ionizing radiation used for diagnostic dental radiology is not a known carcinogen (a proven carcinogen). It would appear that the most reasonable thing dental health care providers can do for their patients would be to encourage them to stop smoking. Reducing cigarette smoking would produce a far greater benefit for mankind in preventing cancer than reducing the number of diagnostic dental X-rays. In comparing other daily risks in life, the hazards of diagnostic dental radiographs are very small and may present the same cancer risk as driving along a fairly busy highway, or breathing polluted air of a large city for two days. We should inform our patients that there may be a very small risk in having diagnostic dental X-rays but there is still no proven relationship between small doses of radiation and cancer.
What can we, as dentists, do to maximize the benefit of diagnostic dental X-rays and minimize the risk? There are several things:

We must use the fastest film speed available {Speed E).
Radiographs must only be taken when there is a professional and clinical need. Time should not be a determining factor.
The ALARA (As Low As Reasonably Achievable) concept must be implemented. This concept means that every reasonable protective aid must be taken to assure that all people exposed to radiation will receive the smallest amount of radiation.
Screening radiographs must not be taken.
Rectangular collimation of the X-ray beam must be utilized.
Proper filtration must be used.
Radiograph techniques must be perfected to avoid retakes.
Processing of radiographs must be consistent and error-free.
Lead aprons must be used.

Everything we do in life has some degree of risk. The benefit patients receive from diagnostic dental X-rays far exceeds documented risk.

Benjamin Ciola, DMD, MS
Associate Professor of Radiology
College of Dentistry
King Saud University