For as long as dentists have used radiographs as diagnostic tools, patients, dentists and dental personnel have been warned of the risks associated with radiation exposure. However, dental radiography technology and procedures have improved with time and so has knowledge of the procedures’ benefits and risks. Dental radiography exposes patients to much less radiation today than the procedures of 35 years ago.

A patient’s trust and confidence in a dentist’s clinical knowledge and skills is essential for maintaining a long-term relationship. Patient trust is built when the dental team actively listens to a patient’s concerns and responds by providing information that the patient can relate to and understand. Knowledge and understanding empower patients to make educated decisions regarding their oral health.

Are you confident your patients understand the necessity of diagnostic X-rays? Here are some of the questions you may get from patients and guidance on how to best respond:

Why do I need dental X-rays?

As trained dental professionals, the benefits and necessity of diagnostic X-rays are well understood. It is easy to forget that most patients do not have a high level of oral health knowledge, and therefore need to be taught the importance of dental X-rays to their overall health.

Use the guidelines jointly developed by the U.S. Food and Drug Administration and the American Dental Association to support your communications with patients. The FDA/ADA guidelines state there is little evidence to support the use of dental X-rays to search for problems in asymptomatic patients and that dentists should not prescribe routine dental radiographs at preset intervals. Radiographs can be prescribed after an evaluation of the patient’s needs that includes a health history review, a clinical dental history assessment, a clinical examination and an evaluation of susceptibility to dental diseases.

Here are some sample scripts to help explain the importance of X-rays to patients:

New patient who just wants a cleaning and not the X-rays:

“Mr. Moore, Dr. Fong has a professional obligation to you, her patient, to provide you with optimum care. To do that, Dr. Fong must first perform a comprehensive examination, which includes X-rays, to best assess your oral health needs. Dr. Fong will then discuss all treatment needs, including her recommendations for your hygiene appointments.”

Recall patient:

“Ms. Davis, as you may recall from your past two appointments, there are some areas of concern that we are unable to see with our own eyes. It is important that we periodically check those areas to make sure we are addressing and preventing any problems.”

New patient with radiographs from another office:

“These X-rays are four years old, Mr. Sanchez, and your medical history indicates you are taking medicine for _______. We are concerned, as the medicine you take can lead to side effects in your mouth. Your old X-rays cannot tell us anything about the current condition of your oral health.”

Avoid telling patients that X-rays are legally required because, on the face of it, it sounds as if you are more concerned about your liability than your patient’s health and safety. Emphasize the benefit to the patient — explain why it is in the patient’s best interest to take X-rays periodically.

Avoid basing the need for X-rays on patient’s dental benefits. Do not tell patients that X-rays must be taken every six months or at any preset interval. Also, do not take X-rays because a dental benefit plan fee schedule will pay for radiographs taken at preset intervals.

Are dental X-rays safe?

When a patient expresses concern for their safety, it is best to begin by first acknowledging the concern and letting the patient know they have been heard. For example, you might say, “Mrs. Jones, I certainly understand your concern.

Patient safety and optimal health is our number one priority.” The next step is to provide the education. Tell patients your practice follows the ALARA principle for radiation safety — “as low as reasonably achievable.” Tell patients the benefits your practice offers to reduce the exposure and keep patients safe: (choose all that apply)

• Uses a lead apron with thyroid shield on patients
• Uses a device to reduce scatter radiation
• Uses F speed film or digital radiography
• Conducts regular quality assurance checks on radiographic processes. This type of check reduces the number of do- overs.

Patients may want to know how much radiation they are exposed to from dental radiographs. You can use the chart below. You can also refer to the website of the Health Physics Society for its helpful Q&A on radiation, its sources and potential health effects.

Responding to the patient who refuses X-rays:

A new patient may refuse X-rays and you, using your professional judgment, agree that at that time X-rays may not be necessary. However, what if the patient continues to refuse X-rays? What should you do?

• Be sure to continually educate the patient on the importance of X-rays at each appointment and document each conversation you have had with the patient regarding the necessity of X-rays.
• Remember — there is no waiver form that patients can sign to absolve a dentist of their responsibility of performing within the standard of care.
• Communicate to the patient that you will have to dismiss the patient from your practice because of the patient’s refusal to allow a necessary examination. “Diagnostic X-Rays Are Required” is a sample letter you can use. If the patient continues to refuse, contact your professional liability carrier to obtain advice on the proper dismissal of a patient. TDIC provides such advice and has a sample patient dismissal letter.

Adult Radiation Dose From Common Imaging Procedures

Source: Radiation Dose to Adults From Common Imaging Examinations, American College of Radiology. acr.org/-/media/ACR/Files/Radiology-Safety/Radiation-Safety/Dose-Reference-Card.pdf. Accessed April 30, 2021.