Guidelines on the use of Dental Radiographs

Abstract

Guidelines in dental radiology are designed to avoid unnecessary exposure to X-radiation, and to identify individuals who may benefit from a radiographic examination.  Every prescription of radiographs should be based on an evaluation of the individual patient benefit.  Due to the relatively high frequency of caries among five-year old children it is recommended to consider dental radiography for each child even without any visible caries or restorations.  Furthermore, radiography should be considered at 8-9 years of age and then at age 12-14, which is 1-2 years after eruption of premolars and second molars.  Additional bitewing-controls should be based of an overall assessment of the caries activity/risk.  The high risk patient should be radiographically examined annually, while 2-3 years interval should be considered when caries activity/risk is low.

Routine survey by radiographs, except for caries, has not been shown to provide sufficient information to be justified considered the balance between cost (radiation and resources) and benefit.

Dental radiography is a useful diagnostic aid in oral examination of children.  In many cases the radiographic findings add important information.  However, the risks associated with radiography should not be neglected.  Guidelines in dental radiology are designed to avoid unnecessary exposure to X-radiation, and to identify individuals who may benefit from a radiographic examination.  Keywords for good practice are appropriate selection criteria for the use of radiography, optimised radiation protection, and utilization of the total amount of information in each radiograph.

Indications for radiographs in children and adolescents

The major reasons for taking radiographs in paediatric dentistry of teeth and supporting tissue are: 1) Detection of caries; 2) dental injuries; 3) disturbances in tooth development, and 4) examination of pathological conditions other than caries.  For each individual a clinical examination combined with interpretation of previous radiographs should be carried out before initiating a radiographic examination.  There should be an individual indication for taking radiograph and the guidelines should serve as an aid and remainder in the planning of the examinations needed.

This general principle should also be followed during systematic examinations that are carried out to detect caries by clinical means and radiography. Radiography should, however, not be performed in a routine manner using the same practice for all individuals (Faculty, 1998, Rohlin and White, 1992, Shwartz et al., 1987, Hanlon, 1985). Radiography should only be performed when the patient history and/or objective findings and symptoms lead to the conclusion that further useful information might be obtained (Table 1). If a radiograph is not expected to change diagnosis or treatment or add other useful information, it should not be taken.