Patient shielding during dento-maxillofacial radiography

Iveta Ramonaite, Dental Tribune International

Mon. 4. December 2023

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MINNEAPOLIS, US: Patient shielding during dento-maxillofacial radiography is a long-standing practice that is believed to help reduce the risk of radiation-caused hereditary effects and radiation-induced cancer. However, the American Academy of Oral and Maxillofacial Radiology (AAOMR) has recently published a position statement in which it recommends discontinuing the use of protective gear during such imaging procedures. It stated that dental radiographic procedures induce no heritable effects in humans and deliver only a negligible radiation dose to the gonads and foetus. Additionally, it stated that the risk of radiation-induced cancer during such procedures is insignificant. The report provides the most up-to-date guidance for radiation safety and protection in oral and maxillofacial imaging.

Although dental radiography is an indispensable part of dental examinations and treatments, owing to its perceived negative health effects, many patients shy away from it. This is especially true for pregnant women and paediatric patients. For such patients, protective gear such as a lead apron or thyroid collar has a profound psychological impact by helping alleviate patients’ and parents’ concerns regarding the dangers of radiation.

Nevertheless, experts now say that protective gear does not offer radiation protection to patients. “There is ample evidence in the scientific literature that shows that the apron and thyroid collar do not provide any additional benefit,” dental radiology specialist Dr Aruna Ramesh, professor of diagnostic sciences and associate dean for academic affairs at Tufts University School of Dental Medicine (TUSDM), said in a press release. She is a co-author of the AAOMR’s new recommendations.

According to the researchers, dental radiography has greatly evolved, and the newest technology poses no threat to patients’ health. They explained that since most radiation exposure results from internal scattered radiation, shielding does not actually protect organs positioned outside of the imaged field. In fact, the report states that protective gear for dental radiology can even potentially increase the radiation dose to the patient by obscuring the anatomy being imaged when placed incorrectly, requiring a retake. Additionally, a lead apron may be contaminated with saliva and thus carry infection control risks if not properly disinfected.

“Preserving the quality of the images is the best way we have of protecting our patients,” said Dr Hugo Campos, associate professor of diagnostic sciences and director of oral and maxillofacial radiology at TUSDM.

The way forward

Although contact shielding during dento-maxillofacial imaging is no longer recommended, the AAOMR highlighted the importance of following other radiation safety principles and devoting careful attention to appropriate patient selection and procedure optimisation. Safety precautions include minimising the radiation dose to the patient and the surroundings to a level as low as reasonably achievable.

In light of the recommendations, the AAOMR urges state and local authorities to update their regulations. Additionally, the researchers encourage the oral healthcare team to effectively communicate the rationale behind the discontinuation of protective shielding during dental radiograph procedures and to explain its factual lack of benefit for the patient.

The position statement outlining AAOMR’s recommendations, titled “Patient shielding during dentomaxillofacial radiography”, was published in the September 2023 issue of the Journal of the American Dental Association.