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How dangerous is x-ray at the dentist?

How dangerous x-rays are at the dentist?

The dentist has various diagnostic options for examining his patients. After an introductory discussion in which the patient describes his symptoms, the status of the teeth and gums can first be determined by means of a visual examination. Here, inflammation of the gums or external damage to the teeth can be detected, but the dentist is unable to look deeper into the jaw. The vital condition of the teeth can be determined by a simple cold test, but this also does not provide reliable information about how it looks inside the tooth or at its root. Even tooth decay in the interdental spaces is not always visible, but can still lead to problems and pain that need to be treated.

In order to get an impression of the jaw, the roots of the tooth and the condition of the teeth, dentistry uses X-ray diagnostics. This is an imaging process in which the teeth are briefly X-rayed with electromagnetic waves. The rays then form the image of the teeth on a special X-ray film or a digital imaging plate and thus give the dentist an insight into the underlying tissue.

X-rays are not harmless

X-rays are ionizing radiation, which is also emitted by radioactive substances. If it acts on the body in high doses or for a long time, this can promote the development of cancer. In order to protect the patient from excessive radiation exposure, he must put on a lead apron that blocks the radiation before the examination. Modern digital X-ray systems, such as those used in many dental surgeries today, additionally reduce the radiation exposure, since they no longer need an X-ray film, but measure the X-ray radiation directly behind the patient’s head and convert it into a digital X-ray image. This not only reduces the radiation dose that affects the patient during an examination, but is also advantageous for the dentist, since the X-ray images generated in this way are available digitally and can thus be used directly on the computer.

In general, the radiation exposure to X-rays depends on various factors: the type and age of the X-ray machine, the duration of the exposure and radiation, the scope and size of the area to be X-rayed. The load is given in the microsievert unit, with the dangerous limit being 100,000 microsieverts per year. For comparison: An analog orthopantomogram (OPG), i.e. the semicircular complete image of the upper and lower jaw, loads the organism with an average of 50 microsieverts, the analog X-ray of a single tooth represents an average radiation exposure of 5 microsieverts. Digital X-rays can be taken the radiation dose can be significantly reduced again, by up to 90 percent in modern devices.

A study from the USA is causing uncertainty

Even if the radiation doses for X-rays are far below the limits that are considered dangerous, many patients are unsettled. Indeed, experts advise not to take X-rays more frequently than is absolutely necessary to minimize radiation exposure. A study published by the University of Yale in 2012 in the specialist magazine "Cancer" also describes possible risks associated with dental X-rays: To this end, the scientists examined almost people and established a connection between X-ray examinations at the dentist and the occurrence of meningiomas (benign brain tumors).

According to the findings of the study, people who would be x-rayed at the dentist once or several times a year are three times as likely to develop a meningioma. The risk is even greater among children under ten years of age, and the scientists assume that the risk is five times higher. The OPG examination is considered to be particularly critical, but they also determined a risk increased by a factor of 1.4 to 1.9 when X-raying individual teeth.

Although meningiomas are not an aggressive cancer, these tumors are not harmless: they can grow over time and press on the brain, causing headaches, memory problems, and personality changes. When such a meningioma is identified and discovered, often only surgical removal helps to relieve pressure and protect the brain.

So it’s better to completely do without X-rays?

Even if the study suggests that excessive x-rays pose a potential risk to the patient, the researchers do not recommend doing without this important diagnosis. Rather, the recommendation is to exercise more restraint in X-rays and to limit X-rays, whether analogue to film or in digital form, to the absolutely necessary extent.

X-ray diagnostics is indispensable, especially in dentistry, because tooth and bone structures can only be made visible using X-rays. Those who do not do so due to fear of excessive radiation or possible damage to health risk other problems, such as loss of teeth or damage to bones and gums.

It is therefore better to deal with the risks consciously and to classify them correctly: The same radiation exposure as with X-rays also arises during a flight of several hours. The natural radioactive radiation to which people are exposed, for example due to natural uranium deposits in the earth, statistically corresponds to a daily OPG at the dentist. Of course, an OPG at the dentist increases this burden, but this additional burden is also directly related to the diagnostic benefit.

Anyone who is still unsure should speak openly to their dentist about their own insecurities and fears. If a dentist changes, for example after a move, the new dentist should be informed about current X-rays so that he can request the images from his colleague and use them for his own diagnosis. If, according to his assessment, new recordings are nevertheless necessary, he should be able to justify this in an understandable manner and inform the patient about the risks.

And of course, large OPGs, i.e. X-rays of the entire jaw, should only be taken if they are absolutely necessary. This is usually the case with the medical history or with extensive interventions at various points in the jaw. If, on the other hand, only a single tooth or two adjacent teeth need to be examined, a detailed picture of the affected area is sufficient, which the patient can and should request.

Conclusion: It doesn’t work without deeper insights

Modern X-ray diagnostics are indispensable for jaw surgery such as the extraction of wisdom teeth, the treatment of the root canals or the insertion of an implant. An x-ray is also required for the diagnosis of deep-seated caries in order to determine the correct treatment and to keep the tooth as long as possible. Therefore, patients should weigh up with the dentist whether an X-ray is necessary and sensible and whether they are not generally denied.

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Christina Cherry
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