Is routine radiography for a new patient considered overtreatment?

Radiography should never be "routine." Like any medical test, radiography should be ordered only after clinical examination of a patient and when the history, a clinical sign or a symptom reveals a potential abnormality that cannot be investigated in any other manner. The results of the radiographic examination must be expected to influence diagnosis and treatment and, thus, the patient can be expected to receive a benefit from the exposure, which although minimal, is considered to carry some risk. With the many technologies now available in oral and maxillofacial radiology, the scope of radiographic examinations should be based on the size, location, perceived nature and accessibility of an abnormality. In some instances, conventional dental-type radiographs may be appropriate, while, in others, more advanced modalities may be necessary. There is no "one size fits all" imaging modality in dentistry.

The guidelines¹ for ordering radiographs in dentistry were published in 1991 following meetings of a consensus panel convened by the United States Food and Drug Administration several years earlier. The guidelines were developed as a protection measure to reduce radiation doses to patients without reducing the quality of their care. In 2004, the guidelines were revisited by a new consensus panel convened by the American Dental Association and the United States Department of Health and Human Services (Public Health Service and Food and Drug Administration). The publication² that resulted includes many evidence-based references supporting the efficacy of the guidelines in clinical practice, but with several minor modifications: namely, the use of radiography for recall patients with periodontal disease and the use of panoramic radiography.

The guidelines list 6 positive historical findings and 22 positive clinical signs or symptoms that may indicate the need for radiography.² It is important that dentists know and understand these 28 points and be able to recognize them in their patients, so that an appropriate selection of radiographs can be prescribed. The use of radiography in the absence of any presenting clinical sign or symptom as a "screening tool" for quiescent disease and the use of "periodic radiography" at predetermined time intervals (except for bitewing radiography) are not evidence-based practices in dentistry.

THE AUTHOR

Dr. Ernest Lam is associate professor and head, discipline of oral and maxillofacial radiology, faculty of dentistry, University of Toronto. Email: Ernest.Lam@dentistry.utoronto.ca

The author has no declared financial interests.