New medical research continually changes and adjusts the way physicians practice medicine and treat patients. Dentistry is no different. Evidence-based recommendations in dentistry are based on high-quality studies that undergo rigorous review. As new research emerges, changes to patient care must be made to align our practice with the science and ensure we are providing the highest-quality care possible. When patients are accustomed to a certain experience at the dentist, a change to that experience can sometimes, understandably, cause discomfort.
I would like to share a new, evidence-based recommendation in dentistry that might make you feel a little uncomfortable when you first hear it: Newest guidance out of the American Academy of Oral and Maxillofacial Radiology recommends “discontinuing shielding of the gonads, pelvic structures, fetuses…and thyroid” during all dental radiographic exposures.
You might be thinking, “Wait, did Dr. Harris just say no aprons for dental x rays?” Yes, I did. Dentists no longer need to place an apron on you when you come in for dental x rays. The use of an apron, called shielding, is a long standing practice in dentistry. The historical rational for apron use was to reduce the risk of radiation-caused hereditary effects and damage to critical organ DNA.
For decades, dentistry used aprons to reduce the risk of radiation. In the past, it was true that film radiographs (an x ray imaging technique) resulted in a higher dose of radiation exposure. Recommendations made by the International Commission on Radiological Protection in the 1950s and 1960s resulted in routine use of aprons to reduce all types of ionizing radiation.
Fast forward to 2023 and the age of digital dentistry. X ray imaging is now done digitally rather than using film radiographs, resulting in exponential reductions in patient radiation exposure. In fact, this reduction in radiation exposure is so
dramatic that a patient’s exposure to ionizing radiation during dental x ray imaging is negligible compared to the daily radiation exposure of simply walking around outside. Consequently, the scientific rational for using aprons was questioned and researched. Here is what I found in the new research:
• Aprons do not protect against internal scatter radiation. This means that anytime a beam of radiation hits something it can’t go through, it bounces off it. If scatter beams get caught under an apron, it may actually increase radiation to the body.
• The minimum amount of radiation that causes cancer or damages human embryo or fetus tissue is several thousand-fold higher than the fetal doses exposed from digital x rays.
• There is no added benefit to shielding breast and thyroid tissue.
• Apron use may increase artifacts that distort dental x rays, requiring retakes or impeding diagnosis.
• Apron use may increase risk of the spread of bacteria or viruses from one person to another if the apron is not cleaned well enough.
The next time you go to the dentist, you may or may not have an apron placed on you. Talk to your dentist about what feels best for you, but know that in accordance with the latest research, dentists will slowly start removing the apron (shielding) except in special circumstances.
If you have further questions, please reference the National Council on Radiation Protection Measurements (NCRP) Statement No 13, No. 177, The American Association of Physicists in Medicine, The British Institute of Radiology, the American Academy of Oral and Maxillofacial Radiology, and the Journal of the American Dental Association Vol 154 Issue 9 September 2023.
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