Is it true that the radiation dose to which patients are exposed has decreased with modern radiographic films?

Radiographic Examination before Dental Extraction from Dentists' Perspective

Background

It is generally agreed that radiographic examination is important before dental extraction. It provides information about the roots and the surrounding tissues. In terms of practice, it does not seem to be a universally implemented protocol regarding the use of dental radiology before dental extraction. Besides, the type of radiographic technique is not specified. Some references prefer periapical dental radiographs. Others prefer orthopantomography), or even cone beam computed tomography Delpachitra et al. (2021) [1]. In terms of the dental practice, it is not clear whether there is a universally adopted protocol regarding the use of dental radiographs before dental extraction. Aim of the study. To assess dental professionals' perspective toward radiographic examination before conventional dental extraction.

Materials and Methods

A Google form questionnaire was circulated to different dental professionals using mainly ResearchGate, in addition to different social media platforms.

Results

One hundred and forty-five dentists participated in the questionnaire. The respondents were divided according to the country of current practice: national (Iraqi), regional (Middle Eastern), and international participants. Out of 144 respondents, 51.4% percent of the participants were international, while 40.3% were Iraqis, and 8.3% were from the Middle East. The need for dental radiography in all dental extraction procedures was reported in the majority of responses (n = 86). Only 11 dentists think there is no necessity for radiographic examination before conventional extraction. The chi-square test showed a highly significant relationship between the country of current practice and the need for X-ray examination for conventional dental extraction (P < 0.01). Seventy-six dentists prefer periapical radiographs. Thirty-five preferred orthopantomography. A highly significant relationship was found between the country of practice and the X-ray technique (P < 0.01).

Conclusion

The study showed that there is no universally adopted protocol regarding the use of dental radiography before dental extraction. The country of practice appears to govern the dentists' decisions regarding the need for an X-ray and the type of radiography prior to dental extraction. Periapical radiographs for posterior teeth seem to be the preferable choice before dental extraction.

EFFECTIVE DOSES AND RADIATION RISKS FROM COMMON DENTAL RADIOGRAPHIC, PANORAMIC AND CBCT EXAMINATIONS

This study was aimed at the estimation of the effective doses and radiation risks from dental X-ray examinations based on the data collection in St. Petersburg and the Leningrad Region. The range of mean values of effective doses for intraoral examinations on the X-ray units with film detectors was from 3.5 to 8.2 μSv and for the units with digital detectors-from 1.2 to 2.5 μSv. The mean effective doses for panoramic examinations were 22.9 μSv and for cone-beam computed tomography (CBCT)-530.6 μSv, respectively. The highest detriment-adjusted lifetime risk values were estimated for the 20-24-year-old age group: 40.8 × 10-6 in females and 32.7 × 10-6 in males for CBCT. Effective doses in St. Petersburg and Leningrad region were comparable or higher compared with the published data.

Radiology of Dental Caries

Dental caries is a dynamic, preventable, reversible, complex biofilm-mediated, multifactorial disease that involves a series of demineralization/neutrality/remineralization of dental hard tissue in primary and permanent dentition. An imbalance in the continuum with a net demineralization over time results in the initiation of caries lesions. Visual inspection and intraoral radiographs are vital in caries detection, although they are of suboptimal sensitivity for early caries lesions. Shifting toward a conservative, noninvasive approach to caries management has resulted in the development of innovative-sensitive technologies. These newer techniques may serve as adjunct for the dental practitioner in detecting earliest changes in tooth structure.

DOSE REFERENCE LEVELS IN SPANISH INTRAORAL DENTAL RADIOLOGY: STABILISATION OF THE INCORPORATION OF DIGITAL SYSTEMS IN DENTAL CLINICAL PRACTICES

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems.

Evolution of diagnostic reference levels in Spanish intraoral radiology

A total of 16 175 official reports of quality assurance on dental radiodiagnostic surgeries from 16 Spanish autonomous regions compiled during 2002-09 were studied to determine the evolution of diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice in Spanish dental clinics. A DRL of 3.1 mGy was set in 2009, which represents a 35.4 % decrease compared with the dose determined in 2002 (4.8 mGy). During the same period, the mean dose fell by only 17.2 %. The DRL recommended by the European Union in 2004 for intraoral radiology is 4 mGy, and this study shows that 83.4 % of the installations used a dose below this. Of the installations using indirect or direct digital systems 1.1 and 1.2 %, respectively, used doses higher than those recommended, while 14.2 % of those using radiographic film exceeded this limit.

Compliance of Iranian dentists with safety standards of oral radiology

OBJECTIVES

Dentists use radiographs in their daily practice. Their knowledge and behaviour towards radiographic examination can affect patients' exposure to radiation. The aim of this study was to survey the knowledge and behaviour of Iranian dentists regarding oral radiology safety standards.

METHODS

1000 questionnaires were given to the participants of the 48th Annual Congress of the Iranian Dental Association, of which 700 were returned. The participants were asked about demographic data, primary knowledge of radiation protection, selection criteria, radiographic equipment and technique, methods of patient and personnel protection and management of radiographic waste. Descriptive analysis of data was performed.

RESULTS

44% of respondents said the initial radiograph they took was of the periapical view of a limited area. 12% preferred the periapical paralleling technique. F-speed film was used by 9% and E-speed film by 62%. Only 2% had digital receptors. Proper exposure time was selected by 26.5%. The use of long and rectangular collimators was 15% and 6%, respectively. 34% occasionally covered their patients with both thyroid shields and lead aprons. 36% used the position and distance rule correctly for their own protection. Proper disposal of the used processing solutions and the lead foils were done by only 1% and 3%, respectively.

CONCLUSIONS

It can be concluded that the majority of dentists in the study group did not select the proper method, material and equipment in order to minimize the exposure of their patient to unnecessary radiation in dental radiography.

The status of Spain's dental practice following the European Union directive concerning radiological installations: 11 years on (1996-2007)

OBJECTIVES

The aim of this study was to assess the influence of European Union legislation on dental radiology practice in Spain and the reduction in doses administered in dental radiological installations 11 years after its introduction.

METHODS

A total of 19 079 official reports on dental surgeries from 16 Spanish autonomous regions published between 1996 and 2007 were studied. We analysed the physical characteristics of the X-ray units, anomalies, film processing, exposure times and mean radiation doses administered in clinical situations.

RESULTS

The dose applied to obtain a radiograph of an upper second molar had decreased by 37% up until 2007, the mean dose being 2.7 mGy, with 81.1% of installations using a dose of less than 4 mGy, with a reference dose for the 3(rd) quartile of 3.6 mGy. Of note was the incorporation of digital systems (50.1%), which are gradually replacing manual processing systems (45.3%). There were significant differences between the systems: direct digital radiology < indirect digital radiology = Insight = Ektaspeed = Ultraspeed (P < 0.001). In installations with digital systems, 6.3% used more than 4 mGy (20.5% with direct radiology and 3.2% with indirect radiology) and 7.4% a dose of less than 0.5 mGy, with a mean dose of 1.8 mGy and a reference dose for the 3(rd) quartile of 2.3 mGy.

CONCLUSION

There has been a gradual improvement in dental radiology practices; however, the incorporation of digital systems has not resulted in all the benefits hoped for, and mistakes are frequent. Besides the physical parameters that have been established, anatomical and clinical image quality criteria should be established to convince dentists of the real benefits of incorporating quality guarantee procedures in their practices.

Diagnostic reference levels in intraoral radiology: from the laboratory to clinical practice

To determine the diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice and to explain the differences between the levels found and the DRLs obtained in other experimental conditions, suggesting that there has been a reduction in the European Union (EU) recommended levels. A total of 2296 official reports on dental surgeries from 16 Spanish autonomous regions compiled during 2008 were studied. A mean DRL of 3.3 mGy was determined: 2.6 mGy for installations using direct digital systems, 3.4 mGy for those using indirect systems, 4.4 mGy for those using Ultra-speed film and 3.7 mGy for those using Insight. The DRLs found in this survey are below the EU recommended values but far above previously described values, possibly because all the different systems were considered and because values refer to those of the normal work conditions of clinical practice.