The use of X-rays to aid in diagnosis is a standard of care. However, the FDA and ADA recommend that dental X-rays be taken only after a clinical examination of the patient has determined that X-rays are needed, and that a thyroid collar and apron be used when X-rays are taken of children or of women of childbearing age.

Some patients refuse to have X-rays taken because they perceive a risk from radiation exposure. Oral health professionals should explain the risk of undiagnosed disease that can result from refusing X-rays. Note all discussions, the patient’s decision, and any actions taken in the patient’s record.

Obtaining the patient’s informed refusal does not relieve the dentist or the clinic of their legal and ethical duty to treat within the standard of care. (For more information, see module 5, Informed Refusal.) A patient has a limited right to dictate the terms of his or her care, but this does not include consenting to substandard treatment. Treating many oral health problems without X-rays would be considered substandard care. If you are unable to convince the patient of the necessity of X-rays, the clinic has the right to terminate treatment. (For more information, see module 5, Avoiding Wrongful Termination of Care and Patient Abandonment.)

In 1981, Congress passed the Consumer-Patient Radiation Health and Safety Act, which aims to protect the public from the hazards of unnecessary X-rays. Currently, 35 states, including Ohio, have established licensure laws for radiologic personnel. In Ohio, dentists and dental hygienists are permitted to expose radiographs as part of their training and licensure, but dental assistants must be certified by the Ohio State Dental Board. The Ohio Department of Health licenses dental X-ray equipment.

ADA’s Council on Scientific Affairs published, The Use of Dental Radiographs, which discusses implementation of proper radiographic practices, including patient-selection criteria, equipment, quality assurance, and continuing education of oral health professionals who are exposed to radiographs.

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