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Background | Resources | Articles



Background


The guidelines titled "The Selection of Patients for X-Ray Examination” were first developed in 1987 by a panel of dental experts convened by the Center for Devices and Radiological Health of the US Food and Drug Administration (FDA). The development of the guidelines at that time was spurred by concern about the US population's total exposure to radiation from all sources. Thus, the guidelines were developed to promote the appropriate use of x-rays. The guidelines have served dentists and other interested parties well during the subsequent 15 years. In 2002, the American Dental Association, recognizing that dental technology and science continually advance, recommended to the FDA that the guidelines be reviewed for possible updating. The FDA welcomed organized dentistry's interest in maintaining the guidelines, and so the American Dental Association undertook this review.

The initial review of the guidelines was carried out by an informal work group, made up of representatives from the American Dental Association, the Academy of General Dentistry, the American Academy of Oral and Maxillofacial Radiology and the FDA. The draft of recommendations produced by the informal work group was then reviewed by representatives of dental specialties, including the American Academy of Pediatric Dentistry, the American Association of Endodontists, the American Academy of Periodontology, the American College of Prosthodontists and the American Association of Orthodontists, and was sent to the American Association of Oral and Maxillofacial Surgeons and Association for Public Health Dentistry for comment. The final draft was then submitted to the FDA for its consideration and was accepted in November 2004.

(Source: US FDA)

These guidelines address the use of thyroid shields or collars when taking dental radiographs.

Once a decision to obtain radiographs is made, it is the dentist's responsibility to follow the ALARA Principle (As Low as Reasonably Achievable) to minimize the patient's exposure to radiation. Examples of good radiologic practice include:

• use of the fastest image receptor compatible with the diagnostic task;

• collimation of the beam to the size of the receptor whenever feasible;

• proper film exposure and processing techniques; and

• use of leaded aprons and thyroid collars.

The amount of scattered radiation striking the patient's abdomen during a properly conducted radiographic examination is negligible. However, there is some evidence that radiation exposure to the thyroid during pregnancy is associated with low birth weight. Protective thyroid collars substantially reduce radiation exposure to the thyroid during dental radiographic procedures. Because every precaution should be taken to minimize radiation exposure, protective thyroid collars and aprons should be used whenever possible. This practice is strongly recommended for children, women of childbearing age and pregnant women.

(Source: US FDA)


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Resources

The Selection of Patients for Dental Radiographic Examinations Revised 2004 AMERICAN DENTAL ASSOCIATION
Council on Dental Benefit Programs
Council on Scientific Affairs U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Food and Drug Administration
Thyroid shields and neck exposures in cephalometric radiography The thyroid is among the more radiosensitive organs in the body. The goal of this study was twofold: (1) to evaluate age-related changes in what is exposed to ionizing radiation in the neck area, and (2) to assess thyroid shield presence in cephalometric radiographs.
X-Rays (Radiography) From the ADA.

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Articles

Should thyroid shields be mandatory? A recent episode of the "Dr. Oz Show" raised more questions than it answered regarding whether thyroid collars should be mandatory when having radiation-based procedures such as dental x-rays or mammograms.
Thyroid Fears Aside, That X-Ray's Worth It It doesn't take much to scare people when it comes to cancer, especially when the cause, unlike smoking, seems beyond one's control.
Does radiation from dental X-rays cause thyroid cancer? Conditions Expert Dr. Otis Brawley Chief Medical Officer, American Cancer Society.
Dr Oz Dental Xrays Dr Oz and Dr Ada Cooper discuss dental xrays and the use of the thyroid.


The Increase in Thyroid Cancer

The Dr. Oz Show.

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