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Latest recommendations for dental radiography in general dental practice.Figure 4: The X mark the regions where minimumscatter radiation occurs, 45° to the beam as it exits thepatient. Maximum exposure occurs as the beam exitsthe patient and also straight back towards the X-raytubehead.Figure adapted from Thomson M E. Radiation SafetyUpdate. www.contemporaryoralhygieneonline.com/issues/articles/2006-03_03.asp. Accessed 28.02.08Staff protectionNational Council for Radiographic Protection 16 inUS has specified the mean dose received by dental workersas 0.2mSv per year. In UK, National RadiographicalProtection Board 2 estimates the mean dose of 0.1mSv peryear. International Council on Radiographic Protectionhas set the effective dose to be no more than 100 mSvin any consequent 5 years with a maximum of 50mSv inany year 48 . These figures are way above the mean dosein a typical dental practice. Therefore staff monitoringby personal dosimeter is not required unless the riskassessment indicates that individual doses are likely toexceed 1mSv per year (workload above 100 intraoral or 50panoramic per week).Medical examination for dental practitionersProtective Leaded ApronsLeaded apron for patients were recommended whendental X-ray equipment was much less sophisticated. Thiswas when poorly collimated, unfiltered dental X-ray dosesused were in the range of 50mGy (equivalent to 50mSv)50. Currently gonadal doses from panoramic or full mouthintraoral examination do not exceed 5µGy (equivalent to5µSv) 3 . In an another study by Saini et al 51 , they foundthe average registered dose in the gonadal region around0.8mrad (8 µSv) for 20 consequent intraoral exposures and0.21mrad (2.1 µSv) for panaromic exposures 51 .Moreover, lead aprons do not provide protectionfrom scattered radiation internally within the body. Incases of panoramic radiography, they may physicallyinterfere with the procedure and degrade the final image 36 .However leaded apron is necessary for any adult whoprovides assistance by supporting the patient and will bein the same room as the patient during the procedure.Thyroid CollarThyroid collar is recommended for childrenand pregnant patients 16,27 because the thyroid gland isparticularly radiosensitive and occasionally is in the wayof the primary beam. Interestingly studies have shown thatrectangular collimation for intraoral radiography offerssimilar level of thyroid protection to leaded shielding, inaddition to its dose reducing effects 32,36 . Thyroid shielding isinappropriate for panoramic radiography as it may interferewith the primary beam. In cephalometric radiography, leadthyroid protection is necessary if the beam collimationdoes not exclude the thyroid gland 52 . Guidelines from theMinistry of Health Malaysia 47 state that thyroid collars tobe used where the thyroid may be in the primary beam.This may be in vertex occlusal view which is very rarelytaken nowadays.According to the Atomic Licensing Act 1984 53 thedental practitioner who operates the X-ray machine isrequired to undergo a complete medical examination beforeusing the radiography machine. This examination whichincludes a chest radiograph, needs to be repeated every 3years until the dentist retires or if there is any abnormalitiesdetected 54 . We could not find any evidence to support thispractice. As mentioned before, the radiation dosage fromdental X-ray is very low and the medical practitionerwould not be able to detect any abnormality during thisexamination. Therefore this additional irradiation on thedental surgeon is indeed unnecessary.CONCLUSIONExposure to any form of ionizing radiation can bedangerous to health and this includes dental radiography.Fortunately the relative risks associated with dentistry arevery low. If the recommended guidelines are followed, ourexposure to radiation can be minimized and traditionalprotection like the lead lined rooms and lead aprons canbe abandoned. This is however dependent on the policymakers at the Ministry of Health.Summary of the new recommendations that are proposed:• Rectangular collimation.• F speed film / Digital Systems• Rare earth intensifying screen for extraoral films withfilm speed of more than 400 (Image speed system).• ‘DC’constant potential X-ray machines.• Long open ended cone ( at least more than 200 mm skinto source distance)• 60 to 70 Kvp for intraoral radiographs.• Use of paralleling technique with film holder forintraoral radiographs.Disclaimer: Practitioners are advised to follow the currentregulations set by the Ministry of Health regarding theuse of dental radiography machines until if there areany changes. The above report is merely for updatingknowledge regarding radiation reduction and protectionprocedures for both the patient, staff/dental surgeryassistants and the dental surgeon without compromisingthe diagnostic quality of radiographs.110
Kathiravan / PhrabhakaranREFERENCES1. Whaites E. Essentials of dental radiography and radiology.4th ed. Churchill Livingstone 2006.2. National Radiological Protection Board. Guidance notesfor dental practitioners on the use of X-ray equipment.Department of Health London. 2001.3. European Commission. European Guidelines on RadiationProtection in Dental Radiology. The safe use of radiographsin dental practice. Luxemborg 2004. Radiation Protection136.4. Gijbels F R, Jacobs G, Sanderink E, De Smet B, NowakJ, Van Dam and Van Steenberghe D. A Comparison of theeffective dose from scanography with periapical radiography.Dentomaxillofac Radiol 2002, 31: 159-63.5. Dula K R, Mini P F, Van Der STelt and Buser D. Theradiographic assessment of implant patients: decision makingcriteria. Int J Oral Maxillofac Implants 2001. 16: 80-96. Maillie H D and Gilda J E. Radiation induced cancer risk inradiographic cephalometrcy. Oral Surg Oral Med Oral Pathol1993. 75:631-77. Scarfe W C, Farman A G. Clinical application of cone beamcomputed tomography in dental practice. J Can Dent Assoc2006; 72(1): 75-808. Osibote O A, Azevedo De A C P. Estimation of adult patientdoses for common diagnostic X-ray examinations in Rio DeJaneiro, Brazil. Physica Medica 2008; 24 : 21-289. Napier I D. Reference doses for dental radiography. B DentJour 1999; 186 (8): 392-39610. Sasaki M S, Ejima Y, Tachibana A, Yamada T, Ishizaki K,Shimizu T, Nomura T. DNA damage response pathway inradioadaptive response. Mutat Res 2002; 504 : 101-11811. Johansson L. Hormesis, an update of the present position. EurJ Nucl Medicine and Molec Imagi 2003; 30 (6) 921-93312. Nambiar P and Lim S C. The practice of dental radiographyin general dental clinics in two states in Malaysia. MDJ 2002.23 (2): 89-9313. American Dental Association Report. The use of dentalradiographs. Update and recommendations. J Am Dent Assoc2006. 137: 1304-1214. Faculty of General Dental Practitioners, Royal College ofSurgeons, London. SAMS guidelines 199815. Rushton V E, Horner K and Worthington H M. Screeningpanaromic radiography of new adult patients in general dentalpractice: diagnostic yield when combined with bitewingradiography and identification of selection criteria. Br Dent J2002. 192: 275-27916. National Council for Radiographic Protection & Measurements.Radiation protection in dentistry. Bethesda, Md.: NationalCouncil for Radiation Protection & Measurements; 200317. Preventing Dental Caries in Children at High Caries Risk.A National Clinical guideline. Sign Publication number 47.www.sign.ac.uk. Accessed 20.12.0718. Isaacson K G and Thom A R. Guidelines for the use ofradiographs in Clinical Orthodontics 2nd Edition. BritishOrthodontic Society, London. 200119. Luke L S, Lee P, Atchison K A and White S C. Orthodonticresidents’ indications for use of the lateral TMJ tomogramand the posterior anterior cephalogram. J Dent Edu 1997. 61:29-3620. Tugnait A, Clevehugh V and Hirschmann P N. The usefulnessof radiographs in diagnosis and management of periodontaldiseases, a review. J Dent 2000. 28: 219-22621. Fava L R D and Dummer P M H. Periapical radiographictechniques during endodontic diagnosis and treatment. IntEnd J 1997. 30: 250-26122. American Dental Association council on scientific matters.An update on radiographic practices. Information andrecommendations. J Am Dent Assoc 2001. 132: 234-823. Bohay R W, Stephens R G and Kogon S L. A study of theimpact of screening or selective radiography on the treatmentand post delivery outcome for edentulous patients. Oral SurgOral Med Oral Pathol Oral Radiol Endod 1998. 86: 353-924. Rushton V E, Horner K and Worthington. Aspects ofpanaromic radiography in general dental practice. Br Dent J1999. 186:342-425. Dental Protection. The whole tooth and nothing but the tooth.Dental News 1999. 20:7-826. Wood R E, Harris A M P, Van Der Merwe J and Nortje` C J.The leaded apron revisited: Does it reduce gonadal radiationdose in dental radiology? Oral Surg Oral Med Oral Pathol1991. 71: 642-4627. Hujoel P P, Bolden A M, Noonan C J and Del Aquila M A.Antepartum dental radiography and infant low birth weight. JAm Med Assoc 2004. 291(16) : 1987-9328. Bernt R L. Commentary on JAMA article by Hujoel et al.Health Phys 2005. 88(4): 379-38129. Smith N J. Selection criteria for dental radiography. Br DentJ 1992. Sep 5; 173(4): 120-130. Espelid I, Mejare I and Weenheijm K. EAPD guidelines foruse of radiographs in children. Eur J Ped Dent 2003. 1: 40-4831. White S C, Pharoah M J. Oral Radiology Principles andInterpretation. 5th ed. St. Louis, Mo: Elsevier; 2003: 161.32. Horner K. Review article on Radiation Protection in DentalRadiology. Br J Radiol 1994. 67: 1041-933. White S C, Pharoah M J. Oral Radiology Principles andInterpretation. 5th ed. St. Louis, Mo: Elsevier; 2003: 161.34. Whaites E and Brown J. An update on dental imaging. BrDent J 1998. 185(4): 166-17235. Cederberg R A, Frederikson N L, Benson B W and SokolowskiT W. Effect of the geometry of the intraoral position indicatingdevice on the effective dose. Oral Surg Oral Med Oral PatholOral Radiol Endod 1997. 84: 101-936. Hirschmann P N. Guidelines on radiology standards forprimary dental care. Royal College of Radiologists and TheNational Radiological Protection Board. Br Dent J 1995. 178: 165-737. Tsiklakis K C, Bakoyanni D, Tassopoulou M andKamenopoulou V. Absorbed radiation dose during lateralcephalometric radiography. Comparison of screen-filmsystems and field-size combinations. J Clin Ped Dent 2000.24: 117-2138. Sevenson B and Petersson A. Questionnaire survey on theuse of dental X-ray film and equipment among generalpractitioners in the Swedish Public Dental Health Service.Acta Odont Scand 1997. 53: 230-539. Emmott L. M. Making sense of sensors. www.drlarryemmott.com/pdfs/Emmott 0302.pdf accessed 18.2.0840. Paurazas S B, Geist J R, Pink F E, et al. Comparison ofdiagnostic accuracy of digital imaging using CCD andCMOS-APS sensors with E-speed film in the detection ofperiapical bony lesions. Oral Surg Oral Med Oral Path OralRadiol Endod 2000; 89(3): 356-6241. Fossum E R. Active pixel sensors: Are CCDs dinosaurs?International Society of Optical Engineering (SPIE) 1993;1900 : 2-14111
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