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Lead shielding not needed during dental x-rays: ADA releases recommendations

Feb. 3, 2024
Learn about recommendations released by the ADA on the use of abdominal aprons or thyroid collars during patient x-rays, and what an ADA council chair tells DentistryIQ about the recommendations.

Per an expert panel established by the American Dental Association, it's no longer recommended for dental practitioners to use lead abdominal aprons or thyroid collars on patients when taking dental x-rays.

According to a press release on the recommendations released on Feb. 1, dental professionals are also advised to consider the diagnostic information needed from x-rays to benefit patient care or substantially improve clinical outcomes: “The central point of these recommendations is that clinicians should order radiographs in moderation to minimize both patients’ and dental professionals’ exposure to ionizing radiation,” said Purnima Kumar, DDS, PhD, chair of the ADA Council on Scientific Affairs, which established the panel that developed the recommendations.

After reviewing numerous published studies on radiography, notes the press release, the panel “determined lead aprons and thyroid collars are not necessary to shield patients from radiation exposure,” with evidence indicating that modern digital x-ray equipment that restricts the beam size to the area that needs to be imaged adequately protects patients against radiation exposure to other parts of their body.

What’s more, lead aprons and thyroid collars can also block the primary x-ray beam, preventing dentists from capturing needed imagery—a point emphasized in comments to DentistryIQ by Kumar, who also stressed that the recommendations pertain to secondary and scatter radiation and that ultimately, “each state has its own radiation safety guidelines and mandates that dentists should follow.”

The Council’s recommendations are aligned with those released by the American Academy of Oral and Maxillofacial Radiology in August 2023 that state in part that “On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging.”

The ADA recommendations were published in an article in the Journal of the American Dental Association (JADA) that states that “With the increasing availability of CBCT and digital-based imaging, the panel recommends that dental office staff members integrate the recommendations presented here, weigh the benefits of newer imaging technologies against radiation-specific risks (particularly for children), and conduct imaging procedures with an aim of obtaining optimal image quality at radiation doses that are as low as diagnostically acceptable.”

Other strategies to protect patients from unnecessary radiation exposure outlined in the press release include using digital instead of conventional x-ray film for imaging; restricting the beam size during an x-ray to the area to be assessed; and incorporating CBCT only when lower-exposure options won’t provide the necessary information.

What to tell patients

The new recommendations apply to all patients, regardless of age or health status (such as pregnancy). In terms of what to share with patients who might wonder or ask about a change at their dental office, Kumar told DentistryIQ that practitioners should share with them “the lines of evidence that argue against the need for lead aprons."

In “Lead shielding for dental x-rays: A thing of the past?” author Amanda Hill points to a question and fact sheet by American Association of Physicists in Medicine with suggested talking points for patients, adding that “For patients who still insist on a lead apron, that’s up to you, the provider. Ensure the placement won’t block the area and the shield is not detectable by the unit. However, be aware that inconsistent use can give the impression to patients of a lapse in proper care. Clear communication is essential as we adopt this change."

Access the full JADA study: Optimizing radiation safety in dentistry