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Should X-Rays Ever Be “Routine”?

Posted Dec 17 2010 9:03am

X-ray imaging is an important diagnostic tool in dentistry. Letting the dentist see “hidden” areas such as the roots, between teeth and under fillings and other restorations, x-rays help your dentist spot any decay or other problems early on, when treatment is usually much less involved and less expensive. They also let dentists better track tooth development and note bone loss or other problems unseeable by the naked eye.

Digital x-rays are even more helpful. We can see the images instantly, compare across time more easily and enlarge, brighten or otherwise adjust the images to help us get the best understanding of a person’s dental condition. Best of all, they use much less radiation than film x-rays, and this is important. In a world in which we’re already subject to all kinds of radiation from wired and wireless electronic devices, anything we can do to reduce the total amount of exposure is welcome.

So, in addition to using digital imaging in our office, we also take fewer x-rays, only doing so when they’re clinically called for. They are never “routine.”

While many other dentists take this route, far from all do. In fact, according to a story in the New York Times, some orthodontists and other dental specialists are embracing a new, high-radition form of imaging.

Designed for dental offices, the device, called a cone-beam CT scanner, provides brilliant 3-D images of teeth, roots, jaw and even skull. This technology, its promoters say, is a safe way for orthodontists and oral surgeons to work with more precision and to identify problems that otherwise might go unnoticed.

But there is little independent research to validate these claims. Instead, the cone beam’s popularity has been fueled in part by misinformation about its safety and efficacy, some of it coming from dentists paid or sponsored by manufacturers to give speeches, seminars and continuing education classes, as well as by industry-sponsored magazines and conferences, according to records and dozens of interviews with dentists and researchers.

Last month, the Journal of the American Dental Association allowed one of the leading cone-beam manufacturers, Imaging Sciences International, to underwrite an issue devoted entirely to cone-beam technology. That magazine, which the association sent to 150,000 dentists, included a favorable article by an author who has equated a cone-beam CT with an airport scan. In fact, a cone beam can produce hundreds of times more radiation, experts say.

Is the quest for profits overriding patient safety? There’s an ovious financial incentive for making cone beam imaging routine. While the machines are expensive – costing up to a quarter of a million dollars – dentists can (and do) charge several hundred dollars per scan. The more scans, the quicker they can pay for the machine and start turning a profit.

It’s important to note that the technology has it’s uses, particularly in complex cases.The problem is when it becomes the default mode of imaging.

“I use my i-CAT for everything,” one orthodontist, Dr. Edward Y. Lin, proclaimed in a full-page advertisement in one magazine.

“I cringe every time I see that ad,” said Dr. Farman, the radiology academy president and a professor at the University of Louisville School of Dentistry.


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