Preventative Diagnosis: The Conundrum of Dental X-Rays

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One of the most frequent questions I have received over the almost 34 years I have been practicing dentistry is, “Do I really need these X-rays?” Many people have concerns about cost, radiation and discomfort when taking X-rays, and the fact that they don’t like getting them, but there is always some underlying reason for someone refusing to allow a dental X-ray, and we have had a few over the years.

The state Dental Quality Assurance Commission and the ADA, along with other state regulatory boards, have come up with the latest guidelines which generally state that it is recommended to take dental X-rays in a timely manner which generally is one year for bitewing X-rays unless the patient is high risk (six months) or low risk (two years). These timelines can be fudged a little according to the doctor and patient’s discretion. We try to inform the patient of the benefits and risks associated with refusing treatment and the potential risks of X-rays. I would like to address a few of the reasons for refusal.


A series of 4 bitewings may cost up to $60 or less depending on the area in which you live. Since we can’t see decay many times hidden in the mouth, nor can we see changes to the bone levels or any other aspect prior to operating in the mouth, we need X-rays to visualize this, track the bone levels, see the calculus missed, see the decalcification of the enamel and decay into the enamel and other problems. Simply put, diagnosing and finding these earlier saves a ton of potential costs in the long run. We are a preventative-oriented practice. We like to catch things as early as possible to prevent the future high cost of restoring a tooth, with a dental implant or root canal/build-up and crown, which could cost up to $5,000 or more for one tooth replacement.


The new digital X-rays have reduced radiation down to almost zero. We placed a radiation badge on our assistant for three months recently and it came back at zero radiation. A series of 4 bitewings is 0.3 millisieverts and the normal background radiation from the sun and other things when you go outside is 300 millisieverts. Eating a peanut butter sandwich releases 0.12 pCi/gram of radiation from radioactive potassium-40, radium-226, and radium-228 or flying on an airplane gives you multiple times more than a dental X-ray. The recent ADA guidelines state that no person of any age or health status, including pregnancy, should wear a lead apron as it has been shown to not help, but actually make things worse by trapping the minimal scattered radiation and not allowing it to “fly off” but bounce back into the body. Europe was further ahead of us and stopped this practice years ago.

3-Complaint of Discomfort

We do our best to mitigate discomfort by using the sensors which are rounded, and using cotton and cushions and other things to help. We also have the phosphor plate X-rays which are thinner and more comfortable, and we can use the panoramic machine to take bitewing X-rays as a last resort, which we rarely have to do. So, there really should not be a reason to not follow the dentist’s recommendations and the latest guidelines from the ADA.

Signing a Consent Form 

In the past, if a patient refused, we would have them sign a consent form for refusal of dental X-rays. But even if they signed a release of X-rays, the courts do not accept this release. A patient is not an expert in the field. A doctor cannot accept supervised neglect. In other words, if a patient chooses to neglect themselves by refusing X-rays and the doctor allows it, the state considers it neglect by the doctor. If it has been three or four years and the patient refuses, we will need to make a notation in the patient record regarding the discussion and refusal. It may be that their needs would best be met in another office which would be at the discretion of the doctor and patient.

Call To Learn More

The good news is, that the new digital X-rays have made it possible to prevent and care for our patients in such a profound way and we use them as needed and not more, according to the latest guidelines, for the best care possible. If you have any questions about this or X-rays in general, please don’t hesitate to ask your dentist.

We welcome you to call Two Rivers Dentistry at 360-256-1202 to speak with one of our team members or schedule a visit with Dr. Vaughn Teuscher, our dentist in Vancouver, Washington.