Getting to know the ADA’s new X-ray recommendations

The American Dental Association (ADA) recently announced new recommendations for ordering dental X-rays. The ADA Council on Scientific Affairs assembled an expert panel to update the 2012 ADA and FDA recommendations. Erika Benavides, DDS, PhD, a clinical professor of dentistry at the University of Michigan School of Dentistry, served as chair of the panel.

Dr. Benavides sat down with Dental Bite to talk about how the new recommendations were developed and how they could be adopted in clinical practice.  

—Interview by Carrie Pallardy, edited by Bianca Prieto

Can you share insight into your involvement in the study that updates the ADA’s recommendations for dental x-rays?

We had a lot of support from the ADA staff. They were instrumental in identifying the articles that we were going to use to support the recommendations. We were meeting regularly for a few years. It has been a long process.  

Can you tell me more about the literature you reviewed and how it led to new recommendations?  

We were interested in the articles that were published in the last 10 years to see if there were any new recommendations or any new updates to the information that we had previously. That was one of the criteria. Then, we concentrated specifically on systematic reviews with strong evidence. 

The recommendations from 2012 did not include cone beam CT for patient selection; we wanted to include patient selection criteria for CBCT.  

We also knew in the medical field, the lead apron was no longer used. We wanted to review all of the literature related to that. We're recommending the discontinuation of the use of the lead apron and the thyroid collar; that was additional information included in these updated recommendations.

The previous patient selection recommendations were based mainly on caries risk. We wanted to include a periodontal disease risk as well. 

How do you think dentists can communicate these new recommendations to their staff and patients? 

We know it's going to take some time to implement the new recommendations, particularly discontinuing the use of the lead apron and thyroid collars because those have been used since the 1950s. It's something that is well established, and it's an expectation of patients.

If the state laws require the use of the lead apron, those take precedence over these recommendations. Even if some dentists want to adopt the new recommendations, they may not be able to, depending on the laws that they have in the particular state where they practice.  

Of course, if you're going to make a change in your practice, you should first believe in that. It takes some time to digest the evidence and to fully understand, “Why am I doing this? Do I feel comfortable explaining this to my staff and to my patients?” 

Dentists may have to reevaluate their workflow. I know there are some practices where the patient comes in and the very first thing they do is take radiographs, and then they see the dental hygienist or the dentist. But we are strongly recommending that it should be the opposite order. The patient should be seen, even if the radiographs are going to be ordered. They should be seen first. The decision to obtain radiographs should be based on the clinical findings, on the specific patient’s needs.

That's also going to take some time and adjustment. Some dentists may be resistant to that because they have been practicing for years. The patient comes in, and they take radiographs. They may argue, “But I need the radiographs anyway.” That may be true, but the decision to obtain radiographs should be based on the clinical exam. 

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Dental Bite is curated and written by Carrie Pallardy and edited by Bianca Prieto