CNN Stirs the Pot

Elizabeth Landau is a health writer for CNN. She posted a blog article about some connections between dental x-rays and the increased risk of brain tumors. There was another article I studied about a year ago that covered the same essential issues. In this entry, Landau informs readers about connections between x-rays and meningiomas. I believe the same information was televised on ABC today.

Concerns about radiation exposure are well-founded. There is countless research that has been conducted to illustrate risks associated with x-rays. As a healthcare provider, my obligation is to exercise the best possible judgement about exposing my patients to any radiation. I have to be sure that the value of exposure outweighs the risks of not exposing patients. X-rays are a vital diagnostic tool for determining my patients' treatment choices. Non-maleficence and beneficence are my key criteria when ordering any tests or imaging. In some cases, I can diagnose problems and find solutions without the need for x-rays. I can also request imaging from other doctors to help patients avoid redundant x-ray exposure. Thes are all strategies that result in a win-win for patient exposure and their treatment planning.

Landau's article is pertinent, in that it reviews the latest findings in some outlying research about the effects of radiation on patients. But she suggests that we ask ourselves about the necessity of x-rays when it comes to our own care, as well the care of our children.

I feel something doesn't sit right about this article after I digested it a couple of times. I'm not sure why she quotes a Yale researcher as a clinical expert who describes her IMPRESSION of needless dental x-ray exposure, yet we don't see any evidence of overexposure published here. In my opinion, I'd like to see researchers make a connection between the number of doses and the presene of thyroid, brain, or head and neck cancers. I read quite a bit of literature on dental x-rays and the discussion is always focused on a commitment to minimize patient exposure, because radiation effects have already been established. In essence, Landau is presenting information we already know to be in existence, but she finishes the post with a call to action for parents to question the necessity of x-ray exposure for their children.

To me, this blog entry seems like a pot getting stirred. As a parent and a clinician, I know all patients are going to need diagnostics. Repeated exposures are the exception rather than the rule. Periodic exposure occurs in dentistry. But the reality is that most patients, including my kids and myself, will not require ROUTINE periodic exposure. There is a difference. And that difference is based on our risk for disease.

If you suffer from a skeletal or orthopedic disease like osteoporosis-induced skeletal fractures, you're going to have a greater number of periodic exposures to x-rays to measure bone damage and/or healing after treatment. Similarly, if you get cavities all the time, you're going to get more periodic exposures to identify emerging problems or the performance or integrity of previous treatment. If you have no cavities over the course of 3-5 years, your risk level of disease is relatively low. But, if you have recurrent or stubborn diseases, imaging and testing are tools to measure how your diseases are improving or worsening. In my practice, I don't routinely order x-rays every six months or even every 12. It's case by case, and always based on risk. And sometimes I can utilize x-ray records from other doctors. These are strategies that limit your exposure. The key here is that we're practicing evidence-based health care to determine a need for your x-rays. Non-maleficence, beneficence, jurisprudence are all in play.

Even with my emphasis on risk-based utilization of x-rays imaging, dentistry has further minimized exposure by using newer imaging technologies. Digital x-ray systems require significantly less radiation energy per exposure than historic equipment and techniques. Exposure times are reduced.

If you feel you or your family are being overexposed, please contact me here on the blog, or at chris@cascadiadentistry.com. I'd be happy to discuss any and all concerns or questions about this issue.