X-rays–When are they Important?
X-rays–When are they Important?
by Bill Kuttler, DDS
“I don’t want any x-rays today.” and “Do you have to take x-rays today?” are probably the two most common comments or questions we hear every week. I don’t hear them very often from our existing patients because they know our rationale about taking x-rays, but I hear it a lot from new patients coming into our practice. When we discuss those concerns, most fall into three broad categories: cost, need, and radiation exposure.
In 2012 the American Dental Association revised their guidelines for taking x-ray films working with the U.S. government’s Federal Drug Administration. (http://www.ada.org/~/media/ADA/Member%20Center/FIles/Dental_Radiographic_Examinations_2012.ashx). They noted that multiple factors impacted when x-ray films should be taken: the patient’s age, symptoms, history (amount of previous problems, etc.), and the frequency of that person’s care, i.e., how often do they visit a dentist. For new patient adults the recommendation was for either a panoramic film and bite-wing radiographs (cavity detecting x-ray films) OR a full mouth series of films (about eighteen individual small films). For new patient children the recommendation varied widely based almost completely on the child’s age and existing conditions. For current patients the recommendations centered on problem-focused films, if necessary, and bite-wing films every six to thirty-six months based on the variables previously noted.
We all acknowledge that x-ray radiation is potentially harmful, although the amount of exposure to a person from dental films is very small compared to almost any other medical exposure. Indeed, we are exposed to far more radiation working outside all day than we are from dental films, but never-the-less, the more we can reduce that exposure the better.
The other area that has always intrigued me is the differences between what the ADA recommends and what the dental benefit industry allows payment for. While I understand that benefit plans attempt to cover an “average” need of the people they cover, those plans vary widely in what they do pay for. Some plans pay for a panoramic film or full mouth series of films as often as every three years while others only allow a single peri-apical film (a film that shows the whole tooth including the root) with a diagnosis of why it was taken. And bite-wing films are often allowed once a year, but not with every plan. My sense is that these plans institute their allowances for a variety of reasons related to marketing and expense control (leading to profit for them), but rarely with the patients’ best interests in mind.
In our practice we follow the ADA guidelines closely. We take initial films on new patients unless we can get reasonably current films from their previous dentist – then we sometimes don’t need to take any. For our existing patients we almost never take bite-wing films more frequently than once a year, and for most of them it is about once every two years or more. That interval allows us to monitor changes in their teeth and bone levels adequately without more frequent exposure. Then every six to twelve years we take a new panoramic film or full mouth series so we can evaluate the complete mouth more thoroughly.
So what is the cost? What I’ve learned from asking people is that the cost isn’t nearly as much as many people expect. Single films may cost somewhere between $10 and $30 each based on many variables while panoramic films often range in cost from $75 to $150. Many of our patients tell me that’s nowhere close to what they expected.
I think I’ve already addressed “need” in my previous comments, but let me add that if you wonder why your dentist is recommending taking certain films, talk to her or him about it. You ought to get a clear answer that makes sense to you. If you don’t, then talk more about it. I literally review each person’s history before each of their appointments with us, and based upon that review, I determine what films we should or should not take at that visit. I prescribe it based on their needs and their current and historic circumstances.
As for radiation exposure, there is no question that less is better, but I am always looking at it from a perspective that in business is called “ROI”. That means “return on investment”. By that I mean that I’m always asking myself “Do YOU, as my patient, get a return of important information that allows me to better care for you from your investment of radiation exposure, hassle, and dollars spent?” Only if the answer is yes, do I recommend that we take the films.
I hope this has been helpful. As always, if you have questions, ask your dentist or give our office a call, and we can discuss it further with you.