Dental Radiographs

[G]

Couldn't find that other thread about dental procedures pro/con, so starting a new one.

Dental radiographs: Minimal radiation, but still radiation; not indigent, but still costs money.

I have read through the ADA guidelines. Every 6 months, when the tech tries to take my bitewings, I decline, pointing out that I will wait til it has been 24 months and I endure the look of mortification.

Today (pediatric dentist), I declined my middle schooler's 6 mo screening films and endured the look of mortification AND signed an AMA form. Really?

Mind you, both of these were after establishing no subjective complaints and before an exam.

Thoughts?

[Orthodoc]

I don't have much to add here other than I agree with you and usually decline the dental x-rays. I'd be curious to hear any dentists weigh in on how often they themselves get the x-rays?

[VentAlarm]

I don't have much to add here other than I agree with you and usually decline the dental x-rays. I'd be curious to hear any dentists weigh in on how often they themselves get the x-rays?

+1

I refused some cancer screening special light and got a funny look at my last dentist.

I recently went to an optometrist (who had no idea I was a doc) who initially told me he couldn’t give me a prescription without dilating my eyes. Look dude, I need a new prescription to update my glasses. I’m 33 and healthy - I don’t need you screening me for diabetic or hypertensive retinopathy. He went on to tell me all how I could go blind.

[jacoavlu]

they want you to get them as often as your insurance will pay for them which is typically once per year

I don’t refuse them, because I’m generally nonconfrontational, the radiation is effectively zero and if it wasn’t for unnecessary imaging there’d be about half as many radiology jobs, so I think of it as paying it forward

[youngDoc]

I'm noticing that more and more patients are getting CT scans in dental offices, not just simple radiographs. I recently had a 6 year old come in with a CT from head to neck. I would love some dentists to weigh in on this anonymous forum, but I've seen a lot of what I am perceiving as unethical practices, worse with the pediatric dental practices. So much so that I am personally seeing dentists at the local community health clinic for my care.

[G]

they want you to get them as often as your insurance will pay for them which is typically once per year

I don’t refuse them, because I’m generally nonconfrontational, the radiation is effectively zero and if it wasn’t for unnecessary imaging there’d be about half as many radiology jobs, so I think of it as paying it forward

Well, if we had half as many radiologists, we'd probably have twice as many plaintiff's attorneys.

I guess a tangential question would be whether dental insurance is worthwhile. I self insure.

[Tim]

Well, if we had half as many radiologists, we'd probably have twice as many plaintiff's attorneys.

I guess a tangential question would be whether dental insurance is worthwhile. I self insure.

Dental insurance- annual limit, restrictions on how often, limited acceptance , procedures partial payment (50%), but some covered items.
Basically procedures at agreed price. If you plan on have dental work, it can save some.

Not a knock, but walking into a dental office I almost always feel like some serious effort at up-selling is going on.
A lot of cosmetic practices.
“ a cosmetic dentist will try to make the cap look beautiful so that it contributes to the general aesthetics of your mouth, even if you or others can see it or not.” Does it really make sense to pay for a work of art that only the dentist appreciates?

[dentoid]

If your child is high risk or has had recent caries, radiographs are indicated q 6-12m per guideliness of the AAPD.
Dental insurance does not dictate frequency of radiographs and has no interest in overall health. In fact certain private insurances may compensate worse than medicaid.
Honestly, most people who avoid xrays are massive PITA (usually) and there are too many patient in insurance driven practices to deal with low reimbursement and grown adults who can't tolerate dental radiographs. The ADA guidelines state q 2 yr for adults who have no lesions or periodontal concerns. The dentist will have a malpractice suit against him/her and be destroyed if standards of care are not followed. It's like going to a mechanic but not letting them open the hood.

[CordMcNally]

If your child is high risk or has had recent caries, radiographs are indicated q 6-12m per guideliness of the AAPD.
Dental insurance does not dictate frequency of radiographs and has no interest in overall health. In fact certain private insurances may compensate worse than medicaid.
Honestly, most people who avoid xrays are massive PITA (usually) and there are too many patient in insurance driven practices to deal with low reimbursement and grown adults who can't tolerate dental radiographs. The ADA guidelines state q 2 yr for adults who have no lesions or periodontal concerns. The dentist will have a malpractice suit against him/her and be destroyed if standards of care are not followed. It's like going to a mechanic but not letting them open the hood.

I got a kick out of this. How is somebody who refuses unnecessary xrays being a PITA? Even if they’re indicated you have them sign the form and move along. Going along with your mechanic analogy, it’s like them wanting to open the hood but you have to keep redirecting them to the flat tire.

[MPMD]

have to be careful not to turn this into anti dentist thread again team.

that being said, i think dental films are basically a revenue stream. you want to shoot me all around once every few years or so, fine, but show me the NNT for taking q6mo films on a health pt w/ no dental complaints. most dentists i've been to do the most cursory review of the films anyway.

i got very annoyed w/ a dentist recently b/c i thought i was getting a new pt panorex and decided not to cause trouble. turns out it was a %$^&#@ CT scan. dentist was probably in the room for 3-4 minutes after my cleaning. i actually called and complained extensively. i think it's borderline unethical to do a CT scan on a patient with no complaints. dentist claimed that he reviewed every scan extensively after hours and that he's "found so much stuff." yeah dude that's called over-testing.

on the malpractice front, give me a break. no one can successfully sue a dentist for missing caries or gum disease. those are slow growing chronic issues that are mostly related to what the pt does at home. that's like saying a pmd is going to get a malpractice suit b/c you didn't control your lipids, good luck w/ causation on that let alone standard of care. your malpractice exposure has to be a heck of a lot higher when you are shooting CT scans and don't know how to interpret all of the soft tissue.

[Vottomatic]

I'd love to see someone try to accurately diagnose caries without the benefit of x-rays. I can't tell you how many times someone comes in with a toothache; we take a PA and there's gross caries that render the tooth either non-restorable or needs a root canal. "Why didn't we catch this sooner doc?" Oh look, you've refused x-rays for the past 4 years and now you're upset that despite us warning you each time this could happen, the tooth is bombed out.

Look, it's your mouth, and we'll do what you want us to do. But there's a reason we take them. I see the same thing dentoid pointed out: the patients who refuse x-rays are typically (yes I'll admit I'm generalizing) the same ones who are going to give you crap about other things. Their cousin posted on Facebook that fluoride is poison so now they don't want fluoride treatment either, or they saw that BS documentary on Netflix before it was pulled that said root canals cause cancer or whatever. I'm sure you guys see this I medicine too, but the lack of respect of respect for experts in any given field is reaching dangerous levels.

Sorry, I'm a little grumpy today. But just get your ************************ x-rays!

[Vottomatic]

on the malpractice front, give me a break. no one can successfully sue a dentist for missing caries or gum disease.

Sorry, you just lost all credibility with that statement. Happens all the time and I know several that have had to settle as a result of such lawsuits.

[Hatton]

I only go once per year so no option for q6mo films. I have never had a CT. I recently refused to have "wellness" bloodwork drawn on my 3 year old dog.. I pointed out that she had had bloodwork done prior to a knee surgery. The tech still acted like I was somehow mistreating her.

[Tim]

If you go in for a cleaning, what is the benefit of taking a full set of X-rays?
Protocol? Was told it is legal and professional standard? The owner dentist wasn’t even working that day. To an extent an investment in equipment is made and someone has to use it. Just business. Make no mistake, business practices often aren’t always the motive in medicine or dentistry.
You need to trust your dentist or doctor. If not, find another. I changed dentist.

[cyrano7]

I’m an oral surgeon so I’m a bit of an outsider and insider for this discussion. Usually my patients already have X-rays from their general dentist when they are sent over.

I think both sides of this argument can be correct, but it depends on your dentist. Obviously there may be some dentists who order X-rays based on when your insurance will cover them, but that is not the majority of dentists. I feel like this may happen more in big cities where they are desperate for more patients and try to squeeze every dollar out of each patient (e.g. the oral cancer screening light which isn’t as good as a thorough exam).

The little X-rays (bite wings) that capture early decay that you can’t visualize or detect clinically are vital. They help the dentist catch decay when it is small enough to just do a filling instead of waiting until it becomes painful. Once painful your chances of requiring a root canal are very high (because the proximity to the pulp/nerve is what causes that pain).

I get all my dental care for free from a great dentist so there is no monetary value for him. I definitely want my bite wings every year because I don’t want a root canal or deep filling.

One more thing... a dental “CT” is NOT a CT. It is a cone beam CT. It has way less radiation (about 1/50 to 1/100 depending on the size). I still do not think these should be taken for general exams and should be used for exploring pathology or surgical planning. Also, your bitewings radiation is less than you get in a day just living on the planet earth.