With now knowing how radiation can have biological or somatic effects on the human body through Radiation Protection class that I am taking in my radiological technology class, I am very couscous about anything in healthcare, that can cause ionization of the human cell.  That is why I would like to bring up radiation protection in the dental offices around the area that I live in.  I took both of my children to the dentist office for a cleaning and exam.  When we walked back to the examination rooms I seen a panoramic, (which is a device that does a full scan of the teeth and this device does a full 360 around the mouth area) my son had to do this.  As they put my son in this panoramic area the dental assistant didn't put any lead protection on him until I asked her too. Now that I knew my son was protected, I turned around and walked outside the exam room and went to the farthest corner of the building because this panoramic was in the hallway walking towards the exam rooms.  My wife asked what I was doing, I told her, "I do not want to get zap with radiation and the further away I am the less dose I am going to get".  I was thinking of the Inverse Square Law ( Which is decrease in intensity is inversely proportional to the square of the distance of the object from the source). She looked at me and she told my son that we would be right back.   My wife asked me, "if it is so bad why is the lady standing right there while they are doing this"?  I told her because either she has had no training on radiation protection, or she has had training on this, but was told that this machine does not give off enough radiation to worry about. After my son was done with the panoramic, we walked onto the examination room where I saw another x-ray tube.

This is where they make the patient bite down on what they call wings. Again, the dental assistant did not put on any radiation protection on my son or herself. I had to ask her again, can you put some lead protection on my son, and she looked at me and said, "sure".  She went ahead and put on the lead apron.  After she put the apron on my son, she left the exam room to get some assistants, this is when I saw the thyroid shield in the closet. So I went over to the closet and grabbed the thyroid shield and put it around my sons neck. At this time the dental assisting came back with another lady to assist her with the examination.  As soon as they put the bite wings in my sons mouth, she told him to bite down, and at that time she asked the lady that was assisting her to go ahead and push the button,  while she was standing there holding the x-ray tube against my sons cheek. I asked the lady that was pushing the button if she could wait until my wife and I went around the bend to get out of the way.  The lady was kind enough to let us get out of the way before pushing the button.  After this experience with my son I was wondering then what the experience was going to be like tomorrow when I bring my two year old daughter in.

The next day, I bring my daughter in, I had to go through the same thing with her.  Except, she did not have to do the panoramic. I had to ask them to put a protective apron and thyroid shield on my daughter. This to me is scary in the sense that either the dental assistants who are taking these x-rays did not get the proper training in their school or bluntly they do not care about what happens to them or their patients. This blog is not to make these people look bad, this blog is here to try to educate the people who are taking the dental x-rays in that no matter how small the dose of the x-ray is there is always a possibility biologic or somatic effect that can occur.

According to Health Canada laws, which follows the International Commission on Radiological Protection (ICRP), states:

9.2 Guidelines for Protecting the Patient During Radiographic Examinations

It is possible to obtain a series of diagnostically acceptable radiograms and have the patient dose vary widely because of differences in the choice of loading factors and film speeds. It is the responsibility of the operator and dental practitioner to be aware of this and to know how to carry out a prescribed examination with the lowest practical dose to the patient. The recommendations that follow are intended to provide guidance to the operator and dental practitioner in exercising responsibility towards reduction of radiation exposure to the patient.

1. The operator must not perform any radiographic examinations not prescribed by the dental practitioner responsible for the patient.
2. The dose to the patient must be kept to the lowest practical value, consistent with clinical objectives. To achieve this, techniques appropriate to the equipment available should be used. It is recommended the X-ray loading factors charts be established when using X-ray units which do not have pre-programmed anatomical feature settings. The loading factors chart must be established after optimizing the film processing procedure.
3. Fluoroscope must not be used in dental examinations.
4. Dental radiography must not be carried out at X-ray tube voltages below 50 kilo-volts (peak) and should not be carried out at X-ray tube voltages below 60 kilo-volts (peak).
5. Dental X-ray equipment should be well maintained and its performance checked routinely. Accurate calibration of the equipment should also be carried out on a regular basis.
6. The quality of radiograms should be monitored routinely, through a Quality Assurance program, to ensure that they satisfy diagnostic requirements with minimal radiation exposure to the patient.
7. The patient must be provided with a shielded apron, for gonad protection, and a thyroid shield, especially during occlusal radiographic examinations of the maxilla. The use of a thyroid shield is especially important in children. The shielded apron and thyroid shield should have a lead equivalence of at least 0.25mmof lead. In panoramic radiography, since the radiation is also not adequate and dual (front and back) lead aprons should be worn.
8. The primary X-ray beam must be collimated to irradiate the minimum area necessary for the examination.
9. The primary X-ray beam should be aligned and the patient's head positioned in such a way that the beam is not directed at the patient's gonads and is not unnecessarily irradiating the patient's body.
10. The fastest film or film-screen combination consistent with the requirements of the examination should be used. The film processing technique should ensure optimum development and should be in accordance with the recommendations given in section 6.1. Sight developing must not be done.
11. Dental X-ray films must be examined with a viewbox specifically designed for this purpose.
12. While recommended dose limits have been defined for radiation workers and the general population, no specific permissible levels have been recommended, to date, for patients undergoing diagnostic radiographic procedures. For patients, the risk involved in the radiographic examination must always be weighed against the requirement for accurate diagnosis. Information from the Dental Exposure Normalization Technique (D.E.N.T.) program is used to provide realistic sets of limits. These recommended upper and lower limits are presented in Table 4. Any patient skin dose greater than the upper limit presented is an indication of poor film processing techniques or sub-standard equipment performance. The lower limits indicate the point where any gain in dose reduction may be reflected by a loss of diagnostic quality of the film.

 Also according to Idaho Radiation Control Rules, Section 207 paragraph 6 subsection b, under Operation Controls it states:

 06. Operating Controls. (7-1-98)
a. Patient and film holding devices must be used when the techniques permit. The safety rules,
required by Subsection 203.01, must list individual projections where holding devices cannot be utilized. (7-1-98)
b. Neither the tube housing nor the position indicating device can be hand held during an exposure.
(7-1-98)
c. The x-ray system must be arranged and operated in such a manner that the useful beam at the
patient’s skin does not exceed the dimensions specified in Subsection 207.02.a.

So now you can see that there is a reason to have you or your child protected while having a dental examination.  I hope this helps people realize the importance of radiation protection during examinations.


Work Cited:

Health Canada: http://www.hc-sc.gc.ca/ewh-semt/pubs/radiation/99ehd-dhm177/index-eng.php#a92

IDAHO ADMINISTRATIVE CODE IDAPA 16.02.27 Department of Health and Welfare Idaho Radiation Control Rules: http://adminrules.idaho.gov/rules/current/16/0227.pdf