X-rays and Brain Tumors

There has been a great deal of controversy about a recent scientific study that associates dental x-rays with meningioma, a common brain tumor. Understandably, this has raised questions from some of you about the safety of x-rays in general and dental x-rays in particular.

Meningioma is the most common brain tumor and occurs in about 15 out of every 10,000 people. It is a benign tumor, which means that it is not cancerous. The study found that people who had dental x-rays were slightly more likely to have meningiomas than those who did not. While there are some questions about the validity of the technique used to determine the patients’ x-ray exposure, (the researchers relied on the patients’ memory to guess at how many x-rays they had) the results of this study generally agree with similar ones done in the past and simply confirm what we have known for years – any kind of x-rays are to be used with caution. In other words, this is not big news.

To put this in perspective, the average American gets about 700 times more ionizing radiation from the environment and from medical procedures than from dental x-rays. Radiation is in sunlight, in the air, given off by building materials, and in cosmic rays from space. Unless you wear a lead suit, including a helmet, there is really no way to escape radiation exposure. But even given the fact that radiation is everywhere and that dental x-rays contribute only a minimal amount to the overall dose, it still makes sense to minimize exposure wherever possible.

So what changes do we plan to make based on the new study? Other than spending more time discussing the issue, we do not plan to do anything different. That is because we are already doing everything we can to minimize radiation exposure. We follow the principle known as ALARA: As Low As Reasonably Achievable. That means we take the minimum number of x-rays to diagnose and treat a patient safely. For example, we determine the frequency with which diagnostic bite-wing x-rays are taken (the ones we take at your recall appointment) by the conditions in your own mouth, not by a set of general guidelines.   Every time an x-ray is taken in our office, you are covered with a lead shield that incorporates a thyroid collar. For over ten years we have been taking only digital x-rays, which produce a significantly lower dose of radiation than conventional ones. In fact, the author of the study admits that the past exposure levels on which the study is based were much higher than they are today. In addition, our modern x-ray equipment is registered and tested by the State of Delaware. Given all these precautions, we believe that the risk of NOT taking appropriate x-rays far exceeds the risk of taking them.

Some patients ask, “Why take x-rays if nothing is bothering me?”

The main reason x-rays are used at all is that they find disease at an early stage – before it starts to hurt. We find tooth decay, gum disease, early abscesses, cysts, impacted or missing teeth and tumors, among other things. Early treatment of these problems is easier, cheaper, less painful and often prevents tooth loss. X-rays are one of the big reasons why most of our patients in their seventies, eighties and nineties still have their own teeth.

Some say, “I don’t care. I’ll just take my chances without x-rays.”

That’s your choice, of course, but it does raise legal and ethical problems for us. Taking appropriate x-rays is the Standard of Care and failure to do so is malpractice. We understand and respect your beliefs, but if you really want ongoing care without x-rays, we can’t be your dentist. Some of our patients have even offered to sign a waiver absolving us of responsibility if we don’t take x-rays. Unfortunately, that won’t work either. We are not allowed, nor do we want, to do negligent dentistry, even if the patient asks for it. The only option for a patient who insists on having treatment without x-rays is to find a dentist who is willing to take the risk – and good dentists won’t.

This study doesn’t really tell us anything new about dental x-rays. Our goal is to do our best to keep your teeth and gums healthy and attractive. As always, we are happy to discuss your concerns.