Are annual x-rays necessary?

My dentist routinely wants yearly x-rays, even if we have no symptoms. Is this ADA or otherwise recommended procedure? We are adults in our 30s and worry it is excessive.


Dear B.,

The American Dental Association (ADA) does have recommendations for radiographs (x-rays), although dentists are also encouraged to use their professional judgment based on the health and dental history of the patient.

For an adult patient who has several restorations and might be cavity-prone, yearly radiographs are recommended. The type of radiographs that aid in diagnosis of decay or bone loss between teeth are called bitewing x-rays. If an adult patient presents with a healthy mouth, few restorations, and is not cavity-prone, a two year interval is acceptable. One reason we take bitewing radiographs is to check between the teeth because we cannot see this area during a dental examination. Bitewing x-rays help reveal problems while they are small, before they cause any symptoms. By the time you feel symptoms, the condition may require more than just a filling! We are also checking the bone level adjacent to your teeth. These radiographs are one guideline we use to diagnose and monitor periodontal disease.

For children, the guidelines are somewhat similar, although in children who are especially caries-prone, bitewings every 6 months might be in order. This is to prevent decay from reaching the nerve which is closer to the tooth surface in children and adolescents. If the child is not caries-prone, a bitewing survey may be done every 12-24 months.

While I definitely understand your concern for exposure, let me assure you that dental radiographs are extremely low in radiation exposure. This is especially true in more recent years as equipment and film speed have improved. Probably the greatest concern is contraction of leukemia due to bone marrow exposure. Radiation exposure from dental radiographs can be directly compared to levels of background radiation to help illustrate risk.

I have stated before that studies show that a person, in an average location in the United States, who receives a full-mouth set of radiographs (about 18-19 films) and a panoramic radiograph every 4 months for the remainder of his life will have about the same risk of exposure as someone who lives in Denver (due to background radiation from cosmic sources) who does not have dental radiographs. Two or four bitewing radiographs taken every year or two obviously have an extremely minimal risk of exposure. While dentists will not deny there is an exposure risk, it is apparent the benefits of diagnosis and monitoring of dental disease far outweigh any disadvantages of dental x-rays.

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