Several patients have asked me about a recent study that linked dental x-rays to brain tumors.
It’s an interesting study, though I have not reviewed the whole thing yet.
It does stimulate concern over the need for radiography, dosage and exposure frequency, and we are always concerned about radiation safety for our patients and staff. Some notes about how we handle this:
1) We use every precaution listed here with the ADA. (Be aware, that link is to a PDF file.)
2) We also invested in new digital radiograph equipment two years ago, which allowed us a decrease of 25% of the ‘most sensitive’ film dose.
3) We employ the principles of ALARA, or radiation As Low As Reasonably Achievable. We don’t use radiographs at the same intervals for all patients – everyone is classified individually for radiographic imaging needs. For example, patients at low risk for cavities may only need new x-rays every 18-36 months.
4) Any patient can refuse radiographic imaging in our office. Radiographic imaging is a service we provide to maintain your health. It is a fantastic tool for saving teeth, finding pathology/infection, malformations and diagnosing gum and bone disease. Without radiographs, oral health care is severely compromised.
However, if a patient is well informed of these details they can decide to refuse the radiographic service by signing a waiver, which we note in the patient’s chart. We always want what is best for you; which can include what YOU think is best for you, as long as you are well informed and understand all the risks and benefits.
Now, back to the tumor study.
To me, it sounds like a very preliminary study which has a significant basis on the participants’ memories. There are several other areas of concern with the study criteria. Specifically, I’m concerned about how the study groups were selected. Further, the group of participants with brain tumors may have been selected easily due to the presence of meningiomas. But how did they select the comparison group? Was it a truly random group representative of the tumor cohort? How were they able to correct for a person’s memory? Were actual dental records utilized?
This may work as an additonal study idea: could we take the total number of dental patients on the planet and then compare that to the total number of dental patients who have meningiomas, and get a rough idea on the fraction of dental patients developing a meningioma? We could then also look at the dental restorative history of the meningioma group and determine whether there is a significant difference. This could be easy, because if someone has had dental care, they almost certainly have had a dental x-ray.
Hopefully, the findings of this study means we could soon have an additional, more defined one.
In any case, I believe this is very important information. New studies are vital, and helps our practice to take a refined look at how we operate in this and other areas of patient care. The one rule we have right now is to make sure every patient is well-informed, and to use ALARA as a guideline.
The American Dental Association has reviewed the study and released their own statement here.
Doing a little research on something unrelated to dentistry, I ended up over on This Old House, where there was an article about the many alternative uses for dental floss. 
