Answer to Question #1369 Submitted to "Ask the Experts"

Q

Our family dentist insists on starting annual x rays for my children (ages three and five) to have information about their teeth and gums. I would prefer to not expose my little tykes to unnecessaary radiation until they are older. Neither the children nor the parents have any oral history that is abnormal. The dentist is stipulating that if we do not initiate x rays, the dental practice will not be able to continue providing service. What are the risks for three and five year olds to have this exposure? Is it safer to wait if there is no problem presenting itself and their baby teeth are all still intact?

A

A number of years ago the Food and Drug Administration (FDA) assembled a panel of experts to develop guidelines for prescribing dental radiographs (x rays) for both new and recall dental patients of all ages. Since then, all of the major dental organizations, including the American Dental Association and the American Academy of Pediatric Dentistry, have endorsed these guidelines. The basic principle underlying the recommendations is that radiographs should be taken when it is likely that they will benefit the patient's diagnosis or treatment plan. With children the major reasons for taking dental radiographs are to detect dental caries ("cavities") and to evaluate growth and development so that abnormalities can be treated before they become serious problems. An example of a developmental problem that can occur is the lack of formation of one or more permanent teeth. If this is detected early, efforts can be made to keep the primary tooth in place as long as possible so that more complex (and expensive) treatment can be avoided. The FDA guidelines recommend bitewing radiographs on young children at the first dental visit if the proximal surfaces (sides of the teeth) cannot be seen well or explored with a dental instrument. Decay is likely to occur on the sides of the teeth where it is difficult to see. If the child's teeth are spaced far apart and there is no clinical evidence of decay, bitewings might not be needed until later. X rays for growth and development depend on the patient's stage of tooth eruption. The frequency of radiographs should depend on the child's risk for decay. Situations that make a child at higher risk for decay include lack of fluoride in the drinking water, high sugar diet, history of cavities, poor oral hygiene, and many others. Although some children will not get any cavities at all during their lifetime, the majority will develop one or more some time in the future. It is much easier and less expensive to treat cavities while they are still small, before they can lead to pain and infection. While children are more sensitive to x rays than adults because they are still growing, the amount of radiation from needed dental radiographs is extremely small, equivalent to a few hours of natural background radiation, which we have around us all the time. It is less radiation than they would receive if they made a trip to the mountains (higher background radiation at high altitudes) or flew in an airplane (increased cosmic radiation at flight levels). The minimal risk of the radiographs needs to be compared with the information obtainable that may be very important for your child's health.

Sharon L. Brooks, DDS, MS Diplomate, American Board of Oral and Maxillofacial Radiology President, American Academy of Oral and Maxillofacial Radiology University of Michigan, School of Dentistry Ann Arbor, Michigan