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Answer to Question #292 Submitted to "Ask the Experts"

Category: Pregnancy and Radiation — Exposures not directly to embryo/fetus

The following question was answered by an expert in the appropriate field:

Q
Does the Society have a position or recommendation regarding clinically necessary dental x rays and/or medical x rays for the female patient of childbearing age? I lecture on dental radiology and am constantly being asked this very question. Any assistance you can provide in the way of a position paper, statistics, etc., would be greatly appreciated.
A

At the present time the Health Physics Society (HPS) does not have such a position paper. Many years ago, the British Institute of Radiology instituted the 10-day rule. This stated that diagnostic exposure of female patients of childbearing age be limited to the 10 days following the onset of each menstrual period—unless there was compelling medical urgency or unequivocal evidence that she could not be pregnant. This rule applies only to diagnostic exposure of the pelvic region such that the uterus would be in the primary beam. Many nations adopted this rule; the United States did not. It has now been repealed in all (I believe) of the countries that originally adopted it.

 Our National Council on Radiation Protection (NCRP) recommended that management of current illness should take precedence over the possibility of pregnancy—specially considering the small doses from most diagnostic exposures (including dental) and the remote possibility of adverse effect. At present I know of no recognized authority or responsible body that recommends cancellation, postponement, or modification of dental radiographic procedures for any patient—except the known pregnant. Dental x-ray exposures for the pregnant patient should be limited to those required for treatment to be rendered immediately (while pregnant). If treatment is to be deferred to term, then x rays should also be deferred. Radiation dose to the pelvic region from a full-mouth series of dental radiographs, done properly, is about 1 microgray (0.1 mrad). Done properly means E speed film, rectangular collimation, time-temperature processing in fresh solutions, etc. This should be compared with average annual genetically significant dose to the US population of about 0.8 milligray (80 mrad) per year from natural environmental sources.

Thus, the dose from typical dental exposure is equivalent to about one-half day of unavoidable natural background—hardly a concern. Helpful background information may be found in NCRP Report No. 54: Medical radiation exposure of pregnant and potentially pregnant women. This report can be ordered from NCRP.

S. Julian Gibbs, DDS, PhD
Professor of Radiology

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