Does My Child Need Dental X-Rays? The Great Debate

I recently got the following text from a friend, the mom of a 6-year-old daughter: “Her dentist got angry and made me sign something acknowledging that I am not allowing her to have X-rays,” she wrote. “Am I crazy? I just don’t like the idea of X-rays in kids.” She just wanted to delay the radiation exposure until her daughter was older, not refuse them altogether. I texted back that I didn’t think she was being crazy at all.

But was she? My daughter, also 6, has not yet had dental X-rays, and so far our dentist hasn’t pushed them. But when I was a kid, biting down on cardboard bits and holding still under that heavy apron while my dentist ran out of the room to snap a few images was de rigueur, at least once a year.

I started looking into the most updated recommendations, and meanwhile, my friend updated me: The dentist fired them. Like some pediatricians across the country who have begun kicking out parents who won’t vaccinate their kids, this New York City dentist gave my friend and her daughter the boot for refusing routine X-rays — only this time, there could be no lecture about how avoiding preventative care would endanger the community.

So what gives? And what should parents consider when it comes to exposing their little ones to radiation?

The Research

Dental X-rays, according to the American Dental Association, represents a “minor contribution” to the total exposure from all sources. The National Council on Radiation Protection and Measurements (NCRP) estimates that the radiation sources affecting people are evenly split between natural sources (like air, water and soil), and man-made sources, such as CT scans and x-rays.

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There are apparently no good studies showing the appropriate number of x-rays to give someone who is not having a dental problem. “It’s crazy,” Dr. Nicholas Dello Russo, an instructor in the department of oral and maxillofacial surgery at the Harvard University School of Dental Medicine, told CNN several years ago. “We’re doing an experiment on a vast number of people in this country and we have no idea how it will play out in the next 15 or 20 years.”

Kids no longer need dental x-rays as a matter of routine. Photo by Corbis Images. 

A much-buzzed-about 2012 study revealed a frightening possibility of risk: Researchers at Yale University School of Medicine and Boston’s Brigham and Women’s Hospital found that getting frequent dental x-rays appears to increase the chances of having a commonly diagnosed brain tumor (the largely non-malignant meningioma tumor) in adults by 40 to 90 percent. It noted that routine dental x-rays are among the most common sources of radiation for most healthy people in the U.S., and that exposure to ionizing radiation — the kind found in x-rays — is the biggest known environmental risk factor for these tumors.

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Smaller studies have shown other possibly increased risks — of thyroid cancer, and of inner ear tumors called acoustic neuroma — although most of the findings have been deemed inconclusive.

What the Experts Say

Pediatric dental expert Dr. Paul Casamassimo tells Yahoo Parenting that there’s no proscribed age for children to start having x-rays. He also says that x-rays should not be taken as a matter of routine for kids, and that they should be used very sparingly, noting that this has been the position of the American Academy of Pediatric Dentistry (AAPD), the American Dental Association (ADA) and the Food and Drug Administration (FDA), with tweaks here and there, since 1987.

The ADA, in fact, has a guiding principal called ALARA (As Low As Reasonably Achievable) regarding responsible radiologic practice, which states that, even once it’s been determined that x-rays are necessary, they should be as minimal as possible to reduce a patient’s exposure. Also, more and more, dentists are switching over to using solely digital x-rays, the dentist says, which can lower radiation exposures by around 80 percent.

A dentist’s decision to take x-rays of a kid’s mouth, says Casamassimo, who is the director of the AAPD’s Pediatric Oral Health Research and Policy Center, should be based on the following: the child’s assessed risk of tooth decay, any signs of a problem that needs to be further investigated (such as pain, swelling, abnormal development), and how tightly together the baby teeth are spaced. “If we can see between the teeth,” he says, “we don’t expose them to radiation.” If there are spots that can’t be seen or felt, he explains, and x-rays of those teeth are taken and no problems are discovered, then the child can go up to two years without more x-rays.

So why are pediatric dentists continuing to recommend x-rays as a matter of routine if it’s not recommended by the ADA or FDA? One factor, Casamassino notes reluctantly, is that insurance is often quick to pay dentists for x-rays. But it’s also a culture that many practitioners find hard to move away from. “There are still some residual beliefs from when we were told in dental school that you needed to get a basic set of x-rays from a child — but that was 40 years ago,” says. “Today we have a whole different approach, and it’s hard to justify doing it just so that a dentist can feel better and in turn can make a parent feel better.”

What Parents Say

“My 6-year-old daughter has never had x-rays. I was asked just once so far and said no. I will say no again for our next visit. She has no cavities — her teeth are healthy.”—Zoe B.

“I agree to them once in a while if they are able to convince me there is a real need — and her orthodontist does it occasionally without asking, which bugs me. I think ultrasounds and X-rays are used far too often.” —Larissa P.

“We get cleanings every 6 months but our insurance only covers x-rays once a year so that is what they get.” —Melissa G.

“We’ll do x-rays once a year until adult teeth come in.” —Denise A.

“My children’s dentist only does an X-ray on the first visit with the cleaning to see how everything is growing and sitting within their mouths and gums. After that it’s only if there are any problems with teeth growing in or their alignment issues.” —Charlene D.

The Bottom Line

Given that the recommendation from the ADA, AAPD, and FDA is to use x-rays sparingly and minimally on children, pediatric dental x-rays probably should no longer be taken as a matter of routine unless your child has a risk factor like pain or swelling. If your child’s dentist recommends x-rays, talk to him or her about the reasons, and about the exposure’s risks and benefits. If a dentist is not comfortable keeping on a patient who disagrees, Casamassino says, that’s okay. On the flip side, he adds, “The best thing a parent can do is ask questions. If a doctor’s answer is ‘my way or the highway,’ then you’re better off leaving.”

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