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Are Dental X-Rays Safe?

February 18, 2014 by Michael Greger M.D. in News with 30 Comments

Are Dental X-Rays Safe?

Every year, doctors cause an estimated 29,000 cancers a year dosing patients with X-rays during CAT scans (see Cancer Risk from CT Scan Radiation). What about dentists? 100 million Americans are exposed to dental X-rays every year, but don’t the lead apron and thyroid shield protect our vital organs? All our vital organs except one, our brain!

A study entitled “Dental X-Rays and Risk of Meningioma,” was recently published. The objective was to explore the association between dental X-rays—the most common artificial source of high-energy radiation—and the risk of intracranial meningioma, the most common type of brain tumor.

The researchers found that those who report ever having a bitewing X-ray had twice the odds of a brain tumor, and those that got a panoramic series—the full mouth X-rays—before age 10 had nearly 5 times the odds (see my 3-min video Do Dental X-Rays Cause Brain Tumors? for details).

While more research is needed, the bottom line is the benefits and risks of radiation exposure must always be carefully weighed. Dentists should consider the justification for every exposure. Furthermore, dentists should not prescribe routine dental X-rays at preset intervals for all patients (such as every 6 months or year, etc.). Says who? Says the official recommendations of the American Dental Association. There is little evidence to support irradiating people looking at all the teeth in search of hidden problems in asymptomatic patients. Accordingly, dentists should select patients wisely—only take X-rays when there is patient-specific reason to believe there is a reasonable expectation the X-rays will offer unique information influencing diagnosis or treatment.

The last time I was at at the dentist for my check-up I was again offered a set of full mouth X-rays (because I was “due”). Normally when I refuse routine dental X-rays I’ve just explained that I try to minimize my radiation exposure, but this time I was able to refuse “as per the official recommendation of the American Dental Association!” I just got a blank stare.

More on avoiding brain tumors in:

This is the third in a five part video series on preventing and mediating the adverse effects of radiation exposure. The first, Fukushima and Radioactivity in Seafood, described the natural and artificial sources of radioactive isotopes in our diet. The previous video, Cancer Risk from CT Scan Radiation detailed the estimated 29,000 cancers that doctors cause with CAT scans every year. I also have videos on Mediating Radiation Exposure from Air Travel, in which I talk about those full-body scanners in airports. And I close out with ways to mediate all these risks with Reducing Radiation Damage With Ginger And Lemon Balm.

-Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death and More Than an Apple a Day.

Image credit: bolandrotor / Flickr

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Dr. Michael Greger

About Michael Greger M.D.

Michael Greger, M.D., is a physician, author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial. Currently Dr. Greger proudly serves as the Director of Public Health and Animal Agriculture at the Humane Society of the United States.

View all videos by Michael Greger M.D.

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  • Nevo

    Speaking of reducing exposure to potentially harmful things in our lives (yeah, dental ex-rays on high on my list of things to avoid), what does your experience suggest about the possibility that vegans are potentially ingesting too high amounts of copper in relation to zinc? I find that my diet, when high in beans, grains, and nuts contains too much copper… RDA amounts well in excess of 200 percent. Is there an accumulation of this heavy metal, and could it contribute to alzheimers and maybe even poor zinc status? Do vegan sources of copper get flushed out of the body quicker than the copper contained in meat, shellfish, and other animal-based products?

  • Laloofah

    The ADA recommendation this links to is from 2006. My dentist says that this caveat has been removed from the latest ADA recommendations. Given that I have a dental checkup in less than a week and after three or four years of refusing X-rays I am being STRONGLY advised to get some as they’re “the only way to find dental decay between the teeth or beneath the gum line before it causes significant problems or tooth loss,” I am in a quandary. Is there nothing more recent you can point to than an 8-year old recommendation?

    • guest

      Grains = tooth pain for me,…tooth degradation.
      citrus seems to not help either.

      I have no problem with non-citrus fruits.

  • dawn

    I have the same problem as Laloofah. Every time I go to the dentist, they push me to get x-rays. And I mean, they really push. It got to the point where I considered going elsewhere because they pressured me to do it, I suspect because they have these very expensive machines sitting there in the exam room and they only make their money back on them if they use them. In recent years I have been to several different dentists, and it’s the same thing with each of them, warning me of dire consequences that could possibly result if I don’t get the x-rays. I really dislike the pressure tactics. Well, for many years I did get x-rays and I’m now in my my 50s and not one x-rays has revealed anything out of the ordinary.

  • Kristin
  • dawn

    I would like to adjust my earlier comment because I didn’t know the meaning of the word “partially edentulous.” When I looked it up just now, I realized it refers to someone who has lost some of their teeth.

    Assuming that most of those reading this will not be toothless, I want to point out another section of the 2012 ADA paper that refers to the frequency of recommended x-rays for patients WITH teeth:

    “Adult (Dentate, Partially Edentulous and Edentulous)In the absence of any clinical signs or symptoms suggesting abnormalities of growth and development in adults, no radiographic examinations are indicated for this purpose.
    Therefore, in the absence of clinical signs and symptoms, no radiographic examination is
    recommended.
    So Laloofah, I’d suggest you go the 2012 document, print it out and highlight the relevant sections to show your dentist. They’re probably counting on your not bothering to look at the recommendation yourself. Good luck!

    • Laloofah

      I had just located and finished reading that document myself and returned here to post it, so thank you, Kristin and Dawn! I remember finding it after my last exam and debate with my dentist, not long after Dr. Greger posted the video on this. I have no symptoms or problems – but it does seem I read something else that backed up the dentist’s argument and resulted in a stalemate. If I locate it, I’ll post it.

      • Laloofah

        I found the bit the dentist used to bolster her recommendation, in one of the charts in the document Kristin linked to. For an adult recall patient with no cavities or risk of cavities, and with all or most of their teeth (which would be me), the ADA recommends dental X-rays at 24-36 month intervals. My exam next Monday will mark the 36 month interval. I was confused last time I read this, since the recommendation in the chart contradicts the recommendation you quoted in your comment, Dawn, though both appear in the same document! I’ll print them both and take them with me, but I agree about the pressure that is brought to bear and the challenge it presents to patients trying to make the right decision. Frustrating!

  • DGH

    My parents refused to let me have these procedures done on a routine basis as a child but in adulthood, I started getting dental X-rays annually. They did pick up one asymptomatic cavity which was repaired. I now get them every 10-12 months. I am going to stop, having read this article.
    I have also had a number of panoramex films done to check for keratocyst, which runs in my family, and for wisdom teeth extraction. So, all the more reason to stop the annual X-rays.
    Thanks Dr Greger.

  • Southlander

    Great article. Well over a year ago, a friend of mine sent me a brief referencing x-rays from the ADA. My bride and I now ask our Dentist to “justify” his request for x-rays. I often wonder about Paul Newman and Senator Kennedy if maybe their brain cancer – white teeth and all – had anything to do with dental x-rays. Don and WE CAN! :-))

  • rollermonkey

    Hi, I have some questions not directly related to this topic.

    I recently began to cook using a cast iron skillet, and I saw on a video a person explaining how to proper use it. While he was explaining he mentioned that cast iron is good because it enhances your iron absortion by providing it to the food you are cooking. Also he said that a little rust may be actually good for you, when explaining how to re use an old unseasoned one. He didn’t said to eat the rust, but that it wouldn’t hurt you if you missed a spot. That last thing kind of creeped me a little bit.

    I saw some more videos, because I was actually just looking up how to mantaince mine, but I found that the fact, or rumor, about the iron from the skillet could be healthy, repeated by the people on the videos.

    I haven’t look that up, but I thought on checking your site for some info. I didn’t find a post about that yet. So I thought on asking.

    I choose to buy cast iron because health reasons and I know that other equipment that is not stainless steel and cast iron can leave a chemical trace in your food.

    So the questions:

    1- Do you know if this fact about the iron is true?
    2- Is there any scientific evidence about it?
    3- Is the rust harmful, harmless or healthy?
    4- Do you recommend using cast iron skillets and pots?

    Hope this topic interests you, thanks for your time and sorry for my grammar, I don’t have much practice writing in english.

    • DGH

      My understanding from reading some of the literature is that you must cook acidic solutions such as tomato sauce or orange juice or lemon juice in cast iron cookware to get the benefit of the iron for preventing iron-deficiency anemia in veganism. There is one study suggesting this from Brazil and there may be more. I don’t know anything about the toxicity. Rust is simply iron oxide. Darryl would know whether that’s absorbable or not.

      • rollermonkey

        Thanks a lot :)

    • Dar

      if you read Dr. Neal Barnard’s book Power Foods for the Brain, he advises against the use of cast iron skillets (unless they are enamel-line) as iron is among the metals found in the amyloid plaques of people with Alzheimer’s Disease. Excess quantities the body is unable to get rid of seems to accumulate in the brain.

  • Ay42

    “There appears to be an association between exposure to bitewing
    radiographs and meningioma according to results of their study. However,
    the authors found no dose-response relationship, and found annual
    visits to the dentist to be protective. Of the radiographs studied,
    bitewings expose patients to the least amount of ionizing radiation, yet
    exposure to full mouth series (an effective dose about 5 times higher
    than that for bitewings)4
    was not significantly associated with meningioma at any age or
    frequency. It also seems contradictory that control patients were
    significantly more likely to have visited a dentist than case patients.
    Finally, the magnitudes of the odds ratios are small, and their
    respective confidence intervals are borderline significant in many
    cases. It is important to be very careful when interpreting these
    numbers and their clinical relevance. One must be diligent when drawing
    conclusions from statistics, and especially cautious when reporting on a
    topic that can potentially alarm the general public.”
    http://onlinelibrary.wiley.com/doi/10.1002/cncr.27812/full

    • Ay42

      While I applaud Dr. Greger’s efforts to help us understand these studies, he has developed a reputation for taking these individual studies out of context, similar to how the media tends to report them. I would hope that he and his readers remain attentive to how the results of individual studies should always be presented in the context of the overall evidence, for those results to be meaningful to the bigger picture. Otherwise, we are simply bouncing from one piece of “breaking health news” to the next, without coming to meaningful conclusions:

      “The impact of isolated foods in isolated feeding studies has little to
      no meaning to the impact of what such foods have as part of an overall
      lifestyle.

      For instance, think about the latest DVD by Dr Greger
      and the section on cancer. In the first study he showed that there was
      triple the rates of cancer for every 50 grams of poultry consumed. And
      then he said that for 1/4 of a chicken breast (50 grams), tripled the
      risk.

      However, in the next 3-4 studies, he showed how powerful a
      plant-based diet was in slowing the growth and even in killing cancer
      cells. Yet, the diet he showed including chicken at 100 grams up to 3x a
      week.

      So, did chicken triple the risk/rate or did chicken help to slow the growth and kill cancer cells?

      This is why everything has to be put into proper context and properly applied to the situation at hand.”

      from: http://www.drmcdougall.com/forums/viewtopic.php?p=418940#p418940

      I hope you find the information at least as worthwhile as I have. Please have a wonderful day.

  • justme

    Thanks for reminding me and giving me more hefty ammunition the next time the dentist ‘suggests’ xrays. It floors me the way doctors and dentists harass patients/customers with dire consequences when we go agains costly protocol.

  • Asha

    The article failed to mention the biggest factor in radiation level, which is digital vs traditional xrays.

    Could you clarify if both are bad or just the traditional xrays

  • Saffrinv

    Dr Greger–I found this more recent PDF from the ADA about patient selection guidelines for dental radiographs–I would recommend adding this resource to your page, particularly to replace and/or supplement your “official recommendations” link in the article text: http://www.ada.org/sections/professionalResources/pdfs/Dental_Radiographic_Examinations_2012.pdf

  • Maggie Jones

    I changed dentist because he refused to not ex ray me every 6 months. He obviously needed the money . Instead of arguing with him I found another dentist. The new dentist is very good except for the pro advocacy about fluoridation in the city drinking water which I and others are fighting against.

    • barbarabrussels

      I am staggered to read that so many dentists routinely x-ray their patients. This is not common practice in Belgium, and I doubt on most of the European continent. X-rays are used very sparingly overall.

  • Kelly

    I usually only allow dental xrays every 2 years and that is only to shut my dentist up. I think I will widen that interval after reading this. they really are pushy about it. I don’t have a single cavity and I’m 47 years old, that’s a lot of years of unnecessary xrays. sad dentists are doing this to make a buck.

  • Ellen

    Ahh this scares me. I’m 20 and I had to get two panoramics last year because they screwed the first one up and recently they pushed me to get 8 individual xrays on specific teeth.
    How long does it take for my brain cells to regenerate? or have i done permanent damage?

  • Dean Durant

    Of course they want you to get x-rays every time you come in. It’s insurance money, right? Cha-ching. I know a guy who never goes to the dentist. He doesn’t have insurance. He doesn’t have much money. He doesn’t have a job. He doesn’t take the best care of his teeth either so they are slowly rotting out on him. But for a guy his age (51), who never goes to a dentist, he’s doing pretty well.

  • bruxe

    My dentist goes almost ballistic if I mention the subject of X-rays. She has just about kicked me out of her office and behind her fake smile I perceive she is actually quite rude about how she handles this. I looked this up because yesterday I had my yearly dental exam and they took 4 X-rays. Of course it had been many years since I have been to the dentist, so I’m probably ahead of the game compared to most.

    I read a book called “Physics For Future Presidents” where they talked about radiation exposure, and it definitely said that below a certain threshold the studies just are getting noise and that low levels of radiation cannot be accurately measured. (these are my words) It was plausible, but I don’t know, and with all the other source of physical “insult” to our bodies these days, I’d prefer to minimize my exposure to X-rays (no pun intended).

    What can I do to make my dentist stop these X-rays, or how can I know for sure when an X-ray is really necessary?

  • Deb

    I expressed radiation concerns to my dentist and was told they use digital x-rays which “expose you to less radiation than being in the sun.” I was also told if I refuse to get x-rays I would be released as a patient and because that’s the only way they can tell what’s happening between the teeth. I asked if I could sign something saying I choose to have no x-rays if I have no symptoms of problems. They said no. What recourse do I have?

    • Thea

      Deb: It’s my understanding (though I’m not an authoritative voice on the topic) that medical professionals have a right to refuse service to anyone they want. So, I think your only short-term options are to give in or find a better dentist. It sucks, but you may look on this as an opportunity to find a much better dentist…

      Good luck.

      • Deb

        Thanks for replying. Yes it does suck. I’ve liked them except for this. Is it true that digital x-rays are better? I know nothing about that. It stinks when you aren’t allowed to be responsible for your own health care. I’ve fought battles like this with regard to other health issues!

        • Thea

          Deb: I have heard that digital x-rays use less radiation. If true, then to the degree that they use less radiation and still provide clear results (do not require re-takes as much), then yes, I think that digital x-rays would be better.

          My personal policy is: If I need the x-ray, then I will get it regardless of what kind is available right then. If I do not need the x-ray, then I will not get it, regardless of what kind is available.

          But that’s easy for me to say right now. I’m not facing the need to find another dentist right now.

          My dentist has been pretty cool. While I haven’t refused bit-wings, I did refuse the full-mouth panarama one. Both the dentist and hygenist put on a little pressure, but they ultimately respected my wishes and did not resort to threats. I respect them a lot for that given stories like the one you are telling.

          Good luck.

  • Alex

    I recently had a full-mouth x-ray (for no good reason) and they said I might have to have my 2 top wisdom teeth pulled (I’m 16). Should I continue and go to an oral specialist? Or is it not worth it? I really don’t want to undergo surgery for their removal, but I also don’t want oral pain for the rest of my life. The teeth aren’t in yet, but they “might” cause problems, as they don’t have much room to move in.

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