I would like to share the story of 14 yr old Patient R, who came in for a routine consultation with his Mom earlier this year. After doing my clinical examinations, I proceeded to expose a panoramic x-ray. There was no indication other than it being part of a routine comprehensive oral health check to take the x-ray (This specific image is indicated as standard screening for all new patients and then every 3-5 years). Our findings revealed a massive tumor in the lower jaw, which had up to this point not presented with any symptoms. Remember, up to this point I found no other problems-his teeth and gums were in exceptional health. Subsequently I referred Mr R to a specialist surgeon, the tumor was removed and he is being monitored closely.

 What shook me is that I could have very easily fallen into the complacency trap due to the pressure one feels to make our work cost effective. I nearly decided against taking the image. I nearly caused my patient irreparable harm by thinking that, as his mouth looked clinically perfect, maybe I shouldn’t take an x-ray.

 With the global economy in the state that it’s in, everyone understandably has to tighten their purse strings. I have noticed more and more patients requesting that no x-rays be taken at check-ups, to keep their costs lower. Other patients request that no x-rays be taken as they perceive the x-rays to be harmful to their well-being.  Interestingly, when it comes to radiation exposure, most dentists today use digital x-ray devices, which on average have a 10-fold reduction in radiation dosages required to obtain a clear image compared to the film-based predecessors. Dentists also adhere to the ALARA principle (as low as reasonably achievable).  This term is often misinterpreted as “no x-rays if there are no obvoious signs or symptoms,” which would in Mr R’s case have been hugely detrimental to his overall wellness. 

  As Dentists we are responsible for more than teeth- we are the custodians of our patients’ oral wellbeing. This includes the teeth, gums, the maxillary sinuses, the jawbones and the jaw joints. Regular check-ups that include x-rays can not only help to identify holes in teeth, but also help to detect problems in the oral cavity while they are still developing and allow us to intercept and act as soon as possible.