New Concerns Arise for Children’s Dental X-Rays

Posted by: Dr. Mercola | December 06 2010 |

Children and adolescents are particularly vulnerable to radiation, which has led doctors to start a national campaign to protect them by reducing their exposure to diagnostic radiation. But there is at least one place where the message has not taken hold -- the dental office.

Most dentists continue to use outmoded X-ray film that requires higher amounts of radiation. In addition, orthodontists are embracing a new scanning device that emits significantly more radiation than other methods. The device, known as a cone-beam CT scanner, provides 3-D images of teeth.

The New York Times reports:

"... [T]he cone beam's popularity has been fueled in part by misinformation about its safety and efficacy, some of it coming from dentists paid ... by manufacturers ... Cone-beam CT scans can help dentists deal with complex cases ...

But many experts in dental radiation have raised alarms about what they see as their indiscriminate use ... putting patients at risk, particularly younger ones."

Sources:

November 22, 2010

Dr. Mercola's Comments:

Dental x-rays can provide your dentist with potentially invaluable information, such as revealing areas of decay, abscesses, cysts, developmental abnormalities, infection or tumors that cannot otherwise be detected.

But these X-rays are not without risk themselves, and in many cases are being vastly overused or used in formats that expose you and your children to unnecessary radiation risks.

Many dentists and orthodontists are also embracing new cone-beam CT scanner technology to provide 3-D images of teeth -- but also exposing you to hundreds of times more radiation exposure.

This risk is especially serious for children, as they have many developing cells and organs that are particularly vulnerable to radiation. Children also have many years of life ahead of them over which they will experience multiple X-rays -- and the risk is cumulative, meaning it grows with every X-ray they receive.

Be Aware of New Cone-Beam CT Scans

These new devices are being heavily promoted by their manufacturers, including Imaging Sciences International, which underwrote the October issue of The Journal of the American Dental Association … an issue entirely devoted to the new technology.

A cone-beam CT scanner provides clear 3-D images of teeth, which dentists and, especially, orthodontists, are using to lure patients, including children and teenagers who need braces. It's not uncommon for teens to receive one to four cone-beam CT scans during the course of their orthodontic treatment.

The problem with these scans is that they subject you to hundreds of times more radiation exposure than conventional X-rays, and there is absolutely no proof that this risk is worthwhile. Further, orthodontists can use a simple digital camera image -- which requires no radiation -- to get many of the same images; it just takes a little bit longer.

Dr. Stuart C. White, former chairman of oral radiology at the UCLA School of Dentistry, put it well in the New York Times when he said:

"So let me ask a question to the mother of a prospective orthodontic patient. Would you like me to use a tool that is entirely safe — a camera — to record the position of your child's teeth, or another method that may rarely cause cancer so that we can save time?"

What are the Risks of CT Scans?

Cone-beam CT scans are lower in radiation than typical CT scans used in the medical field, but that doesn't mean they are without risk.

There are four primary reasons that X-rays and other diagnostic tests that rely on ionizing radiation, such as mammograms and CTs, should be minimized:

They cause chromosomal mutations that are often irreparable, and the effects are cumulative.
They cause DNA changes that are proven to lead to cancer.
They cause DNA damage in your arteries, which can lead to cardiovascular disease.
They often result in misdiagnosis and false positives, increasing the likelihood of follow up tests—further increasing your radiation exposure.
X-rays and other types of ionizing radiation have been, for decades, a proven cause of virtually all types of mutations—especially structural chromosomal mutations. X-rays are an established cause of genomic instability, which is frequently seen in the most aggressive cancers.

X-rays act like tiny little "grenades" that are far more damaging to your DNA than the metabolic free radicals, which are routinely produced by your cell's natural metabolism.

Ionizing radiation can damage the genetic material of every internal organ or cell lying within the path of an X-ray beam. Within an organ, even a single high-speed high-energy electron, set into motion by an X-ray photon, has a chance of inducing the types of damage that defy repair.

That is why there is no safe dose of X-rays or ionizing radiation.

Even when such mutations are not lethal to the cell, they persist and accumulate with each additional exposure to X-rays or other ionizing radiation.

In the case of cone-beam CT scans, there is an alternative … a tiny digital camera can be used to take 3-D images of your child's teeth, with absolutely no radiation risks whatsoever.

So why risk it?

Heavy Industry Pressure Misleading Dentists about Cone-Beam CT Scan Safety

Cone-beam CT scanners were initially intended to provide an alternative to full medical CT scanners, especially when diagnosing mouth and face problems. However, aggressive marketing on the part of the scanners' manufacturers has succeeded in getting them into dentists and orthodontists' offices, where they are now being used in some areas as a routine part of getting braces.

As Dr. Nicholas Dello Russo, a Boston periodontist who also teaches at Harvard Dental School, told the New York Times:

"The parents of these children have no idea about the amount of radiation used in these CT scans, and even more frightening, neither do the dentists."

Why are dentists so blissfully unaware of the radiation risks? Because manufacturers have been infiltrating trade shows, medical journals and industry conferences heavily touting this new "miracle machine" while downplaying its risks.

As the Times reported, six manufacturers spent close to $300,000 in October alone promoting the technology to the American Dental Association. Still, despite the heavy marketing campaign, the American Association of Endodontists has issued a statement stating cone-beam CT scans "must not" be used "for screening purposes in the absence of clinical signs and symptoms."

Some have even likened the scans to the "shoe-fitting fluoroscope" -- essentially, an X-ray machine used to look at the bones of your foot in order to judge your shoe size -- that was popular prior to the 1950s.

So if your child goes in for a routine checkup or to get braces, please avoid using this new technology without first learning the risks and alternatives. It is a serious health hazard to children, and I would encourage you to share this with your Facebook friends and family so they can be warned of this danger.

Go Digital if You Use X-Rays as Radiation is 80-90% Lower

Digital X-rays are one of the newest X-ray techniques around and can reduce patient radiation exposure by 80-90%.

Because it is so new and because the machines can be so expensive, your dentist may not have it yet; but watch for this process to become standard in the future. With digital X-rays film is replaced with a flat electronic pad or sensor.

The X-rays hit the pad the same way they hit the film. But instead of developing the film in a dark room, the image is electronically sent directly to a computer where the image appears on the screen. The image can then be stored on the computer or printed out.

Many Dentists Use Outdated X-Ray Film, Leading to Greater Radiation Exposure

Cone-beam CT scans are not the only form of radiation you should be on the lookout for in your dentist's office. Many are also using older D-speed X-ray film, which requires up to 60 percent more radiation than faster film.

It's a mystery why dentists are not at least upgrading their technology to faster, lower radiation X-ray film (again, digital X-rays would be even better as they use even less radiation), but there also has been no push by state dental boards to encourage them to do so.

Unfortunately, if your dentist is sticking with the status quo you or your child could be receiving radiation exposure that is way beyond what is necessary.

Remember, children are especially vulnerable to the effects of radiation, and they also tend to receive more dental X-rays than adults because their teeth and jaw are still developing, and their teeth are more subject to decay.

However, do not simply consent to X-rays that seem unnecessary or excessive … and make sure your dentist is not only using the lowest radiation digital X-rays available, but also is on board with your philosophy to use them only when absolutely necessary.

The UC Berkeley Wellness Letter offers some good suggestions for questions you should ask before undergoing any diagnostic scan, and this includes dental X-rays or cone-beam CT scan:

Is the test really necessary?
What difference will it make in my care?
Is there a non-radiation alternative, such as ultrasound or MRI (or digital photographs)?
Is the facility accredited by the American College of Radiology?
Will the test use the lowest level of radiation for adequate imaging? (Will it be adjusted for my size, or my child's size?)
Will the scan be limited to the indicated area, and will nearby areas be shielded?
Ultimately it is your child and your body that will be receiving the radiation dose from the X-ray or CT scan, so you need to be fully informed and certain that the benefit will truly outweigh the risk before you consent.

Also please remember to have your dentist use digital X-rays to radically reduce the radiation you or your child is exposed to and avoid the new CT X-rays at all costs.

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