Radiology Course page 8 – Prescribing

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An expert panel from the dental profession under the supervision of the Food and Drug Administration developed guidelines for prescribing dental radiographs. The panel was concerned with patient safety. Dentists use the guidelines as recommendations to help determine the type of radiograph needed, how often and under what conditions radiographs should be taken. Dentists prescribe radiographs on the basis of clinical observation and the patient’s health history. Patient selection criteria include descriptions of clinical conditions derived from patient signs, symptoms and history that identify patients who are likely to benefit from a particular radiographic examination. The recommendations in the chart are subject to each Dentist’s clinical judgment and may not apply to every patient. [i]

Guidelines for Prescribing Dental Radiographs [ii]

Clinical situations for which radiographs may be indicated include:

Positive Historical Findings

  • Previous periodontal or endodontic therapy
  • History of pain or trauma
  • Familial history of dental anomalies
  • Postoperative evaluation of healing
  • Presence of implants

Positive Clinical Signs or Symptoms

  • Clinical evidence of periodontal disease
  • Large or deep restorations
  • Deep carious lesions
  • Malposed or clinically impacted teeth
  • Swelling

Evidence of Facial Trauma

  • Mobility of teeth
  • Fistula or sinus tract infection
  • Clinically suspected sinus pathology
  • Growth abnormalities
  • Oral involvement in known or suspected systemic disease
  • Positive neurological findings in the head and neck
  • Evidence of foreign objects
  • Pain and/or dysfunction of the temporomandibular joint
  • Facial asymmetry
  • Abutment teeth for fixed or removable partial prosthesis
  • Unexplained bleeding
  • Unexplained sensitivity of teeth
  • Unusual eruption, spacing or migration of teeth
  • Unusual tooth morphology, calcification or color
  • Missing teeth with unknown reason

High Risk of Carious Lesions Possible

  • Failing existing restoration(s)
  • Poor oral hygiene
  • Inadequate fluoride exposure
  • Prolonged nursing (bottle or breast)
  • Diet with high sucrose frequency
  • Poor family dental health
  • Developmental enamel defects
  • Developmental disability
  • Xerostomia
  • Genetic abnormality of teeth
  • Many multi-surface restorations
  • Chemo/radiation therapy

A licensed dentist or a properly supervised dental student must determine the number and types of x-rays. Taking radiographs based on a predetermined timetable (every year or every 6 months) is not considered an acceptable standard of care. The needs of each patient should be evaluated clinically before the decision of taking x-rays is made.

The dentist is responsible for keeping the equipment in good working condition. The dentist is also legally responsible to use licensed personnel for taking x-rays.

[i] Eastman Kodak Company Recommendations developed by an expert dental panel comprised of representatives from the Academy of General Dentistry, American Academy of Dental Radiology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Academy of Periodontology, and the American Dental Association under the sponsorship of the Food and Drug Administration (FDA).

[ii] American Academy of Pediatric Dentistry

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