Journal of the American Dental Assocation (JADA)Patient Shielding During Dentomaxillofacial Radiography

American Academy of Oral and Maxillofacial Radiology Recommends Discontinuing Routine Use of Gonadal and Thyroid Shielding

The American Academy of Oral and Maxillofacial Radiology has released new evidence-based guidelines that challenge long-standing practices in radiation shielding during dentomaxillofacial imaging. These guidelines are based on comprehensive reviews of existing studies and aim to provide dental professionals with updated recommendations on patient safety.

HCN Medical Memo
These new guidelines signify a paradigm shift in how we approach radiation safety during dentomaxillofacial imaging. Although the recommendations are grounded in extensive research, implementing them will require not only updates to regulations but also a concerted effort to educate both dental teams and patients about the changes. The ultimate goal remains the same: to ensure the highest level of patient safety while obtaining the necessary diagnostic information.

Key Points:

• Recommendation Against Gonadal Shielding: The committee found no evidence of radiation-induced heritable effects in humans and negligible dose to gonads and fetuses. They recommend discontinuing the use of gonadal shielding.
• Thyroid Shielding Not Necessary: The risks from thyroid cancer due to dentomaxillofacial imaging are considered negligible, making thyroid shielding unnecessary during most dental radiographic procedures.
• State and Local Regulation Updates: The guidelines call for updates in state and local regulations to reflect these new recommendations.
• Dentist Perspectives: Although the guidelines are backed by scientific evidence, they may face resistance due to long-standing practices and patient expectations.

The radiation dose from contemporary dentomaxillofacial imaging is several thousand-fold below the threshold doses for occurrence of tissue reactions, making the risk virtually negligible.

Additional Points:

• Pregnant and Pediatric Patients: Special considerations are advised for these groups, although the guidelines suggest that shielding is generally unnecessary.
• Infection Control and Artifacts: The use of shielding materials like lead aprons can pose infection control risks and may interfere with image quality.
• Global Consensus: Similar recommendations have been made by other organizations, including the British Institute of Radiology and the European consensus group.

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