According to a recent study, 92 percent of Americans say they would delay dental care because of the cost. While fillings and root canals may not be negotiable, some experts say that routine dental X-rays should be the first thing to go. In a series of recent letters published by the medical journal JAMA Internal Medicine, some dental experts argued that our current standard of care—taking dental X-rays on a set schedule of every six to 18 months—is woefully out of date.
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“Evidence-based medicine, a movement that gained prominence in the 1990s, has profoundly affected the practice of medicine. Unfortunately, little progress has been made on using data from clinical trials to determine best practices for dental care,” wrote Paulo Nadanovsky, DDS, PhD, Ana Paula Pires dos Santos, DDS, PhD, and David Nunan, PhD, a group of Brazilian dental experts who penned the opening letter.
According to that trio, many dental care practices are driven by “the economic pressures of running a dental practice, dentists’ professional training and opinions, and patients’ expectations,” all of which lead to excessive intervention. “The result is that while many people who have low income go without any dental care, those who can pay are subjected to overdiagnosis and overtreatment,” they argued.
Yehuda Zadik, DMD, MHA, a board-certified specialist in oral medicine, responded with his own letter, calling this a “critical viewpoint.”
However, others disagreed. In written responses to the original JAMA letter, several experts emphasized the importance of preventative care and the early detection of dental issues, both of which can be buoyed with the help of dental imaging.
New 2024 recommendations outlined by the American Dental Association (ADA), which serve as an update to the 2012 FDA/ADA recommendations for dental radiographic examination, call for dentists to make more personalized decisions on a patient-by-patient basis. Their expert panel now says that your dentist should only take X-rays when they have determined that they are considered diagnostically necessary.
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“The dentist must weigh the benefits of taking dental radiographs against the risk of exposing a patient to x-rays, the effects of which accumulate from multiple sources over time. The dentist, knowing the patient’s health history and vulnerability to oral disease, is in the best position to make this judgment in the interest of each patient,” the ADA writes. “For this reason, the guidelines are intended to serve as a resource for the practitioner and are not intended as standards of care, requirements or regulations. The guidelines are not substitutes for clinical examinations and health histories,” their experts add.
Not all dentists will agree on the exact schedule for optimal imaging: Paul Casamassimo, DDS, MS, a pediatric dentist, titled his own response to the letter, “It’s Complicated.” However, most can agree that it’s time to bring down costs and increase access to care.
“The lack of necessary care for those in need—and there are millions of people in that category—and the provision of low-value care to equally as many are conflicting challenges that U.S. dentistry needs to address,” Casamassimo wrote.