Dentaltown July 2013 - (Page 26)

second opinion column » Radiation Minimization – “Are We There Yet?” by Dale A. Miles, BA, DDS, MS, FRCD(C) Second opinions are common in health care, whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a “second opinion.” Perhaps some of these observations will change your mind, while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. – Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine If you’ve been on a long trip with kids you’ve probably heard the question many times – Are we there yet? It’s easy to answer if you are driving the family car, not so easy in the dental practice when the patient asks you “Why do I need these X-rays?” or “Are these X-rays safe?” Hopefully this brief discussion of current concepts and guidelines, updated recently, jointly by the AAOMR and ADA, will give you the information necessary to take the final steps to minimize all of your patients’ X-ray burden successfully and easily as well as answer their questions. What Have We Done Well? Manufacturers and clinicians have continued the move to faster image receptors. We’ve gone from D-speed film to F-speed film with conventional film-based imaging. Many offices have adopted PIDs (position indicating devices), largely because their staff members who take radiographs have been trained this way in dental schools and in dental auxiliary programs. The use of the PIDs with any type image receptor facilitates the correct placement of the receptor and greatly reduces retakes – a significant factor for increased patient dose. Every retake increases the X-radiation burden to the patient by 100 percent for that area. Dental offices using conventional film are more routinely using the leaded aprons and thyroid collars for their film-based imaging procedures. With the new NCRP #145 report,1 dental offices that switch to become totally digital for their X-ray procedures do not actually have to use a leaded apron except on females who are pregnant or might be pregnant. Use of the 1. leaded apron for procedures where the apron might interfere with the diagnostic information (panoramic and cone beam imaging) is unnecessary according to the new NCRP guidelines. However, if the patient asks for a leaded apron, one should be provided. These current guidelines have both “should” and “shall” statements, and the “shall” statements are considered mandatory. Thus, the use of the thyroid collar on all children is mandatory, independent of the type of image receptor – conventional film, phosphor plates or solid-state detectors (sensors). Only about 45 percent of North American dentists have adopted solid-state, digital imaging receptors. These clinicians and their offices should be commended for using fast image receptors. Manufacturers have also helped the profession minimize radiation to the patient. We now have contemporary X-ray generators that are DC (direct current) with state-of-the-art timers to accurately match the very fast exposure times for solid-state detectors. And, of course, all of the companies who make or resell solid-state systems should be commended for helping the profession advance the radiation-minimization cause. Institutionally, dental schools and dental auxiliary programs continue to adopt faster image receptors when economically feasible. Dental auxiliary schools teach long cone, rectangular collimation technique and rectangular collimation devices. Unfortunately no one is using them in their offices. After graduation, dentists, assistants and dental hygienists all abandon rectangular collimation. The main reason being, “I can’t possibly hit the image Radiation Protection in Dentistry: Recommendations of the National Council on Radiation Protection and Measurements, report #145; December, 2003. continued on page 28 26 JULY 2013 » dentaltown.com http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown July 2013

Dentaltown.com Highlights
Howard Speaks: Quit Rambling On
Professional Courtesy: New Patients with Baggage
Second Opinion: Radiation Minimization – “Are We There Yet?”
Is Anyone Really Cementing e.max with RMGI?
Please Critique My “Breakaway” Office Design
Surely People Don’t Die from Tooth Decay?
Townie Choice Awards Preview: Dentistry’s Official Gear Guide
Corporate Profile: Gendex
What’s On Your Tray? Endodontics
Product Profile: Synergy
Do-it-Yourself Finance, Part VIII: It’s Retirement Time! How Do I Get My Money?
Dental Education by Circuit Training
Everyday Dentistry with CAD/CAM and Lithium Disilicate
Ad Index
Maximizing Anterior Design for Predictable Results in a Six-unit Anterior Makeover
In This Issue: Dental Hygiene Diagnosis
Perio Reports
Continuing Education Periodontal Probes: An Overview of History, Evolution and Clinical Technique
Dentally Incorrect

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