Can We Stop Using Lead Aprons & Thyroid Collars on Dental Patients?

Are you confused by all the changes? Shield or don’t shield?

ADA Updates on Radiography Safety

The ADA updated their recommendations for radiography safety in dentistry on February 1, 2024. The use of lead abdominal aprons or thyroid collars on patients when taking x-rays is no longer recommended. This decision was based on the ADA’s expert panel after reviewing published studies on radiography for dental patients. This applies to all dental patients, including, quite surprisingly, pregnant patients. According to them, the lead aprons and thyroid collars can block the primary x-ray beam, diminishing the quality of the radiograph and resulting in more exposures.

Radiation Levels in Dental Imaging

Radiation associated with imaging modalities used in dentistry ranges from low-dose intraoral digital radiographs to higher-dose imaging procedures using CBCT, according to the ADA. These modalities are generally low compared to medical radiographs.

Moderation and ALARA Principle

The key factor to focus on is the fact that clinicians should order radiographs in moderation to minimize exposure. Use the ALARA (as low as reasonably achievable) principle for the safe use of radiographs and also as low as diagnostically acceptable for CBCT. Radiographs should be ordered based on diagnostic and treatment planning needs. Make a good faith effort to obtain previous radiographs from the previous provider. This is part of the right-to-access rule embodied in HIPAA.

Regulatory Oversight and State Laws

Keep in mind that ADA and CDC are not regulatory agencies. Federal, state, and local agencies may enforce their regulations as it relates to lead aprons and thyroid collars. For example, California law requires the use of lead or lead-equivalent aprons during dental X-rays, as published by the California Dental Association on December 7, 2023, as set forth in section 20211 of California’s Code of Regulations.

Based on our understanding of the state of Tennessee, the laws are still the same regarding shielding. However, it appears that the new director of inspections would not be enforcing lead apron requirements in dental settings, only medical.

ADA Recommendations for Safe Use of X-Rays

The ADA provides several recommendations for the safe and appropriate use of ionizing radiation in dentistry. These are worth summarizing alongside the previously mentioned points:

General Guidelines

• Follow the law regarding the safe and effective use of x-rays.
• Follow the manufacturer’s instructions for safe and proper operation, maintenance, and infection control for x-ray procedures.
• Implement a radiation safety program.
• Those who take X-rays should have the necessary qualifications, education, training, and licensure as required by federal, state, and local regulations. For example, in Tennessee, a dental assistant must hold a certificate in dental radiology from the Tennessee Board of Dentistry to operate dental X-ray equipment.

Specific Practices

• When barrier protection is not available for intraoral imaging, the operator shall stand at least 2 meters from the tube head and out of the primary beam path.
• Handheld and portable devices shall be safely secured to prevent unauthorized use.
• Dental staff members who take X-rays and may be exposed to an annual dose that exceeds 1 mSv, or as otherwise determined by state or local guidance, should consider wearing personal dosimeters regardless of anticipated exposure levels.
• Before taking X-rays, clinicians should complete a comprehensive clinical examination and patient assessment, considering the patient’s oral and medical histories, including previous radiographs and the patient’s specific oral disease risk.
• Prescribe dental radiographs and CBCT scans only when the diagnostic yield will benefit patient care, enhance patient safety, or substantially improve clinical outcomes.

State Compliance and Policy Updates

Before you ditch the lead aprons and thyroid collars, be sure you are in compliance with your state.

Additional Resources

For more information regarding ADA’s updated recommendations, visit ADA’s press release on updated radiographysafety.

Final Reminder: Update Your Radiation Policy

Please be sure to update your radiation policy to reflect these changes.

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