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Radiation hygiene and practice in dentistry
Radiation hygiene and practice in dentistry
Council on Dental Research Council on Dental M a te ria ls and Devices
The A m erican D ental A ssociation has been a n d continues to be very active in a variety of p ro grams related to radiation hygiene and practice. These program s have included the production o f m otion pictures, sponsorship of inform ational articles in t h e j o u r n a l , representation on th e N ational Council for R adiation Protection a n d M easurem ent, collaboration w ith the A m erican College of Radiology and with the A m erican A cadem y of O ral Roentgenology. It is ap p ro p ri ate from time to time to reem phasize the p rin ciples of protection from unnecessary exposure to ionizing radiation. The Councils on D ental R e search and on D ental M aterials and Devices will issue a series of statem ents relating to dental radiation hygiene and practice. These reports will appear in this and in future issues of t h e j o u r n a l and will include the following topics : ■ Protection of the patient, including recom m end ations as to frequency of radiographic exam ination and use of protective coverings. ■ Protection of office personnel, including a d is cussion of shielding, radiation barriers, and m o n i toring services. 1032
■ Guidelines for minimizing radiation exposure, including collim ation, filtration, and other per tinent factors. ■ E xposure control factors, including tim ers, con version technics, film speed, kilovoltage, milliam perage, and others. ■ Visualization factors, including darkroom pro cedures and illum ination technics. C hapter X II of the A ssociation’s publication G uide To D ental M aterials is devoted to the sub ject of radiation hygiene, equipm ent, m aterials, and procedures and forms the basis for the arti cles. Articles on biologic effects of ionizing radiation, on m onitoring program s, and on other features of radiation hygiene and practice will also be pre pared. These reports are intended to present accept able procedures and guidelines and to discuss pre cautions that deserve consideration in the use of radiation in dentistry.
Protection of the patient T he Councils m aintain that the dentist is responsi ble for adhering to proper procedures in his of fice for the protection of the patient, his office
personnel, and himself. R adiography is unques tionably an essential p art of m odern dental p rac tice but its use requires an understanding both of the hazards involved and the protective m eas ures required. D ental radiographic exam inations should be m ade only when necessary for the p a tient’s dental welfare, and such exam inations should- involve the m inim um radiation necessary to form images with suitable sharpness and con trast for diagnostic purposes. This rep o rt discusses frequency of radiographic exam ination in dental practice and the need for protective coverings for patient safety.
■ Frequency of radiographic examination in dental practice: T he use of X -ray radiation for diagnos tic purposes should be kept to a m inim um and should be m ade only after careful consideration of both the dental and the general health needs of the patient. T he prim ary deciding factor is the total welfare of the patient. T he nature and ex tent of actual or suspected disease and its re sponse to treatm ent, rath er than the concept of routine use of radiographs as a p art of periodic exam ination of all patients, constitute the only rational basis for determ ining the need o r the frequency of dental radiographic exam ination. A c cordingly, there can be no generalization about a “preferred num erical frequency” for dental radiographic exam ination. R adiographic exam inations should not be a standard p art of every dental ex am ination. In other words, diagnostic radiography should be lim ited to those instances in which the dentist anticipates th at the inform ation he is likely to obtain will contribute m aterially to p roper diag nosis and prevention of disease. T he num ber of exposures to be m ade in the exam ination should be the m inim um that is necessary to obtain this inform ation. T he previous history of the patient’s
radiation exposure, especially to the head and neck, should be considered in m aking such an evaluation. In essence, the decision to use diagnostic radi ography rests on professional judgm ent of its necessity for the benefit of the total health of the patient.
■ Leaded protective aprons: In some state codes on dental radiation, the use of a leaded apron has been suggested or m entioned. In two states, Cali fornia and W isconsin, the use of an apron on the patient is m andatory. T he U.S. Public H ealth Service recom m ends the routine use of a leaded apron.1 The leaded apron is suggested by the A m erican A cadem y of O ral Roentgenology as a prudent m easure to use with children and preg nant w om en.2 T he prim ary function of the leaded apron is to protect against possible genetic dam age through exposure to the gonads. The Councils believe that the role of the apron in this respect is m inor as com pared with the benefit gained through use of high-speed film, a beam th at is properly restricted by collim ation and filtration, and an open-ended, properly shielded cone. These three conditions are generally accepted as the critical and im por tant factors in reducing gonadal exposure in dental radiographic procedures and will be discussed in detail in a subsequent report. T he leaded apron is not to be considered as a substitute for careful radiation practices. The next report will contain a discussion of the protection of office personnel. 1. Radiation protection for dentist and patient. Public Health Service publication no. 885. Washington, D.C., Superintendent of Documents, 1962. 2. Yale, S. H.; Moos, W . S., and Videka, M. A. Measurement of gonodal dose in children during intra oral radiography. Oral Surg. 13:1081 Sept., 1960.
REPORTS OF COUNCILS AND BUREAUS ■ 1033
Council on Dental Research Council on Dental M a te ria ls and Devices
The A m erican D ental A ssociation has been a n d continues to be very active in a variety of p ro grams related to radiation hygiene and practice. These program s have included the production o f m otion pictures, sponsorship of inform ational articles in t h e j o u r n a l , representation on th e N ational Council for R adiation Protection a n d M easurem ent, collaboration w ith the A m erican College of Radiology and with the A m erican A cadem y of O ral Roentgenology. It is ap p ro p ri ate from time to time to reem phasize the p rin ciples of protection from unnecessary exposure to ionizing radiation. The Councils on D ental R e search and on D ental M aterials and Devices will issue a series of statem ents relating to dental radiation hygiene and practice. These reports will appear in this and in future issues of t h e j o u r n a l and will include the following topics : ■ Protection of the patient, including recom m end ations as to frequency of radiographic exam ination and use of protective coverings. ■ Protection of office personnel, including a d is cussion of shielding, radiation barriers, and m o n i toring services. 1032
■ Guidelines for minimizing radiation exposure, including collim ation, filtration, and other per tinent factors. ■ E xposure control factors, including tim ers, con version technics, film speed, kilovoltage, milliam perage, and others. ■ Visualization factors, including darkroom pro cedures and illum ination technics. C hapter X II of the A ssociation’s publication G uide To D ental M aterials is devoted to the sub ject of radiation hygiene, equipm ent, m aterials, and procedures and forms the basis for the arti cles. Articles on biologic effects of ionizing radiation, on m onitoring program s, and on other features of radiation hygiene and practice will also be pre pared. These reports are intended to present accept able procedures and guidelines and to discuss pre cautions that deserve consideration in the use of radiation in dentistry.
Protection of the patient T he Councils m aintain that the dentist is responsi ble for adhering to proper procedures in his of fice for the protection of the patient, his office
personnel, and himself. R adiography is unques tionably an essential p art of m odern dental p rac tice but its use requires an understanding both of the hazards involved and the protective m eas ures required. D ental radiographic exam inations should be m ade only when necessary for the p a tient’s dental welfare, and such exam inations should- involve the m inim um radiation necessary to form images with suitable sharpness and con trast for diagnostic purposes. This rep o rt discusses frequency of radiographic exam ination in dental practice and the need for protective coverings for patient safety.
■ Frequency of radiographic examination in dental practice: T he use of X -ray radiation for diagnos tic purposes should be kept to a m inim um and should be m ade only after careful consideration of both the dental and the general health needs of the patient. T he prim ary deciding factor is the total welfare of the patient. T he nature and ex tent of actual or suspected disease and its re sponse to treatm ent, rath er than the concept of routine use of radiographs as a p art of periodic exam ination of all patients, constitute the only rational basis for determ ining the need o r the frequency of dental radiographic exam ination. A c cordingly, there can be no generalization about a “preferred num erical frequency” for dental radiographic exam ination. R adiographic exam inations should not be a standard p art of every dental ex am ination. In other words, diagnostic radiography should be lim ited to those instances in which the dentist anticipates th at the inform ation he is likely to obtain will contribute m aterially to p roper diag nosis and prevention of disease. T he num ber of exposures to be m ade in the exam ination should be the m inim um that is necessary to obtain this inform ation. T he previous history of the patient’s
radiation exposure, especially to the head and neck, should be considered in m aking such an evaluation. In essence, the decision to use diagnostic radi ography rests on professional judgm ent of its necessity for the benefit of the total health of the patient.
■ Leaded protective aprons: In some state codes on dental radiation, the use of a leaded apron has been suggested or m entioned. In two states, Cali fornia and W isconsin, the use of an apron on the patient is m andatory. T he U.S. Public H ealth Service recom m ends the routine use of a leaded apron.1 The leaded apron is suggested by the A m erican A cadem y of O ral Roentgenology as a prudent m easure to use with children and preg nant w om en.2 T he prim ary function of the leaded apron is to protect against possible genetic dam age through exposure to the gonads. The Councils believe that the role of the apron in this respect is m inor as com pared with the benefit gained through use of high-speed film, a beam th at is properly restricted by collim ation and filtration, and an open-ended, properly shielded cone. These three conditions are generally accepted as the critical and im por tant factors in reducing gonadal exposure in dental radiographic procedures and will be discussed in detail in a subsequent report. T he leaded apron is not to be considered as a substitute for careful radiation practices. The next report will contain a discussion of the protection of office personnel. 1. Radiation protection for dentist and patient. Public Health Service publication no. 885. Washington, D.C., Superintendent of Documents, 1962. 2. Yale, S. H.; Moos, W . S., and Videka, M. A. Measurement of gonodal dose in children during intra oral radiography. Oral Surg. 13:1081 Sept., 1960.
REPORTS OF COUNCILS AND BUREAUS ■ 1033