The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#237 Updated Radiography Guidelines
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In this episode, the Divas discuss the purpose and scope of the updated guidelines. We encourage all our listeners to download a copy of the guidelines from the show notes and do a recap with the team, to determine if any changes in the practice protocols are needed.
- ADA and AAOMR patient selection for dental radiography and cone-beam computed tomography. https://jada.ada.org/action/showPdf?pii=S0002-8177%2825%2900631-2
- Dentistry IQ - New CBCT use guidelines for endodontics updated for the first time in 10years: https://www.dentistryiq.com/print/content/55343908
Welcome. I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_03I'm Olivia Juan. And together we are the Compliance Divas.
SPEAKER_02Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I'll be the moderator for this episode. In January of this year, the American Dental Association published a new set of guidelines on radiation safety in dentistry, specifically a collaboration between the ADA and the American Association of Oral and Maxillofacial Radiography on patient selection for dental radiography and cone beam computed tomography or CBCT. This is the first time that this has really been addressed in a set of guidelines. So at the outset, what we're going to do is give our listeners a summary of these and some other guidelines that pertain to radiation safety and exposing patients to radiation. But we encourage you to look in the show notes for the links to all of the documents that we're going to talk about. There was an article released by the ADA in 2024, and there are guidelines that were published by the ADA and the Food and Drug Administration back in 2012 and updated in 2019 that talk about recommendations for patient selection. So, Linda, we're going to start off with you. And if you can just give us a little summary of why we're getting all these updates to the guidelines for radiography.
SPEAKER_00Happy to do so, Mary. First, I'd like to take us back to another document from 2012, where the ADA and the US Food and Drug Administration published the dental radiographic examinations, which was the recommendations for patient selection and limiting radiation exposure. I think it's important to know a little bit of history here. So as we come forward, everyone will understand what the changes are. That particular resource provides decision-making guidance on the use of various imaging modalities for general and pediatric dental care practitioners. And out of that, the conclusions and practical implications were the fact that clinicians should base their imaging decisions on the patient's medical history, their dental history, their clinical examination findings, risk disease assessment, and the presence of specific dental care or clinical conditions. So that makes perfect sense. But then coming forward to where we are now in the 2020s, we know that there's been rapid advances in the imaging modalities. And this has led to the increased use of digital imaging, portable handheld radiographic uh devices and cone beam, CT and everything. So there's been a lot of changes, and this is practical in every office because I remember when we first started seeing CBCTs and dental practices, there was maybe one on every block or one in every you know, every couple of miles, or and now it's one in every office. So it's really changed tremendously. So along with that, there's an updated document from 2024, which I know you'll give our listeners a little bit more information about in a few minutes that talks about some updated guidance. And this relates to shielding and different things along those lines. So it's important to know the distinction. And as we will say throughout the podcast, be sure you know your state laws. Check both. Make sure that you look at your state regulations as well as these guidelines to be sure you're following the more stringent protocols.
SPEAKER_02You're so right, Linda, because there are some state dental board rules that still say that patients must be shielded. And um, last week I was doing a webinar for the Virginia Dental Hygiene Association, and we found out that if you use a handheld radiography unit in the state of Virginia, the operator has to wear a shield, not the patient, but the operator. So you need to go to your state's Department of Radiological Health and also check your state dental board rules to see what those rules are. Some of our listeners may remember in 2012 when the FDA ADA guidelines came out about patient selection, they stated that there's a couple of interesting charts in the middle of that document, and you can download it from the show notes. But on one of the charts, they talked about selection of patients and frequency of exposing patients to bite wing x-rays. And we had followed the guideline of Bitewings once a year for a very long time, and this recommendation was changed to every two years. Well, almost immediately the benefits, insurance benefits plans picked that up and started only approving them every two years. But the caveat is that even though you follow that recommendation, if you have a patient who's very caries active or who has very aggressive periodontal disease, you can write a narration about that. And it's possible that the insurance company may pay it at a greater frequency, but you have to have a lot of good documentation and history, as you said, Linda. Look at the medical history, look at everything. So, Leslie, can we call on you to talk about some of these practical implications? What about shielding? What do we need to do? And so forth.
SPEAKER_01Well, Mary, it's so important, as was mentioned already, to check with your own state dental board. Some dental boards do require the shielding. And so, regardless of whether you have the American Dental Association article in hand or not, you'll need to check. I know in California I uh sent an email into the Department of Health Services radiologic branch, and I got an email back saying they were well aware of the American Dental Association's recommendations in their article, but still California has a requirement for the shielding. I also asked about whether there was a requirement for thyroid collars, because I've heard many times that that is recommended, especially on pediatric patients, that you're making certain that you're protecting this young bodies and young organs. And they said we don't have a regulation surrounding thyroid collars here in California. So again, it's important to check with your own state dental board to be sure. Also, with regards to some of the machines, the handhelds that you mentioned, uh, it's been demonstrated and accepted, at least here in California, that the nomad machine doesn't require the operator to wear uh shielding or to wear a decimeter badge. So monitoring the amount of radiation that the operator is getting so that it's less than five REMs in a calendar year. The other thing that's interesting about this article that came out in 2026 is that uh it helped to give what's called 12 condensed clinical recommendations, and I know Olivia is going to touch on that, for greater clarity and implementation in clinical practice. And uh one of the things that uh you might wonder is does this apply to intraoral and extraoral, such as cone beam is mentioned earlier today, and it absolutely does, and it's become an essential component, cone beam, for diagnostic imaging, and especially for endodontists. My father was an endodontist, and being able to diagnose patients and abnormalities and disease more easily. So, with all of the different AI tools, that it really means following the current practices and methodology, which is critical to case success. So, according to an article on Dr. by Cuspid, the new Cone Beam CT guidelines don't just impact endodontics, they also ensure that we have uh up-to-date case-by-case decision making, as you mentioned, that you're tailoring doses specifically for individual patients and needs. And I know that's so important for myself. It took a while for me to convince my general dentist that I only needed bite wings every two years. And while he wanted to take them every year because insurance paid for them every year, uh I told him that I wanted to go with what's called Alara, as low as reasonably achievable for x-rays. I have very low carries rate, same with my husband. And so we felt that the having bite wing x-rays every year was really not necessary. So again, following the guidelines is very, very important. They actually have another type of uh Alara guideline. It's called uh A-L-A-D-A-I-P, which means uh as low as diagnostically acceptable. So that's another term that we want to keep in our toolbox when it comes to deciding uh what images and and how many images and what type of uh machines we're going to be using to achieve those images.
SPEAKER_02That was a great summary, Leslie. Thank you so much. And Olivia, I'd like to ask you to highlight the um recommendations that are in the article for our listeners. If you download the 2026 article, which we have linked, it's in box one. And so give us give us the scoop on that, Olivia.
SPEAKER_03Sure, Mary. So under these general recommendations, which I think the divas have covered well already, is making sure we are adhering to our state or local rules because it may vary. Sometimes the law doesn't catch up to where the guidance is, so we have to be mindful of that. Also, we should not be doing radiographic screening before the clinical exam. We should be assessing patients' medical and dental history and so forth. And I think if you think about it, Mary, it makes sense. We don't want to start popping a bunch of x-rays just because the insurance pays for it. And so there should be a clinical exam first documenting conditions that warrant taking the x-ray exposing the patient to radiation. And all radiographs should be examined for caries, calculus, bone loss, and so forth within professional guidelines. So it does trigger a big responsibility, which I think is worth the time of our listeners reviewing this updated guidance. And so also the team members that are taking the X-rays should be trained in appropriate techniques. And what I wanted to mention is I did have a case not too long ago where uh Medicaid was disputing payment of radiographs. And what happened here is when the radiographs were sent in, they were such poor diagnostic quality that Medicaid did not agree that they should have been billed for them, that the problem was you know, learning how to take x-rays correctly. And so we we want to be mindful of that, and that you know, they really do look at the x-rays when they're sent in, and when there's cone cuts or they're not, you know, exposed properly, uh, that could be problematic. And so just be sure we're reviewing the guidance, comparing it to our state rules, and uh making some adjustments internally. And really, these are things that we've learned before, but there's some healthy reminders.
SPEAKER_02Absolutely, Olivia, and thank you for that summary. Um, and that you bring up such a good point that if we're going to take these radiographs and we're going to expose the patient to, although it's a very low dose of radiation, then we better be having these images of good diagnostic quality. And the nice thing is that some of the AI programs that are available now to assist with identification of disease can actually help to increase the resolution and help the um the diagnostic qualities of those radiographs, but you still have to have the sensor or your um phosphor plate in the correct position. And a cone cut is a cone cut is a cone cut, whether you're doing analog or digital film. The other thing I'd like to call our um listeners' attention to is in the 2026 ADA article in box two, there are a number of indications listed, and they're very detailed. For example, the first indication is imaging recommendation for caries. That's a very common one. This could be a great team meeting activity to go through what these indications are. There are recommendations for periodontal disease, and again, another frequently used condition for or for which radiographs are used. And they go on to talk about recommendations for ortho, for third molar and supernumer, supernumerary teeth, head and neck lesions, TMD and oralfacial pain, for implants. This has become probably the biggest driver in people adapting the CBC technology, um, CBCT technology, so that they can get a better picture of where they're going to place those. Um and for restorations, for periomaintenance, and any kind of CBCT um application in auto-transplantation, if you are going to use a donor tooth for implanting. So again, I think these are great topics for a team meeting, especially if it's the clinical team talking about um in indications for radiographs, and it's all spelled out for you, and I think pretty easy to understand language. Okay, so just to quickly review in the show notes, you're going to find the ADA article on dental radiography and CBCT from 2026, January 2026. There is a link to an article in DentistryIQ that talks about CBCT use for endo. And again, the 2024 updated recommendations for enhancing radiation safety. That's where some of the information came out about shielding patients or not shielding patients. And then finally, the ADA and FDA guidelines for radio radiographic examinations for patient selection that came out in 2012 and were updated in 2019. So all those documents will be available for you. Please take the opportunity to download them and make sure you review them with your team. The compliance divas brings simplicity to compliance by navigating the regulatory world to keep you on course. You can submit any questions about this or other podcasts to us by email at support at the compliancedivas.com. You can subscribe to our podcast on your favorite podcast app or visit our website, thecompliancedivas.com. Thanks for listening.