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Are Lead Aprons still necessary when taking Dental Xrays?

Are Lead Aprons still necessary when taking Dental Xrays? 

As a parent and employer, I am extremely concerned for both my clients, and my dental team regarding exposure to excess radiation. That is why we try to follow the current recommendations when it comes to dental xrays.

Current research shows that lead apron use is not required due to the limited exposure and tight beam pattern of current digital xrays.

There is no reason for lead apron use due to the improvements in digital radiography.  In some instances, thyroid collar use is recommended if the xrays are in close proximity to the thyroid gland on younger clients.

At our offices, we have some of the newest technology available in dental radiology and our machines have been tested by State officials which show that the amount of radiation from our modern xray units is negligible.

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Below are some research excerpts pertaining to current thinking in dental radiology regarding both lead aprons and thyroid collars.

Should patients and carers wear lead aprons and personal protective devices during a dental radiographic procedure?

With well designed and optimized equipment and procedures there is no need for routine use of lead aprons for the patient in dental radiology. Lead aprons may provide some protection in the case of the vertex occlusal examination, and may be prudent in the case of vertex occlusal examinations in a patient who is, or may be, pregnant. On the other hand, the use of a lead apron may reassure patients that every effort is being made to ensure their safety, and may reduce the amount of time that needs to be taken to reassure them. Certainly a lead apron should be provided for any patient who requests one. It may also be advisable to consider using them on a cautionary basis where equipment and/or technique have not been verified by a radiation protection specialist, and where they will not otherwise interfere with the examination. Thyroid collars should be used in the few examinations where the thyroid may be in the main beam.

Lead aprons should be provided for a person who is required to support a patient during the radiographic procedure (i.e., a comforter or carer). Assisting adults should be positioned so that all parts of their body are out of the main beam.

What are the recommendations and safety measures for children undergoing dental radiography?

Many actions are similar to those recommended in adult procedures. Although radiation exposure arising from dental radiology is low, a child may undergo many repeated procedures during childhood and adolescence. Therefore, the accumulated effect of the radiation exposure should be taken into consideration. The salivary and the thyroid glands are among the organs at risk in dental radiology. The salivaries are often within the primary beam, while the thyroid receives dose mainly due to scattered radiation. Since the thyroid is a radiosensitive organ in children, it may be necessary to consider shielding it from time to time.

Leaded aprons

Lead aprons do not protect against scattered radiation internally within the body and in the case of panoramic radiography, they may physically interfere with the procedure and degrade the final image. Despite the extremely low gonadal dose associated with dental radiography, the use of a lead apron has been recommended in the past in order to allay patient anxiety. However, it has been shown that gonadal doses are not significantly different in dental radiography with and without a lead apron. UK Guidance Notes for dental practitioners on the safe use of X-ray equipment, clearly state that there is no justification for the routine use of lead aprons for patients in dental radiography. An official report of the American Academy of Oral and Maxillofacial Radiology, pointed out that the value of leaded aprons is minimal compared with the benefits of the use of E-speed films and
rectangular collimation. It was concluded that their use could be considered optional except when required by law. There is no evidence to justify routine use of abdominal (gonadal) lead protection for dental radiography.

Thyroid collar

The thyroid gland is one of the more radiosensitive organs in the head and neck region. It is frequently exposed to scattered radiation and occasionally to primary beam during dental radiography. Because people under age 30 are at greater risk of radiation induced thyroid cancer than older individuals, some have argued that thyroid collars should be used when intraoral radiographic examinations are made on this population. However, it is probable that rectangular collimation for intraoral radiography offers similar level of thyroid protection to lead shielding, in addition to its other dose reducing effects. Thyroid shielding is inappropriate for panoramic radiography as it may interfere with the primary beam. Lead shielding of the thyroid gland should be used in those cases where the thyroid is in line of, or very close to, the primary beam.

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Although lead aprons and thyroid collars may not be necessary, we have them available and offer them to our clients who prefer them. In the future, if  you would like to have a lead apron/thyroid collar for any future xrays, please ask us.

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Dr. Mike Maroon owns & operates Advanced Dental with offices in Berlin, CT & Cromwell CT. More information about his dental practice can be found at www.AdvancedDental.com. He can be reached at MMaroon@AdvancedDental.com.