Contemporary Dentistry

X-RAYS AND THE HOLISTIC DENTIST: Why Do We Need X-Rays?

One of the most common questions I hear from patients is, “You’re a holistic dentist, why do you want to take x-rays? I don’t think I need any more…” and perhaps you have found yourself saying the same thing. I believe a balanced approach that takes all factors into consideration could help us all feel comfortable with one of the most frequent sources of conflict between patients and dentists.

I wish I had Superman’s x-ray vision, but since I don’t, I still have to utilize dental x-rays in my diagnostic process. What ARE x-rays? This is an easy to understand explanation from Steven D. Rima, CHP (a certified health physicist who promotes the science and practice of radiation safety):

“ X-rays are energy in the form of waves, identical to visible light. In fact, the only difference between light and x-rays is that light doesn’t have enough energy to go through your body and x-rays do. Both can make an image on photographic film, so both types of energy are used to make pictures; light makes photographs of the “outside” of objects, x-rays make pictures of the “inside” of objects, including your body. A unit called a “rem” is used to measure radiation. A rem is a large unit, much like a mile is a large unit of length, so we usually use a millirem (mrem) instead, much as you would measure in inches instead of miles for most purposes. (It takes 1000 mrem to equal one rem.)”1.

Many patients are concerned about excessive radiation exposure, particularly those who have had extensive medical x-rays or radiation therapies and I agree that you should be cautious about exposure. However, bear in mind dentists are not trying to take unnecessary x-rays. There is a principle that has been taught in dental radiography for decades called ALARA (As Low As Reasonably Achievable) in which we make every effort to ensure that we keep radiation exposure as far below the dose limit as possible. I always weigh the risk vs. the dental benefit and never ask you to have any more x-rays than you absolutely need. 1.

THE REALITY OF RADIATION

The word “radiation” often conjures up terrible post-apocalyptic horror movie images in our heads, but radiation actually exists all around us, in food, existing in the universe, in building materials, we even receive radiation from sleeping next to another person! 2. In the dental arena, we use x-rays to see through bone and tooth in areas that are impossible to see in our clinical examination. In-between (we call them “interproximal”) areas and overlapping teeth cannot be probed or examined.  The areas of tooth and bone that are concealed under your gums are also invisible in a normal examination. Only with an x-ray can we see the beginning stages of decay, bone loss, infection, or defects. Early detection of tooth decay (which is a disease) is crucial to ensure that we can perform minimally invasive dentistry and ensure oral and total body health. When we DO have to perform an invasive procedure, diagnostic radiographs are required because performing a procedure without them can be considered malpractice.
How much radiation are you getting anyway? Compare some of these items with dental x-rays: (annual radiation in millirems)

* Living in a brick house: 7mrm       * Tobacco products: 1300 mrm
* Cosmic Radiation: 27 mrm            *  Flying: 23 mrm
*Mammogram: 13 mrm                    *  Dental bitewing x-ray: 0.23mrm

Dental x-rays are designed to target just a very small area, limiting the amount of radiation to other areas of your body. In addition, we add a lead apron and thyroid collar to cover your chest and organs. Because of the limited beam of dental x-rays and the fact that we are using digital x-rays that expose you to up to 90% LESS radiation than film, you are exposed to far less in a dental office than a medical situation. Combined with a judicious selection of situations in which x-rays are taken, we are able to keep you safe while still detecting dangers to your teeth.

A COMMON QUESTION

You may wonder why the assistant or hygienist leaves the room when they trigger the x-ray unit. Remember that you are exposed to only a very small amount of radiation, it is directed into a very small beam, you are covered with a protective vest, and you are only having x-rays done periodically. Dental professionals can see 10+ patients per day, so think of how much more exposure they could potentially have; this is why we leave the room!

A LITTLE CAUTION

What if you decline all x-rays and even examinations (as I’ve seen certain wellness blogs advocate)? This can be a really bad idea. A lot of bloggers and even MDs make bold statements about dentistry without even understanding how everything works, so I’d like to share a little bit of what I’ve experienced and give you a proposal that we all can live with!

teeth close upLet’s compare the two images and you’ll get to play dentist with me! In the first image (above), the tooth on the left has a crown, I could tell by using my explorer (the hook shaped dental instrument) and feeling at the gumline.  What I DON’T see until I look at the x-ray is the fact that the tooth has a root canal and post as well (that thick white line running down the center). In the photograph, the tooth on the right is a beautiful, natural looking tooth. When I look at the x-ray, I see a dark shadow that almost looks like a tunnel breaking through the tooth on its left side.

Notice decay forming on  the left side of the tooth.

tooth decay xrayThis is a large, deep area of decay! I could not possibly feel this area with my explorer, the patient may not always feel anything painful in the tooth, and the tooth looks normal from the outside. The decay has broken down the first layer (enamel) and has penetrated into the second layer (dentin) and is creeping very close to the center of the tooth (pulp). If this patient were to decline x-rays and postpone examination, the tooth could be in real trouble before it was ever discovered.

 

tooth infection xray​​Do you see the round halo around the tooth in the middle of this picture? This is a large area of infection!! The patient had no symptoms, no swelling, nothing externally indicated infection. The only way to detect it was this x-ray.

Finally, you can see that this patient actually has an EXTRA tooth (called a ‘supernumerary tooth”). The supernumerary tooth and wisdom teeth are all hiding under the gumline and can only be revealed with an x-ray.
full teeth xray

MY PROPOSAL

As I have said to my patients before, I believe that customized, individual care is the new paradigm of dentistry. Allow me to make a proposal: Find a quality holistic/biological dentist in your area. Complete a Comprehensive Oral Evaluation with a Full Mouth Series of digital x-rays (18 small individual x-rays of each region of the mouth). From this visit, the doctor can determine your Caries (another word for “cavities”) Risk Factor. This is crucial. Once this baseline is established, the frequency of dental x-rays for YOU can be determined. If you are someone who does not have decay, is regular with hygiene maintenance appointments, has few restorations, and is very careful with homecare, you may not need to have x-rays as frequently. If you are prone to having cavities, maybe have lots of crowns or implants, you may need to have regular x-rays to monitor these areas and make sure decay or bone loss has not occurred. Feel free to ask your dentist why they are taking the x-ray, we want you to feel comfortable and know that we are trying to be proactive about tooth decay while still thinking of your total health and safety.

1. http://www.physics.isu.edu/radinf/dental.htm
2. http://www.iem-inc.com/information/tools/common-radiation-exposures