Editor's note: Edwin T. Parks' column, Talking Pictures, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.
There is no such thing as a good photon -- trite but true. As dental professionals, we are the steward of our patient's exposure to dental diagnostic x-rays. A recent article in the Journal of the American Dental Association suggests that even a small bit of x-ray exposure carries risk and that the dose to the patient be kept to a minimum.
Using f-speed x-ray film or digital receptors decreases patient exposure. So does the use of rectangular collimation.
But there is a much better way to decrease exposure to the patient: Don't take the image unless it has the potential to change your treatment.
"Selection criteria" have been available since the 1980s. These criteria were approved by virtually every dental specialty organization, as well as the FDA and ADA, and can be downloaded from the ADA Web site.
The central premise for selection criteria is quite simple: The dental status and overall health status of the patient determine the images to be taken. For example, an 18-year-old patient with two pit restorations and healthy periodontium needs a panoramic image and bitewings. Another 18-year-old patient who downs a 2-liter bottle of soda by 9:00 in the morning and chases it with a snack cake most likely needs both a full mouth series as well as a panoramic image.
The point is that two 18-year-old patients with completely different dental needs shouldn't have the same radiographic series.
A quick look in the mouth will give you the biggest diagnostic yield for the lowest possible patient dose. One size does not fit all!
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