Sometimes the old is new again. Or it can take decades for an idea to come to fruition. Then again, maybe a fresh reboot on a concept that has been percolating for a long time is what’s needed to get things going.
What am I going on about?
When I was accepted into dental school, one of the things that attracted me to the school was it’s philosophy that the oral cavity is but just one part of the entire body, and in order to gain an understanding of how to manage and treat oral diseases, one needed a broader study of the entire body. Hence, the first two years of my dental school education were at the medical school, taking all of the same courses as my medical colleagues – biochemistry, gross anatomy, microbiology, genetics, immunology, patho-physiology and so on. It was fantastic and helped me broaden my understanding of medicine in general.
Dentistry does not exist in a vacuum. On a daily basis we treat patients in the dental chair with complex medical conditions, allergies and who may be on a variety of medications. As pediatric dentists, we are often referred patients with chronic diseases that necessitate coordinating care with other medical specialists. It is crucial that we develop a global medical expertise which gives us the skill set to recognize how medical conditions can impact the dental care we recommend.
The dental/medical community is still asking ourselves what role the dentist should have in diagnosing and managing medical conditions such as high blood pressure, diabetes, asthma and depression. Studies have shown that a lot of people see a dentist more often than their primary care medical doctor. If that is true, we are missing a tremendous opportunity in improving the overall health of our patients.
Fast forward 20 odd years, and the dental-medical community is still struggling to reconcile the mouth-body gap, and the role of the dentist in our patient’s overall health. A recent article “Fluoride and a Physical: Patients see Docs at the Dentist” reviews changes being implemented at the Harvard School of Dental Medicine is hoping to address this challenge. Primary Care Physicians and Nurse Practitioners are now actively involved in the clinical care of patients alongside dental students.
Hopefully this initiative will stick, be picked up by more dental schools and be transformative in the way we deliver health care. I’m hopeful that eventually this will come to be, but I’m still waiting (ergo my first paragraph of this article). Because 24 years ago I was a first year student at Harvard School of Dental Medicine and despite having this concept of holistic care ‘drilled’ into me, this idea of “putting the mouth back in the head, and putting the head back in the body” is still trying to gain traction in the broader community.
“I don’t want my child to have any x-rays!”
“I think my child is getting too many x-rays and I’m worried about radiation”
These are just a few of the comments that we hear on a daily basis at our office. Parents are extremely concerned about the amount of radiation that their child is being exposed to, and instead of running from these important questions , our practice welcomes them and we spend a lot of time discussing their concerns.
Parents, like most individuals, have heard about the dangers of excessive exposure to radiation. They have most certainly heard about the high levels of exposure when taking a chest x-ray, CAT scan, or MRI. They have probably also heard that radiation exposure accumulates over a lifetime; hence, the more one is exposed, the greater the amount of lifetime accumulation.
The simplest explanation I usually give parents is that the amount of radiation a bite-wing x-rays emits is extremely , extremely low – about 10 times less than that of a chest x-ray and 1000x less than a CT scan. One of the more important things to consider is that for we are also all exposed to radiation from natural sources all the time. The average person in the U.S. receives an effective dose of 3 mSv (millisieverts is the scientific unit for radiation dose) from naturally occurring radioactive materials and cosmic radiation.
Radiation Type Radiation Amount
Daily background radiation 0.008 mSv
Single Digital Bitewing 0.005 mSv
Digital Panorex 0.01 mSv
Cross Country Flight 0.03 mSv
Chest X-ray 0.1 mSv
Chest CT 7 mSv
Head CT 2 mSv
To put things in perspective, a single typical dental x-ray is less than a day of usual background radiation, and a panoramic x-ray is 3 times less than flying a plane cross country. One chest CT is the equivalent of 1400 dental x-rays. In fact, if one lived in higher altitudes such as in Colorado, you are exposed to 50% (1.5 mSv) more background radiation than those of us at sea level (that’s the equivalent of 300 dental x-rays for those of you keeping count). Click here for more information.
The takeaway from this data and the multitude of studies done on x-ray safety is one should not worry about the amount of exposure one gets from dental x-rays. As shown, the amount of exposure is low, and the estimated additional risk of developing cancer as a result is negligible.
All things in life are about considering the cost:benefit ratio. The cost of not taking a dental x-ray is the inability to diagnose disease (dental caries) and allowing it to progress to a point where one is put at risk of pain, localized and systemic infection, and extensive treatment which could have been avoided. The cost of taking an x-ray is…..well, as we have seen, is less than a day outside. One should note that people who live in Colorado get 50% more background radiation than those of us in Boston, are deemed some of the healthiest people in the United States, with cancer rates not being any higher.
Certainly, if you do have concerns about the need to take x-rays, I would encourage you to speak with your dentist. There is a recommended schedule for taking x-rays – the key word here is recommended. There are certainly reasonable cases to be made for not taking x-rays routinely (ie. low caries risk, exfoliating baby teeth) which should be made on a case to case basis.