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X-ray frequency

The office I am in takes X-rays every two years generally. I try to get them every year and patients complain that the old hygienist never did that. How would you approach this without them thinking one of you is wrong ?



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13 Answers

Do you take digital x rays? If so, I would explain the safety and minimal exposure of the x rays compared to the VALUE of catching problems when they are small. I explain that our office believes in ” minimally invasive dentistry ” and that yearly digital x rays help us to achieve this. Most dental insurance companies pay yearly and we all know that the insurance won’t cover anything they deem unnecessary! Anything can happen in 2 years and a lot of dental problems are asymptomatic and not visible clinically until they are advanced.. I explain that problems never get smaller or less expensive and we can save them tooth structure AND $$ by early intervention! Good luck!
( The American Nuclear Society has worksheets that show how SMALL the exposure is from digital dental films… I copy it and hand it to the patients ! )

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The ADA recommends bitewing radiographs every 6-18 months depending on caries risk. For those who are at a high risk for carious lesions, it is recommended to take the bitewings every 6 months for 18 months following a treatment for a carious lesion. For those at a moderate risk, it is recommended yearly. And for those at a low risk it is recommended at 18 months. Go to mouthhealthy.org (an ADA site)to find the guidelines to share with those patients who question your dentist’s recommendation for more frequent radiographs than have previously been taken. After all, it is your dentist who is prescribing the radiographs, not the hygienist. That isn’t within our scope. 🙂

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I agree with PattyZ and seltld. If they are comparing you to the previous hygienist, remind them that they are in good hands and you are giving them the standard of care. If they refuse after your efforts I would have them sign an X-ray refusal form and document it!
Here is a great read from RDHmag.com on radiographic frequency guidelines as stated by the ADA. I like the scenario and bullet points on risk factors that determine need for X-rays. Generally all my patients have AT LEAST one of these risk factors. However if a patient does not have any of these risk factors, why expose them? Every office has different philosophies but this is something I would make sure my Dr and I are on the same page with.

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I also explain to patients that we cant diagnose what we cant see. If we wait too long to take xrays there could be issues happening that we arent seeing and waiting too long in between could make a problem a bigger one than if we get proactive and do them annually. There are still some patients that refuse but I reiterate at each appointment we cant diagnose or treat problems we cant see and the hope is that we dont find anything on the xrays!

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You can always blame the ADA. Explain to the patient that “New recommendations” from the ADA have come out and that the standard of care has changed. 🙂

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My word choice would be…”I understand that the previous RDH didn’t …however, recommendations have changed. The Dr. does not want to miss something b/c he/she cannot see in between your teeth””

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No digital X-rays. They believe that because they were always taken at 2yr intervals that I am wrong. I don’t want to make them think the previous hygienist was wrong either!

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We like bwx 1 x yearly for children, teens , and adults. FMX or Pano every 3 to 5 years. Pano is taken for baseline if patient has started on any bisphosphonate medication, then every 2 to 3 years. We do cut back on bwx if pt has low decay or few restorations. Going digital and using a thyroid collar has eased a lot of anxiety for our patients.

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My office likes to take new bitewings every year and if it’s a new patient they get a PANO and bitewings at their first visit. I have patients refuse quite a bit and I basically explain to them the negative effects of skipping them. I tell them the radiation levels have decreased from using digital and that they get more atmospheric radiation from being outside for an hour, or riding in a plane. I recently went to an OSHA re-training seminar and the ADA has changed their recommendations.
-Conservative Prescription
Prescribe films only AFTER clinical exam
Prescribe films based on patient needs, not insurance payment schedule
-Film Speed
Film speed slower than E shouldn’t be used
Digital sensors are comparable (if not faster) than F speed
-Technique Reminders
Use film-holding devices to avoid retakes
Use body and thyroid shielding on all patients (thyroid is mandatory)
Use collimators when possible

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I would just tell them office policy is yearly….most insurance companies have limited BWs to yearly also…xrays are probably our most refused service…we do educate on risks and document refusals…

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High incidence of carious lesion patients radiographs should be taken every 6 months until home care changes and cavities cease then go to yearly. Some patients only need radiographs every couple years if that. Use your judgement.

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Always follow either the ADA or American Association of Radiology guidelines.
Always state why you are taking the radiographs, what radiographs were taken and what the findings were.
This is important for legal reasons.

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Am I missing something here… Are they not prescribed by the doctor?

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