Are your X-ray practices current? Explore the latest updates in dental radiography standards and what they mean for your team.
By Paige Anderson, CRDH
In modern dentistry, staying up to date with imaging protocols isn’t just about following the rules. It’s about protecting our patients and improving the quality of care. With new technologies emerging and old recommendations evolving, now is the perfect time to revisit how, when, and why we take dental X-rays. Let’s review updates in dental radiography protocols and what they mean for your practice.
Dental Diagnostics Have Evolved
The tools we use to diagnose oral health issues are more advanced than ever.
Digital X-ray technology has made it possible to capture high-quality images with lower radiation doses, allowing for safer and more efficient imaging across the board. In addition to X-rays, many offices have incorporated adjunctive technologies like infrared caries detection, fluorescence-based tools, and laser diagnostics.
While helpful, these tools do not replace radiographs, which remain the backbone of dental diagnostics. However, they may enable us to perform effective preventive dentistry while minimizing our need for X-rays.
These alternatives are a great addition to our collective toolboxes, especially considering that X-ray hesitancy can be a major roadblock for many patients. Recent changes to the ADA’s X-ray recommendations focus on minimizing unnecessary exposures, making alternative diagnostics a wise investment.
What’s New in X-Ray Recommendations?
Recent updates to imaging protocols reflect both technological advancements and a growing understanding of radiation safety. Here are a few key takeaways.
Personalized Imaging Intervals
Most of us have long adhered to the old routine of yearly bitewings and alternating full-mouth series and panoramic x-rays every three to five years. However, the ADA updated these recommendations several years ago and now recommends a much lower frequency for many patients.
For example, adults with low caries risk and no specific indications should only get bitewings every two to three years. Current recommendations are to base X-ray frequency on caries risk, age, and clinical history rather than following a one-size-fits-all schedule.
CBCT Only When Indicated
Just a few years ago, CBCT scanners were rare, and you may have needed to refer to a specialist such as a maxillofacial surgeon or periodontist to get this type of imaging. These days, more dental practices than ever have a CBCT on-premises.
These powerful scanners offer high-resolution, cross-sectional imaging that can dramatically improve treatment planning. However, CBCT exposes patients to significantly more radiation than conventional 2D radiography, so careful case selection is key.
Changes in Shielding Practices
Perhaps the most surprising update is that lead aprons and thyroid collars may no longer be necessary for many dental X-rays. These updates are based on data showing that, with modern imaging systems, scatter radiation is minimal and the actual benefit of shielding is far less than previously thought.
Do We Still Need to Use Lead Vests and Thyroid Collars?
Lead aprons and thyroid collars were considered essential protective measures for decades. But newer studies have questioned their routine use, especially the thyroid collar, which can sometimes obstruct the beam or cause artifacts, leading to image retakes and increased exposure.
Thanks to improved beam collimation and filtration, modern X-ray systems minimize scatter radiation, and what little scatter occurs often misses the thyroid area entirely. In fact, multiple professional bodies, including the ADA and AAPD, now state that routine shielding may not be necessary for properly calibrated equipment and exposures.
Still, abandoning shields entirely might not be right for every practice or patient.
The Basics Never Change
Even as the tools and recommendations evolve, one principle remains constant: ALARA (As Low As Reasonably Achievable). Every x-ray decision should be grounded in this idea, balancing the diagnostic value of imaging against the need to protect patients from unnecessary radiation.
Educating your team on updated protocols and communicating clearly with patients is also critical. Transparency about why you're taking (or not taking) an X-ray, and how you're minimizing their exposure, builds trust and reinforces your commitment to their well-being.
So, Should We Ditch the Lead Vests?
Not necessarily. While the research supports scaling back on shielding in some cases, patient perception still matters. Many patients associate lead aprons with safety and may feel anxious without one. If it helps reduce patient anxiety and encourages compliance with necessary imaging, it may still be worth using, especially with proper placement that doesn’t interfere with the beam.
Ultimately, the goal is to keep your imaging protocols evidence-based, patient-centered, and flexible. Whether that means modifying shielding habits, adjusting imaging frequency, or upgrading your tech, staying informed ensures that your diagnostic tools work for your patients, not against them.
Author: Paige Anderson is a certified registered dental hygienist with eight years of clinical experience and an English degree. She blends her two areas of expertise to create resources for dental providers so they can change lives by giving their patients the highest possible standard of care.
