The American Dental Association (ADA) has released new X-ray recommendations for the first time in over ten years. Here’s what you need to know.
By Genni Burkhart
On January 5th, the ADA recommended using 2D (planar) and 3D (cone beam computed tomography) imaging only when needed, to limit radiation exposure for patients and dental professionals.
The recommendations appeared in the January issue of The Journal of the American Dental Association and were also published online before being printed in Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology.
Ask, Is This Necessary?
The updated guidelines stress that imaging should follow a clinical exam, not before. Furthermore, dentists should review a patient’s medical and dental history, check current findings, and look at previous images before deciding on new X-rays.
This approach ensures X-rays are used for diagnosis, not just as a routine step. It also helps avoid unnecessary repeat imaging and keeps radiation exposure lower.
Guidance on 2D and 3D Imaging
For most routine checkups, the ADA recommends using intraoral 2D X-rays as the main imaging tool. When combined with a good clinical exam, these X-rays usually give enough information to diagnose common dental issues.
The ADA also suggests cone beam computed tomography (CBCT) should be reserved for complex cases that need extra detail. The guidelines list situations where CBCT is appropriate, such as:
- Suspected root fractures.
- Complex endodontic cases.
- Implant planning.
- Unclear pathology.
- Temporomandibular disorders.
- Cases where symptoms do not match what appears on standard images.
If CBCT is needed, the ADA recommends using the smallest field of view possible to get the information required.
Consensus-Based Recommendations
These recommendations were developed by an expert panel convened by the ADA Council on Scientific Affairs, with input from dental specialists across multiple disciplines and endorsement from the American Academy of Oral and Maxillofacial Radiology (AAOMR).
While this panel reviewed the available research, they also concluded that the current evidence doesn't point to a single right answer for every patient or situation. As a result, the ADA stopped short of issuing regulations. Instead, guidance leaves room for clinical judgment, recognizing that imaging decisions should be based on the clinical examination, the patient’s medical and dental history, and the specific condition being evaluated.
Radiation Safety and Previous Guidance
This paper is the second publication focused on diagnostic imaging in dentistry. In 2024, the ADA updated its recommendations on radiation safety and regulatory considerations. That guidance concluded that thyroid collars and lead abdominal aprons are no longer necessary for most patients due to improved technology.
Together, the two publications emphasize balancing diagnostic value with long-term patient safety. The ALARA principle, which stands for "as low as reasonably achievable," should still guide decisions about dental imaging.
Patient Transparency and Trust
Routine X-rays are no longer the norm. Now, X-rays should be used only when they directly help with a patient’s diagnosis or treatment plan.
Many patients think they need X-rays at every visit, but insurance doesn’t always cover them. Explaining when imaging is needed and when it isn’t helps build trust and keeps things transparent. Patients will also appreciate not having to pay for unnecessary services.
Practices are encouraged to review the updated recommendations, compare them with current protocols, and ensure the entire team understands how imaging decisions comply with new ADA guidance on the matter.
To read the full practice guidelines on these recommendations, visit JADA.ada.org.
Author: With over 16 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.
