Dental X-rays

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Dental X-rays

Postby scubadiver » Wed Jun 20, 2012 10:46 am

I had an interesting experience at the dental office the other day and would like to get some outside opinions, preferably from someone in the dental profession. A bit of backgroun first.

I recently switched employers and my prior dentist does not accept the dental insurance provided by my new employer. I found a new dentist that did accept the insurance and made an appointment for an oral exam and cleaning. The hygenist insisted that we start off the visit with dental x-rays. I politely declined. She insisted. I spoke with the office manager who also insisted and who subsequently made the claim that they had a legal responsibility to do so per VA state law and refused to proceed with a cleaning until the x-rays were done. I found this very odd and ended up leaving the office with no x-rays and no cleaning.

After perusing the ADA website I found a response under frequently asked questions that seemed to address the issue. The website provided no strict guideance as to how often x-rays should be performed and explicitly stated that the dentist would make a recommendation regarding x-rays after performing an oral exam and reviewing my dental history, none of which happened in my recent office visit.

My question is this: can I refuse dental x-rays (for whatever reason) and if so can the dentist then refuse to see me?
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Re: Dental X-rays

Postby livesoft » Wed Jun 20, 2012 11:10 am

I refused a panoramic X-ray on my last visit. No problems.

I am happy to have "bite-wing" X-rays with a CCD detector every couple of years or if symptoms are present. I would select a dentist with modern X-ray equipment that gives much lower doses than the old systems used with film. And beware: Dentists and their staff are usually clueless about X-rays.

As you can imagine, I am not a dentist, but one of the hats I wear is radiation physicist.
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Re: Dental X-rays

Postby tc101 » Wed Jun 20, 2012 11:15 am

Dental X-rays Linked to Brain Tumors, not recommended every year
http://www.webmd.com/brain/news/2012041 ... ain-tumors
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Re: Dental X-rays

Postby ScottW999 » Wed Jun 20, 2012 11:16 am

Yes and yes. Both the consumer and the provider have the right to decline.
But would you bring your car in for service and then decline a test or inspection which would give the technician the information to either find a problem or be sure there were no problems?
Or at least form a baseline to compare with later on of or when a problem arises.
P.S. I am a dentist and I try not to be biased either way.
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Re: Dental X-rays

Postby cheese_breath » Wed Jun 20, 2012 11:20 am

Maybe it depends on where you live? I don't know. But I'm not aware of any such laws in Michigan. I believe I have the right to refuse any dental service I want, and the denstist can refuse to see me for whatever reason he wants. I can understand why the dentist might refuse to perform some services such as a root canal without taking x-rays first, but not teeth cleaning. If my dentist tried forcing something on me I didn't want I'd walk out too. I don't buy his story about legal requirements.

Funny story though. My dentist also does cosmetic dentistry. I have a crooked front tooth. Some time ago when I was about in my late 50s or early 60s he suggested braces to correct the tooth. I told him I'd lived with it all my life so I guess I'd live with it the rest. He looked at me like I had two heads, but I didn't get the braces and he's still my dentist.
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Re: Dental X-rays

Postby cheese_breath » Wed Jun 20, 2012 11:29 am

ScottW999 wrote:But would you bring your car in for service and then decline a test or inspection which would give the technician the information to either find a problem or be sure there were no problems?

Yes I would decline it if I came in for a routine oil change, was having no problems with the car, and he wanted to charge me a fee to inspect it. I doubt this dentist wants to do the x-rays for free.
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Re: Dental X-rays

Postby sscritic » Wed Jun 20, 2012 11:39 am

This was a first visit, not a regular visit. If you went to a new doctor, wouldn't you expect to be examined before getting an operation or a prescription? It may not be a law, but this is a very common practice for new patients on a first visit. I expect some dentists will refuse to treat you (except in an emergency) if you are unwilling to be examined. If you are unwilling, find a different dentist who doesn't want to know the condition of your oral health before treating you.
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Re: Dental X-rays

Postby Call_Me_Op » Wed Jun 20, 2012 11:41 am

I would also add that the risk to your health from dental xrays is much less than from scuba diving.
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Re: Dental X-rays

Postby jasonlitka » Wed Jun 20, 2012 11:59 am

cheese_breath wrote:
ScottW999 wrote:But would you bring your car in for service and then decline a test or inspection which would give the technician the information to either find a problem or be sure there were no problems?

Yes I would decline it if I came in for a routine oil change, was having no problems with the car, and he wanted to charge me a fee to inspect it. I doubt this dentist wants to do the x-rays for free.


Many insurance plans cover a full set of x-rays every year or two with little or no cost to the patient.

The dentist just wants to do them because the OP is a new patient, probably didn't bring a reasonably-current set with, and x-rays are a diagnostic tool to finding cavities and other decay.
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Re: Dental X-rays

Postby scubadiver » Wed Jun 20, 2012 12:07 pm

sscritic wrote:This was a first visit, not a regular visit. If you went to a new doctor, wouldn't you expect to be examined before getting an operation or a prescription?


Sure, if I were seeking an operation or prescription, this would be fair game. However, I was primarily seeking to have my teeth cleaned and was willing to accept the limitations associated with a visual review to assess my oral health risks.

Call_Me_Op wrote:I would also add that the risk to your health from dental xrays is much less than from scuba diving.


Ouch! :)

Since a number of people have commented on this, I'll just add that I'm not extremely concerned about the x-ray exposure. I do think it's prudent to limit such exposure in general, but again this is not a big concern.

My motivation, which admittedly may qualify me as crazy, was that I don't feel that I need the x-ray exam and I don't want my insurance company billed for it. Period. I'm actually thinking about dropping dental coverage all together and just going back to the old dentist and paying out of pocket. I seem to recall that as a cash paying (i.e., no insurance having) college student, the issue of dental x-rays never came up.

I found it odd that the dentist refused to even clean my teeth, a procedure which I do not believe requires an x-ray to perform. That said, finding a dentist who is willing to accomodate my world view on x-rays is the obvious common sense solution.

Thanks for the responses.

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Re: Dental X-rays

Postby Fallible » Wed Jun 20, 2012 12:19 pm

livesoft wrote:I refused a panoramic X-ray on my last visit. No problems.

I am happy to have "bite-wing" X-rays with a CCD detector every couple of years or if symptoms are present. I would select a dentist with modern X-ray equipment that gives much lower doses than the old systems used with film. And beware: Dentists and their staff are usually clueless about X-rays.

As you can imagine, I am not a dentist, but one of the hats I wear is radiation physicist.


I also have refused some X-rays, but mainly because I'd had 17 X-rays in one area over the course of two years for work (oral surgery and root canals) on two teeth. Many of these X-rays I later realized were unnecessary (because the teeth had already been recently X-rayed by another dentist but a second one (an endodontist) wanted to take his own X-rays) or were repeats because the hygienst or technician incorrectly aimed the "camera." When I mentioned the 17 to another hygienst, she said she wouldn't want more X-rays either. Problem is, no one is certain how many X-rays are too many (dentists just tell me the dosage is "low"), so I really end up going by how scared I am of them. I get full-mouth every five years, bite-wings every couple years, but my regular dentist always wants to do the latter every year. And in addition to those, there are X-rays of individual teeth being worked on.
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Re: Dental X-rays

Postby BogleBrit » Wed Jun 20, 2012 12:25 pm

My wife and I cycled through several dentists because of what we felt were misleading interactions designed to get money from insurance regardless of the impact it had for our dental health or out of pocket expenses. Eventually we settled on a dentist that we really like and although they are not a preferred provider in either of our insurance plans we have never been surprised by a bill or 'encouraged' to receive a treatment without getting a pre-determination of the costs from the insurance company. It is worthwhile for us to maintain dental insurance because it significantly decreases our out of pocket expenses despite the dentist not billing at 'preferred' rates and the insurance company paying at the lower out of network rates. The dentist processes the claims with the insurance company even though are not part of that insurance company's network but we could do that on our own if they didn't offer to do it and the insurance company would send the checks directly to us.
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Re: Dental X-rays

Postby FrugalInvestor » Wed Jun 20, 2012 12:26 pm

I imagine that the dentist being a private entity can refuse service for reasons related to care but cannot substantiate that opinion. I often refuse x-rays at my dentist's office. They want to x-ray pretty regularly and I only allow them to x-ray about half as often as they'd like.
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Re: Dental X-rays

Postby BigFoot48 » Wed Jun 20, 2012 12:38 pm

I'm a big user of dental services, and have had many dentists around the country over the years. While I have never refused to have xrays done, because I was a new patient, and expected to use their services for a long time, I find this dentist's insistence on xrays rather odd. I think his refusal to do a simple cleaning unless you get the xrays as an indicator that he is using it as a revenue generator, both in taking the xrays, and finding additional dental work.

You were right to walk out. Find a dentist who is not looking to squeeze his/her patients for every buck they can.
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Re: Dental X-rays

Postby ScottW999 » Wed Jun 20, 2012 12:57 pm

jasonlitka wrote:
cheese_breath wrote:
ScottW999 wrote:But would you bring your car in for service and then decline a test or inspection which would give the technician the information to either find a problem or be sure there were no problems?

Yes I would decline it if I came in for a routine oil change, was having no problems with the car, and he wanted to charge me a fee to inspect it. I doubt this dentist wants to do the x-rays for free.



Having nothing to do with teeth, but everything to do with automobiles, I would want and appreciate an inspection of my car at the time of oil change in order to try to prevent surprises down the road. (Pun intended.)
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Re: Dental X-rays

Postby Rozdg » Wed Jun 20, 2012 1:09 pm

I'm replying as a fellow patient.....not an expert. I don't have routine dental x-rays and left my former dentist over 10 yrs. or so ago, because she made such a big deal over it. I sort of inherited her as a dentist, as my former one retired and she bought out his practice. I stayed with her for several yrs. (good dentist) but got tired of the hassle over yearly x-rays. I switched dentists and couldn't be happier with who I now have. I explained that I don't want routine x-rays unless they're warranted for a reason and he said he's fine with it as long as it's an informed decision on my part. It is.....and I get them routinely every 3 yrs. unless there's a cause.I know some will diasagree but this is what I'm comfortable with. I feel all these routine x-rays mount up....as dental aren't the only ones a person has done routinely.
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Re: Dental X-rays

Postby HueyLD » Wed Jun 20, 2012 1:11 pm

Scubadiver,

Finding a dentist (or a doctor, a lawyer, etc.) that you feel comfortable with is very important, IMO. Chances are: you will need his service for a long time.

I do find it a bit "over" the top that the dentist's office refused to accept a new patient w/o a panoromic x-ray first. I can understand that the dentist may want such an x-ray in the future for liability and diagnostic reasons.

Do you by any chance have a recent x-ray from your previous dentist? If it was taken within the last five years, you can certainly have the record transferred to the new dentist. If the new dentist still insists on doing a whole new x-ray after such a transfer, then he is not a dentist you want.

I was also forced to change my dentist due to a change in dental insurance carrier and it was not a pleasant experience. Best of luck with your search.
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Re: Dental X-rays

Postby cheese_breath » Wed Jun 20, 2012 1:44 pm

ScottW999 wrote:
jasonlitka wrote:
cheese_breath wrote:
ScottW999 wrote:But would you bring your car in for service and then decline a test or inspection which would give the technician the information to either find a problem or be sure there were no problems?

Yes I would decline it if I came in for a routine oil change, was having no problems with the car, and he wanted to charge me a fee to inspect it. I doubt this dentist wants to do the x-rays for free.



Having nothing to do with teeth, but everything to do with automobiles, I would want and appreciate an inspection of my car at the time of oil change in order to try to prevent surprises down the road. (Pun intended.)

You apparently missed the "charge me a fee to inspect it" part of my comment. It's not unusual for mechanics to do free basic inspections when they change the oil and give you a checklist with their findings. I would also expect the dentist to perform a free visual inspection while cleaning the teeth. But I wouldn't want to pay for an engine tear-down before an oil change any more than the OP doesn't want to pay for x-rays before a cleaning.
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Re: Dental X-rays

Postby beachplum » Wed Jun 20, 2012 2:06 pm

scubadiver wrote:I had an interesting experience at the dental office the other day and would like to get some outside opinions, preferably from someone in the dental profession. A bit of backgroun first.

I recently switched employers and my prior dentist does not accept the dental insurance provided by my new employer. I found a new dentist that did accept the insurance and made an appointment for an oral exam and cleaning. The hygenist insisted that we start off the visit with dental x-rays. I politely declined. She insisted. I spoke with the office manager who also insisted and who subsequently made the claim that they had a legal responsibility to do so per VA state law and refused to proceed with a cleaning until the x-rays were done. I found this very odd and ended up leaving the office with no x-rays and no cleaning.

After perusing the ADA website I found a response under frequently asked questions that seemed to address the issue. The website provided no strict guideance as to how often x-rays should be performed and explicitly stated that the dentist would make a recommendation regarding x-rays after performing an oral exam and reviewing my dental history, none of which happened in my recent office visit.

My question is this: can I refuse dental x-rays (for whatever reason) and if so can the dentist then refuse to see me?


When I switch drs/dentists I try to bring my former records along. Why not get a copy of your X-rays from your former dentist to bring to a new one so they have some records to look back on. My dentist never pressures me about these things. I plan on having less X-rays since learning about the latest findings on the frequency of dental X-rays.
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Re: Dental X-rays

Postby fsrph » Wed Jun 20, 2012 2:38 pm

scubadiver wrote:I had an interesting experience at the dental office the other day and would like to get some outside opinions, preferably from someone in the dental profession. A bit of backgroun first.

I recently switched employers and my prior dentist does not accept the dental insurance provided by my new employer. I found a new dentist that did accept the insurance and made an appointment for an oral exam and cleaning. The hygenist insisted that we start off the visit with dental x-rays. I politely declined. She insisted. I spoke with the office manager who also insisted and who subsequently made the claim that they had a legal responsibility to do so per VA state law and refused to proceed with a cleaning until the x-rays were done. I found this very odd and ended up leaving the office with no x-rays and no cleaning.

After perusing the ADA website I found a response under frequently asked questions that seemed to address the issue. The website provided no strict guideance as to how often x-rays should be performed and explicitly stated that the dentist would make a recommendation regarding x-rays after performing an oral exam and reviewing my dental history, none of which happened in my recent office visit.

My question is this: can I refuse dental x-rays (for whatever reason) and if so can the dentist then refuse to see me?


Of course you can refuse dental x-rays or any service for that matter. I believe the dentist also can refuse to provide care if you don't follow their office rules. Note however that every dentist I ever went to allowed to me to make my own decisions regarding x-rays and care plans. I believe my (recently changed to) dentist did a panorex x-ray initially (I consented to this because I didn't have an x-ray for a while) and bite wing x-rays every 2 years. Before my 2 year bite wing x-ray the dental technician said, "this visit you are due for a bite wing X-Ray, is that OK with you?" I juat had to ask what if I didn't want it? She looked at me and said, "then we wouldn't do it".

Also, at every checkup the dentist mentions that a left molar should be capped due to a large filling. I said I know the filling is large but I've had it for 15 years with no problems. He didn't pressure me into doing it nor say he is dropping me as a patient. Probably the oddest example of dental non-treatment was -- the dentist told me a patient came in with a tooth missing and he was using a self made bridge using a wad of chewing gum. The dentist told the patient he could make a real bridge for him. The patient decline. Dentist said OK but use sugarless gum from now on.

So, you can always refuse any proposed treatment. But you do have to realize that procedures have both risks and benefits. By refusing a procedure and eliminating the risks you do not receive any benefit either.

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Re: Dental X-rays

Postby nimo956 » Wed Jun 20, 2012 3:37 pm

I really need to get in the habit of writing down exactly when I get xrays from the dentist. I visit him twice a year and somehow it feels like they always say I need new ones. Perhaps they get a lot of money from the insurance company so they always want to push them on patients?
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Re: Dental X-rays

Postby dave1054 » Wed Jun 20, 2012 5:22 pm

This is incredible. I am a physician and radiologist. I always refuse routine dental xrays. The exposure is close to the brain, and even
though the risk of cancer is very low, why do it. So what if they miss a cavity. They will find it next time when its larger. Sorry, but
I am not aware of any medical emergency in Dentistry that requires xrays.
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Re: Dental X-rays

Postby sscritic » Wed Jun 20, 2012 5:56 pm

In an unrelated case:
Respondent failed to perform an adequate comprehensive initial examination in that respondent failed to obtain a complete series of x-rays
from a license suspension/revocation complaint by the state board concerning repeated acts of negligence.

Dentists are covering themselves.
Any licentiate may have his license revoked or suspended or be reprimanded or be placed on probation by the board for
unprofessional conduct, or incompetence, or gross negligence, or repeated acts of negligence in his or her profession, or for the
issuance of a license by mistake, or for any other cause applicable to the licentiate provided in this chapter. The proceedings under
this article shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of
the Government Code, and the board shall have all the powers granted therein.
Name that state! :)

P.S. focus on the word initial, not routine, not subsequent, not annual.
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Re: Dental X-rays

Postby Rozdg » Wed Jun 20, 2012 6:08 pm

Most dentists (I did) have you sign a statement saying this is what you want to do and details as to the frequency you want your routine dental x-rays performed. The former dentist had me sign a statement also, and that was fine with me. But my objection to her was she didn't let it go at that....it was a hassle every time I went for my scheduled dental appts. This dentist, too, had me sign a statement as to my x-ray preferences, but that was the end of it. No hassles.....doesn't even bring it up; and when the time comes for the agreed upon time for the scheduled routine x-rays, he just reminds me that my due date is this visit......and that's it.
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Re: Dental X-rays

Postby donall » Wed Jun 20, 2012 7:08 pm

Sheesh, it sounds like this new dentist or his office staff is not a good fit for you. I never heard of a state law that mandates x-rays before treatment. Next time ask for the exact law and bring your x-rays from your old dentist. X-rays are an important diagnostic tool that is part of a dental exam.

You have every right to limit your x-ray exposure. So if you have x-rays taken, make sure the dentist has the newer digital models that expose you to much less radiation. Also it helps to have x-rays done for the proper reason. Panorex x-rays are common for oral surgery, implants, and orthodontics, which means some people never have them taken. Full mouth x-rays (that includes bitewings) should be taken periodically as a baseline for caries (cavities) and periodontal (bone) conditions and then at intervals of 3-5 years (I have new ones every 4 years), depending on how stable the particular mouth is. Bitewings (there are 4) are recommended annually, especially if a mouth has high caries activity, because no one, not even a dentist can see decay between the teeth. People with high caries activity may also need annual x-rays of the anterior (front) teeth. Endodontics (root canals) often need multiple x-rays that show the root of the tooth.
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Re: Dental X-rays

Postby brad_g » Wed Jun 20, 2012 8:00 pm

I had some X-rays done yesterday so this thread piqued my interest in the health risks. Here's what Wikipedia has to say about it:

To place the increased risk in perspective, a plain chest X-ray or dental X-ray will expose a person to the same amount from background radiation that we are exposed to (depending upon location) every day over 10 days.[41] Each such X-ray would add less than 1 per 1,000,000 to the lifetime cancer risk.

http://en.wikipedia.org/wiki/X-ray#Health_risks
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Re: Dental X-rays

Postby roymeo » Wed Jun 20, 2012 8:02 pm

I wish my old dentist had spent less time trying to upsell whitening treatments and more time looking at the X-rays they were taking--maybe that tooth would have still been lost to the abscess but it wouldn't have had to be so dicey because it also dug down into the jawbone risking a break.

When I worked at Kodak I head that the new computer x-rays took 100th of the exposure as the film version, but the 2 minutes I spent looking couldn't verify that.

http://en.wikipedia.org/wiki/X-ray#Health_risks

http://en.wikipedia.org/wiki/Dental_radiography
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Re: Dental X-rays

Postby protagonist » Wed Jun 20, 2012 11:40 pm

scubadiver wrote:
sscritic wrote: I'm actually thinking about dropping dental coverage all together and just going back to the old dentist and paying out of pocket. I seem to recall that as a cash paying (i.e., no insurance having) college student, the issue of dental x-rays never came up.

I found it odd that the dentist refused to even clean my teeth, a procedure which I do not believe requires an x-ray to perform. That said, finding a dentist who is willing to accomodate my world view on x-rays is the obvious common sense solution.

Thanks for the responses.

Scubadiver



Hi, Scuba.

A dental xray results in less radiation exposure than a transatlantic flight, and the same amount as a bag of brazil nuts. Stranger than fiction, I know....the brazil nut tree absorbs radon from the soil.


Scuba is DEFINITELY more dangerous, but also DEFINITELY more fun than dental x-rays (and probably more fun even than eating Brazil nuts). Still, if the dentist who requires the x-rays is the best practitioner in your area (in your opinion), I would recommend that you get the xrays, especially if your insurance is paying for them. There are more important criteria, imho, for choosing a clinician.

That said, on the subject of dental insurance, if you don't require an inordinate amount of dental work, you probably would come out way ahead in the long run if you dropped it. Most people do.
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Re: Dental X-rays

Postby beachplum » Wed Jun 20, 2012 11:45 pm

brad_g wrote:I had some X-rays done yesterday so this thread piqued my interest in the health risks. Here's what Wikipedia has to say about it:

To place the increased risk in perspective, a plain chest X-ray or dental X-ray will expose a person to the same amount from background radiation that we are exposed to (depending upon location) every day over 10 days.[41] Each such X-ray would add less than 1 per 1,000,000 to the lifetime cancer risk.

http://en.wikipedia.org/wiki/X-ray#Health_risks


Personally I'd rather take the advice from the web md article about the potential increase in risk for brain tumors from dental X-rays and have less frequent X-rays.
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Re: Dental X-rays

Postby interplanetjanet » Wed Jun 20, 2012 11:52 pm

protagonist wrote:A dental xray results in less radiation exposure than a transatlantic flight, and the same amount as a bag of brazil nuts. Stranger than fiction, I know....the brazil nut tree absorbs radon from the soil.

Brazil nut trees absorb radium from the soil, not radon. A very small amount of radon may be present in brazil nuts as the radium decays, but given the half lives involved not much of this will happen during the lifetime of the plant and nut.

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Re: Dental X-rays

Postby protagonist » Thu Jun 21, 2012 12:01 am

interplanetjanet wrote:
protagonist wrote:A dental xray results in less radiation exposure than a transatlantic flight, and the same amount as a bag of brazil nuts. Stranger than fiction, I know....the brazil nut tree absorbs radon from the soil.

Brazil nut trees absorb radium from the soil, not radon. A very small amount of radon may be present in brazil nuts as the radium decays, but given the half lives involved not much of this will happen during the lifetime of the plant and nut.

-janet


Correct. I meant to type radium, not radon. Cut me slack...it's 1 am (giggle)
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Re: Dental X-rays

Postby shaiboy » Thu Jun 21, 2012 3:10 am

In general, the use of x-rays is constant balance between information gained from the scan, and the risk of the exposure to radiation. While the radiation dosage of dental x-rays (bitewings<panoramic<CBCT) is relatively low, all radiation exposure should be minimized. In regards to when x-rays should be taken, it depends on the patient. If the case of a new patient (as in the OP's situation), the clinician should make a good faith attempt to get previously taken scans from the patient's former dentist. If the patient has had few problems in the past, is an adult (no more primary teeth/little teeth movement/already erupted or removed wisdom teeth), and has good oral hygiene, an x-ray may not be warranted. However, if the patient has had little dental treatment in the past, has teeth that are still erupting, pain, and/or has poor oral hygiene, x-rays would be recommended. As far as if a clinician may require a patient to receive x-rays for treatment, I imagine it depends on the state and the insurance company, but I know of no such law--at least in the state of California. And yes, a dentist can refuse service to a patient as long as their reason is justified (not discriminatory in nature), especially in the case for the OP where the patient was not in pain.

You might find the following useful:
http://www.fda.gov/Radiation-EmittingPr ... 116504.htm

http://www.ada.org/sections/professiona ... ations.pdf


-shaiboy
2nd year dental student
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Re: Dental X-rays

Postby sscritic » Thu Jun 21, 2012 6:54 am

shaiboy wrote: I imagine it depends on the state and the insurance company, but I know of no such law--at least in the state of California.
-shaiboy
2nd year dental student

But you could lose your license in CA for repeated acts of negligence if you don't get a complete series in your comprehensive initial examination.
Respondent failed to perform an adequate comprehensive initial examination in that respondent failed to obtain a complete series of x-rays

Failure to take a complete series in your comprehensive initial examination probably won't get you suspended, but it could be used as one piece of evidence against you by the state board. And I did quote the law in CA about repeated acts of negligence. It's not that not taking x-rays is against the law, but that it could be judged an act of negligence.

So it does become a part of good practice for many dentists. If you see a patient and don't get a complete series during your initial examination and later treat the patient without going back and getting a complete series, you could be in jeopardy. Getting them up front is prophylactic, not for the patient but for threats to your practice.

P.S. If you are a student in CA, you failed my "name that state" test that I posed earlier.
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Re: Dental X-rays

Postby sscritic » Thu Jun 21, 2012 7:03 am

One more reason for taking a complete set on an initial examination: it sets a base line.

You don't wait until after you have breast cancer to get a mammogram. Mammograms are taken to detect breast cancer, but often what the doctor is looking for is changes from previous mammograms.

You don't wait until after you have prostate cancer to get a PSA. The PSA doesn't really say if you have prostate cancer, but often what the doctor is looking for is changes in your PSA. A rapid increase in PSA even if the level is still low is an indicator.
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Re: Dental X-rays

Postby VictoriaF » Thu Jun 21, 2012 8:17 am

The dental X-rays are an example of the principal and agent problem. A dental client is the principal, and the dentist is the agent in this transaction. As an agent, the dentist has a lot to gain from administering X-rays and nothing to lose. His gains are the profit on the X-ray procedure and a reduction in liability from a potential legal action. Client's increased susceptibility to cancer is the principal's problem, not the agent's.

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Re: Dental X-rays

Postby scubadiver » Thu Jun 21, 2012 9:01 am

sscritic wrote:
shaiboy wrote: I imagine it depends on the state and the insurance company, but I know of no such law--at least in the state of California.
-shaiboy
2nd year dental student

But you could lose your license in CA for repeated acts of negligence if you don't get a complete series in your comprehensive initial examination.
Respondent failed to perform an adequate comprehensive initial examination in that respondent failed to obtain a complete series of x-rays


The state is Virginia.

For the record, I have absolutely no history of any lifetime dental issues.

dave1054 wrote:This is incredible. I am a physician and radiologist. I always refuse routine dental xrays. The exposure is close to the brain, and even
though the risk of cancer is very low, why do it. So what if they miss a cavity. They will find it next time when its larger. Sorry, but
I am not aware of any medical emergency in Dentistry that requires xrays.


sscritic wrote:You don't wait until after you have breast cancer to get a mammogram. Mammograms are taken to detect breast cancer, but often what the doctor is looking for is changes from previous mammograms.


This is exactly the point. We're not talking about breast cancer here, something which kills tens of thousands per year, we're talking about cavities. We're also talking about how much influence that I as a patient should have over my medical care. I've made much weightier decisions about my health care with my primary physician and I've always found that we we're partners in making those decisions. I did not get that feeling here at all.

All that said, I'll be shopping around until I can find an office that is more accomodating to my personal preferences.
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Re: Dental X-rays

Postby protagonist » Thu Jun 21, 2012 10:23 am

scubadiver wrote:[

dave1054 wrote:This is incredible. I am a physician and radiologist. I always refuse routine dental xrays. The exposure is close to the brain, and even
though the risk of cancer is very low, why do it. So what if they miss a cavity. They will find it next time when its larger. Sorry, but
I am not aware of any medical emergency in Dentistry that requires xrays.


We're also talking about how much influence that I as a patient should have over my medical care. I've made much weightier decisions about my health care with my primary physician and I've always found that we we're partners in making those decisions. I did not get that feeling here at all.

All that said, I'll be shopping around until I can find an office that is more accomodating to my personal preferences.


Dave is factually correct, though I wonder if he uses airplanes when he can drive instead, or eats Brazil nuts. To me, the issue is how good is this dentist, and if you DID require major dental work, is he the one you would most trust to perform it? In other words, I would not throw the proverbial baby out with the bath water- settle for a less-desirable dentist because of your feelings about dental x-rays and control. Personally I want the most competent clinician working on me possible. If this guy has the best reputation in your area, the bodily risk involved in compromising care by rejecting him is probably MUCH greater than the risk involved in dental x-rays. I think it is important to choose your battles wisely.

That said, you seem to feel very strongly about this, so you need to do what is right for you.
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Re: Dental X-rays

Postby Fallible » Thu Jun 21, 2012 10:33 am

Articles I've read on dental X-rays refer only to bite wings and full-mouth X-rays. But what concerns me are the ADDITIONAL X-rays that are taken during treatment of a tooth. For example, if I've had regular bite wings X-rays a year or less previously and I have a tooth that hurts, the dentist will want an X-ray. Then during treatment or after, depending on the treatment, he or she will want one or two more X-rays. If you're referred to a specialist, he/she will want another X-ray (though you may be able to prevent this by bringing along the X-ray from the regular dentist) and then there will be an X-ray (s) after treatment. Then let's say you have another problem tooth...more X-rays. Next thing you know, it's time for the routine bite wing X-rays. I'm not saying that X-rays during treatment of a problem tooth are not warranted. I'm saying it's the cumulative effect of all these X-rays that concerns me.
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Re: Dental X-rays

Postby ThatGuy » Thu Jun 21, 2012 10:47 am

protagonist wrote:To me, the issue is how good is this dentist, and if you DID require major dental work, is he the one you would most trust to perform it? In other words, I would not throw the proverbial baby out with the bath water- settle for a less-desirable dentist because of your feelings about dental x-rays and control. Personally I want the most competent clinician working on me possible. If this guy has the best reputation in your area, the bodily risk involved in compromising care by rejecting him is probably MUCH greater than the risk involved in dental x-rays. I think it is important to choose your battles wisely.


The dentist in question is not the most desirable practitioner from scubadiver's perspective. Everyone has their own utility curve.
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Re: Dental X-rays

Postby Confused » Thu Jun 21, 2012 11:16 am

Of course you can refuse dental x-rays or any service for that matter. I believe the dentist also can refuse to provide care if you don't follow their office rules.


I haven't been to a dentist in seven years, but the last time I did I declined the x-ray and they made me sign a document signifying that I had declined it.

When I went to a doctor earlier this year (and it had been at least five years since my previous doctor visit), the first couple offices wanted my social security number and stuff. I left. The third office I visited tried to get my SSN but let me get by without giving it to them. Then I paid in cash. They don't need to know who I am or anything previous about me - just look at me, tell me if I'm healthy, and then I'll leave.

I would suggest the same with a dentist - you're the customer, so find one that works the way you want. I figure since we're paying them, shop around until one is willing to do it the way you want.
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Re: Dental X-rays

Postby kramer » Thu Jun 21, 2012 11:35 am

Yes, it seems like dental X-rays are popular for apparently healthy patients, above and beyond what are medically necessary or desirable, because they represent CYA cover for dentists and because most people have third party payers so the cost does not need to enter into their decision. I am with Scuba on this issue 100%.

I didn't get X-rays at my current dentist or my last one, my teeth are very healthy. Although I have a set of X-rays with me from a previous dentist several years ago (which I have not needed to show).

I took a poor person from the country where I am now living to my (first world quality) dentist today, someone who has never visited a dentist in their life, and X-rays will be required on the next visit due to the teeth condition (this visit was just for a cleaning and checkup to assess). The dentist even explained in detail how the X-ray will affect a decision she will need to make, in addition to explaining each thing wrong in the patient's mouth. A great experience.
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Re: Dental X-rays

Postby jbk » Thu Jun 21, 2012 1:12 pm

This topic was just covered in the latest issue of Consumer Reports on Health. Jay Friedman (DDS and MPH) states that for adults full mouth X-rays and bilateral bitewing X-rays should be taken at the initial exam, but copies taken by a previous practitioner within the last few years can be used if there are no new symptoms. For those with no or few cavities, bitewings should be repeated every 2-3 years. For the cavity-prone, bitewings every 18 months. Full-mouth X-rays every 10 years or not at all if there are no reasons to expect a new dental disorder.
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Re: Dental X-rays

Postby cheese_breath » Thu Jun 21, 2012 3:52 pm

Coincidentally I just got back from having my teeth cleaned this morning. The dental assistant noticed I hadn't had x-rays in a couple years and asked if it would be OK to do new ones. Since she asked permission first I let her do them. But if she had tried to force them on me there would have been problems.
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Re: Dental X-rays

Postby bungalow10 » Thu Jun 21, 2012 4:07 pm

I used to work at a dental office... admittedly in high school at the time, but I learned a lot :)

Most dentists do want an initial set of x-rays for a few reasons.

1. As a baseline. That way if things change or crop-up over time, they can look to see what, if any, changes there were.

2. As a record. If you call in with a "massive tooth ache" on a Friday night and want drugs, they can look at the x-ray and either call BS or possibly see you potentially have a real issue that needs to be addressed. Sadly, this is all too common. Especially with new patients.

3. To provide the best treatment recommendations. X-rays do show a lot of potential issues you may not know about. Many people prefer to wait for the tooth-ache, but if something serious is going on, you might like to know before you are out of town on business.

Most dentists are fine with you refusing, and many will offer to request your x-rays from previous practices. I personally have no issue with a new set ever 3-5 years, but I've had extensive work done and I like to know if there is decay under an in-lay or a possible abscess starting under a crown before I'm hit with the massive pain and infection.
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Re: Dental X-rays

Postby dm200 » Thu Jun 21, 2012 4:31 pm

No dental expert here, but a few observations:

1. IF the issue is some sort of "baseline" X-Rays are needed, could you (or did you) get whatever X-Rays the previous dentist had done and get those sent to this dentist?

2. I had never thought of a relationship between cleaning and X-rays, but for a few years I had not taken care of my teeth very well and had not been to the dentist for several years. I went back to the dentist last year (and now go regularly), but they showed me how the lack of taking care of my teeth had begun to show onthe X-Rays. Frankly, that frightened me and after needing to go back every 3 months for cleaning, my teeth/gums are all fine now and I am back on a 6 month schedule.
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Re: Dental X-rays

Postby Mudpuppy » Thu Jun 21, 2012 4:44 pm

My current dentist only takes x-rays when I have some complaint of pain, but he did insist on a full panel when I first went in since it had been years since I saw a dentist. I have extreme difficulty getting the back bite-wings done due to severe gagging, so we muddled through it on the first visit and now avoid it unless needed (and my discomfort with x-rays was why I avoided a dentist for so many years).

Most dentists are willing to work with you on the issue of x-rays, as long as you calmly and rationally explain your reasoning. So when you call to make the appointment for the next dentist, just tell them up front that you have x-rays from your previous dentist taken xyz years ago and you would rather avoid the exposure of getting another full set done and would that dental practice be okay with that. By pre-screening on the phone, you avoid the hassle (and wasted gas) of going into the office only to find out they aren't willing to accept the x-rays of your previous dentist.
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Re: Dental X-rays

Postby dm200 » Thu Jun 21, 2012 5:13 pm

It is my understanding (from several dentists I have seen) that X-Rays show (or show better) when there are cavities that may not be so apparent from the surface and that addressing these cavities sooner rather than later results in less severe treatment of the cavities.

Is that true?
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Re: Dental X-rays

Postby ScottW999 » Thu Jun 21, 2012 7:08 pm

100% true.
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Re: Dental X-rays

Postby scubadiver » Thu Jun 21, 2012 7:55 pm

Mudpuppy wrote:By pre-screening on the phone, you avoid the hassle (and wasted gas) of going into the office only to find out they aren't willing to accept the x-rays of your previous dentist.


This is good advice as I was a bit niave about how much weight my "no thank-you" would carry regarding the x-rays. I clerarly failed to appreciate the relationship I had established with my prior office, which by the way, I called today. They said my last set of x-rays was in 2008, so I'm not sure if the new dentist will accept them. Anyway, at least I'll have a better starting point for initiating the conversation next time. Given that it has been 4 years and that this will be my first visit to a new office, I'm willing to go through the routine the first time so long as there's an understanding that it's a once every three or four years or as needed type of thing and not yearly.
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Re: Dental X-rays

Postby mephistophles » Thu Jun 21, 2012 8:52 pm

scubadiver wrote:
Mudpuppy wrote:By pre-screening on the phone, you avoid the hassle (and wasted gas) of going into the office only to find out they aren't willing to accept the x-rays of your previous dentist.


This is good advice as I was a bit niave about how much weight my "no thank-you" would carry regarding the x-rays. I clerarly failed to appreciate the relationship I had established with my prior office, which by the way, I called today. They said my last set of x-rays was in 2008, so I'm not sure if the new dentist will accept them. Anyway, at least I'll have a better starting point for initiating the conversation next time. Given that it has been 4 years and that this will be my first visit to a new office, I'm willing to go through the routine the first time so long as there's an understanding that it's a once every three or four years or as needed type of thing and not yearly.


Why not stay with your original dentist. Maybe you can pay out of pocket then submit bills to your insurance company for reimbursement.
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