Are dental X-rays safe for my child?

August 16, 2022

One of the most common questions parents ask me is, “are dental x-rays safe for my child?”.

Long story short- yes.

You and your dentist will need to weigh the risks vs benefits for your child’s individual needs, but hopefully I can help you feel more prepared to have that conversation.

What are dental X-rays and what do they show?

X-rays are a form of energy, just like light, heat, radio waves, or microwaves, that are used to create an image. But, unlike light waves, X-rays have enough energy to pass through your body.

When the radiation from an X-ray passes through the body, some of it gets absorbed by the tissues (bone, teeth, gums, cheeks, etc) and the rest of it passes through the body and gets absorbed by a film or digital sensor, creating an image.

The image will be in various shades of white and black depending on how dense the tissue is that it passes through.

Bones look white and air or empty space will be black, everything else is a shade somewhere in between.

X-rays can provide valuable information about the health of your child’s mouth, helping the dentist make an accurate diagnosis.

For example, the enamel of your tooth is quite dense and will show as white. If there is decay on the enamel in between the teeth that a dentist can’t see or feel, the X-ray image will show a dark spot. This is decay (cavity) that a dentist would not otherwise be able to find.

How much radiation exposure do dental X-rays cause?

Dental X-ray machines use a single beam of radiation, rather than scattered radiation, that is restricted to the size and shape of the film. This helps to limit the amount of radiation the patient is exposed to.

Dental X-rays also use short exposure times to limit the amount of radiation to the patient.

Any part of the body not being X-rayed should be shielded to limit the amount of radiation exposure as well.

Modern dental equipment, such as digital X-rays or high-speed film, allows the dentist to take high-quality images using very low doses of radiation.

The most common X-rays your child will be offered are bitewing X-rays that help the dentist see in between the back teeth. According to the United States EPA, a set of 2 bitewing X-rays exposes your little one to .002 mSv of radiation.

To put that into perspective, we are exposed to .008 mSv of radiation every day from our environment alone.

Most of us will not experience the fallout of a nuclear bomb. The concern with radiation is not how much we are exposed to at one time, but how much we are exposed to over time. And the younger that exposure starts, the bigger the impact it can have over time.

Concerns with taking dental X-rays on children

Because children still have rapidly growing cells, they are more sensitive to radiation exposure than adults. So the cancer risk for children per dose of radiation is higher.

It’s not a single X-ray’s worth of radiation that leads to cancer, but the accumulation of radiation over time. The younger a patient is when they start getting X-rays, the longer they have for the effects of radiation to show up as cancer.

Dental X-ray units have different dosage settings for adults vs children. If the settings are not adjusted for a child then they are getting far more radiation exposure than is necessary.

The ALARA Principle

If a dentist feels that taking a dental X-ray on a child is necessary, s/he will follow the ALARA principle.

According to the CDC, “the guiding principle of radiation safety is ALARA. ALARA stands for “as low as reasonably achievable”. ALARA means avoiding exposure to radiation that does not have a direct benefit to you, even if the dose is small.”

In other words, if there is no suspected reason or benefit to taking an X-ray, it should not be taken.

It’s important to note that early cavity detection is important for the prevention of infection, pain, and tooth loss. Prevention is a huge benefit to consider when it comes to having routine X-rays taken on your child.

Types of Dental X-rays and their purpose

Most commonly used:

Bitewing- this is the most common dental X-ray. It shows a portion of both the upper and lower teeth allowing the dentist to check in between the teeth for decay.
Periapical (PA)- this image is used to zoom in on a single tooth or area to check for infections (ie. an abscess). It shows the whole tooth from crown to root as well as the surrounding bone that it’s anchored into.
Panoramic– shows the entire mouth in one photo. Used to check whether teeth are impacted, confirm existing or missing teeth, and identify tumors.

Other/Specialty:

Occlusal- this X-ray shows an entire arch of teeth from a bird’s eye view. It is good for showing checking the placement of teeth.
Cephalometric- this is mostly used by orthodontists. It is a side-view image of the entire head that allows the dentist to see how teeth are placed in relation to the jaw, nose, and overall profile.
CT Scan- this would be more commonly used in a hospital after a dental trauma, like a fractured jaw bone, or if you are having oral surgery.
Cone-beam computed tomography- CBT scans can create a 3D image allowing the Dentist to better understand what a 2D image can not show. For example, checking the TMJ or a failed root canal.
Tomogram- Allows the dentist to check a specific layer of the tooth
Sialography- this type of imaging uses a contrast dye to check salivary glands for issues such as a blockage or Sjögren’s syndrome.

When are dental X-rays beneficial or necessary for children

I don’t recommend X-rays be a part of every routine, 6-month exam, but X-rays are a valuable diagnostic tool and there are several instances where the pros far outway any cons.

Some common reasons to consider taking a dental X-ray on your child would be:

When decay is suspected
When an existing filling or crown is suspected to have recurrent decay
When a dental infection or abscess is present
When developmental issues are suspected (missing tooth, extra teeth, crowding)
After dental trauma to detect fractures
To identify cysts or tumors
Impacted wisdom teeth

This is not an exhaustive list, but the idea is that you will need to weigh the benefits vs the risks with your dentist.

Taking an X-ray is far less risky than leaving an infection to spread throughout your child’s mouth or beyond. Not only could it lead to a traumatic dental experience, but it could be dangerous.

That being said, be sure that an X-ray is being recommended by the dentist specifically based on your child’s need… not just based on an office or insurance policy.

It’s okay to seek an understanding of the need, benefits, and risks to help you decide what is best for your child.

Pregnancy and dental X-rays

Dental X-rays during pregnancy should be avoided.

If you regularly see your dentist, then most routine dental X-rays can be postponed until after Baby arrives.

If dental X-rays are necessary during pregnancy to diagnose any concerns, use a lead apron and thyroid collar to minimize exposure to your precious growing bundle.

How to decrease radiation exposure from dental X-rays

Remember the ALARA principle here. The best way to decrease exposure is to only take dental X-rays if there is a specific need.

If there is a concern that your dentist feels warrants an X-ray then the following options can help increase the safety of X-rays for your child:

Ask for a thorough exam to be performed before any X-rays are taken to determine whether they are necessary or if they can be postponed.

Ask the dentist if a cavity-detecting wand could be used to diagnose any suspected decay. This technology has come a long way and can be a good alternative to dental X-rays for children. But be aware that there is the potential for user error.

Make sure that your child wears a lead apron and thyroid collar… even if you are told: “They aren’t necessary with this type of machine because the radiation is so low”.

Always use a film holder that your child bites down on. Don’t let your child help steady the X-ray using a finger.

Have Digital X-rays taken instead of traditional film. Digital X-rays use less radiation. If traditional film is the only option, then opt for E film as it requires less radiation to produce a quality image.

Make sure that the exposure settings on the X-ray unit have been set to child settings so that your little one is getting an adult dosage of radiation.

So, are dental X-rays safe for my child?

Dental X-rays are nothing to fear. They are a valuable tool and are necessary to properly and efficiently diagnose a dental issue.

I am a huge advocate for creating positive dental experiences by preventing negative ones such as unnecessary cavities and pain. X-rays do play a big role in that prevention- especially in baby teeth, where tooth decay can progress quickly in a child who may not be able to verbally communicate whether they are in pain or not.

I am also a huge advocate for keeping cumulative radiation to a minimum and using the ALARA principle when it comes to taking X-rays. It is important to take each child’s individual needs into account, so don’t be afraid to advocate for your child by asking questions to understand the need for X-rays before they are taken.