Lead aprons are no longer recommended by ADA

Anisha Hall Hoppe, Dental Tribune International

Tue. 5 March 2024

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CHICAGO, US: An expert panel established by the American Dental Association (ADA) Council on Scientific Affairs has published new recommendations for safety during dental imaging, considering the essential balance between the clinical value of radiographs and the need to minimise radiation exposure. They found that modern digital radiography and precise beam targeting have rendered lead aprons and thyroid collars unnecessary. These protective measures can interfere with image quality, potentially necessitating repeat exposures, which the recommendations aim to avoid.

The study involved a systematic review of the relevant literature and regulatory guidance since 2010. Utilising 95 significant resources, including organisational guidelines, systematic reviews and regulatory documents, the expert panel made recommendations emphasising radiation safety, appropriate imaging practices and exposure reduction strategies.

Key findings and recommendations

The authors recommend the discontinuation of lead aprons and thyroid collars and state that dental radiographs should be ordered based on clear diagnostic needs, contribution to patient care or significant improvement of clinical outcomes. Previous images should be utilised whenever possible to avoid unnecessary exposure.

Another recommendation is that the transition to digital radiographic film should be advocated for its lower radiation dose compared with conventional film, aligning with the broader industry shift towards digital modalities. When it comes to the actual scanning procedure, beam size restriction and patient positioning are vital. The recommendations highlight the importance of restricting the X-ray beam to the area of interest (rectangular collimation) and ensuring proper patient positioning to optimise image quality and minimise exposure.

Furthermore, when CBCT is required, it should be reserved for cases where lower-exposure options are insufficient for necessary diagnostic information, reflecting a cautious approach to this higher-exposure modality.

In the document, the ADA panel also urges dentists to comply with all relevant radiation safety regulations at the federal, state and local levels, ensuring that practices are both legally compliant and aligned with best practices for patient care.

The updated recommendations for radiation safety in dentistry emphasise a patient-centred approach that prioritises diagnostic value while minimising radiation risks. The shift away from routine use of lead aprons and thyroid collars, the preference for digital imaging and the careful application of CBCT reflect an evolving understanding of radiation safety in dental practice, supported by both technological advancements and a growing body of research.

The study, titled “Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations”, was published on 1 February 2024 in the Journal of the American Dental Association, ahead of inclusion in an issue.