The concept of
ALARA As Low As Reasonably Achievable
November 2004
FDA accepted updated guidelines for dental radiography to achieve ALARA as presented by ADA representing many dental professional organizations.
Protective Devices
Lead apron-not required if all other guidelines in 2004 report are followed rigorously Thyroid Collars-provide for all children and for adults when it wont interfere with examination
Protective Devices
Cephalometric imaging-filters for imaging the soft tissues of the facial profile together with the skeleton should be placed at the x-ray source rather than at the image receptor, the x-ray beam should be collimated to the area of clinical interest Image receptor (film speed)-use no speed slower than E speed
CollimationRectangular collimation should be used for periapical radiography and when feasible for bitewing radiography
It assumes the multiplicative risk projection model, averaged for the two sexes. In fact, risk for females is always relatively higher than for males.
Radiation Bone Marrow Effects Radiation Effects to Thyroid Embryo/Fetus Radiation Effects
Basic Principles
Time
Distance
Shielding
BWXR (4 films)
D Speed Film .017 mSv F Speed Film <.007 mSv
Panoramic radiograph .007 mSv Average natural background radiation 3 mSv / yr (.01 mSv / day)
New Patients
Adolescents
Because of increase in possibility of periodontal disease panoramic is recommended
Adult
Posterior bitewings, and selected periapicals or panoramic, a full-mouth series is preferred when the patient has evidence of disease or history of extensive treatment
Adult edentulous
Individualized exam based on clinical signs and symptoms
Recall Patients
Adult edentulous
Radiographs should not be performed without evidence of pathology
Adolescents
BW every 18-36 months
Adult
BW every 24-36 months
Patient A
22 year old female Recall patient-every 6 months Negative medical history Lives in a community with fluoridated water Has had no previous dental restorations in permanent teeth
Answer
C. Every two years
Sources
Perry, D.A., Beemsterboer, P.L., & Taggart, E.J.(2001). Periodontology for the dental hygienist. Philadelphia, PA: W.B. Saunders Company. Iannucci-Haring, J. & Jansen, L. (2000). Dental radiography: Principles and techniques. Philadelphia, PA: W.B. Saunders Company. DiGangi, P. (2006) ALARA: What does it mean? Contemporary Oral Hygiene, March 2006, 22-28. Thompson, E.M. (2006) Radiation safety update. Contemporary Oral Hygiene, March 2006, 10-17.
Sources
FDA website
http://www.fda.gov/cdrh/radhlth/adaxray-1.html
Radiation Health in Dentistry Procter & Gamble Website for Professionals Continuing Education Section www.dentalcare.com