By Dr. John Paul, FDA Editor
Lately, I’ve had a run of patients who are reluctant to have — or are flat-out refusing — dental radiographs. I’ve let a few patients go because I believe it is beneath the standard of care to routinely practice without the aid of radiographs; although, I think they should be prescribed for each case and use the ALARA principle (As Little As Reasonably Acceptable). I try to use the refusal as the introduction to a conversation with the patient.
“Dr. Paul, I don’t want any X-rays today.”
“Mrs. Gruntbuns, why don’t you want any X-rays today?”
“They cost too much and there’s too much radiation.”
“Mrs. Gruntbuns, radiographs are important enough to me to evaluate your health that I will take them for you today at no charge. Will that change your mind?”
“No, radiation makes people sick, it gives them cancer and I don’t want any radiation.”
“Mrs. Gruntbuns, dental radiographs (X-rays) are safe when used properly. With the X-rays I take during a checkup, you get about 1/600th of the amount of radiation1 you can expect to receive just from walking around — it’s even less because you walk around outdoors in Florida. Because you take good care of your teeth, do all the things we ask you to do at home and come in as often as we ask for professional maintenance, we have prescribed radiographs for you every two years. This is the bonus you get for keeping up your oral health. You are at low risk of decay or gum disease, and unless something changes, we won’t change by taking more radiographs.”
Most patients accept the radiographs when they find out I think they are important enough to take them for free. I only offer this to a patient one time. I have released several patients (less than 10) for refusing radiographs because I believe this patient is asking me to provide care with one hand tied behind my back and one eye closed. Some days I do miracle dentistry, but I don’t have time to do tricks. I hope this patient didn’t leave my office for yours.
Have a question you have a tough time answering? Send it to Dr. Paul at email@example.com.
1The amount of radiation is based on an article in JADA, September 2011, Volume 142, Issue 9, Pg. 1101.