In 1981, Congress passed the Consumer-Patient Radiation Health and Safety Act, which aims to protect the public from the hazards of unnecessary radiographs. As a result of this law, states have accredited training programs and individuals who practice medical or dental radiology must be certified.
The radiation protection program in your state may provide specific requirements for:
FDA’s Center for Devices and Radiological Health regulates medical devices, including X-ray machines. Some states also require inspection and/or licensing of dental X-ray equipment. FDA dental-specific guidance is:
The use of radiographs to aid in the diagnosis of many dental conditions is a standard of care. However, radiographs are not needed at every visit for all patients. Both FDA and ADA recommend that dental radiographs be taken only after a clinical examination of the patient and a determination of the need for the films.
In 2012, the ADA Council on Scientific Affairs in collaboration with FDA published updated recommendations for patient selection and for limiting radiation. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure also includes guidance for the safety of dental radiographs in pregnant patients and pregnant operators. ADA and FDA recommend the use of aprons and thyroid shields for pregnant patients and dosimeters and work-practice controls for pregnant operators. Safety of oral health care for pregnant patients has been affirmed in studies of pregnant patients receiving oral health care. The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women’s 2013 committee opinion states: “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) … are safe during pregnancy.”
Some patients may refuse to have oral X-rays taken because they perceive a risk of injury from radiation exposure. Health professionals should explain the risk due to undiagnosed disease from not having X-rays taken. Under the doctrine of informed refusal, health professionals must also disclose the potential adverse effects. Note all discussions, the patient's decision, and any other actions taken in the chart.
Merely obtaining the patient's informed refusal does not relieve the health professional or clinic of the ethical and legal responsibility to treat within the standard of care. A patient has a limited right to define the terms of his or her care, but this does not include consenting substandard treatment. Treating many oral health problems without radiographs would be considered to be substandard care. If you are unable to convince the patient of the necessity for the radiographs, you are likely within your medico-legal rights to terminate treatment. Oral health professionals may terminate care for any reason that isn't legally discriminatory, so long as they notify the patient in advance and so long as termination won't cause or exacerbate injury.