In a significant change from long-standing practice, the American Dental Association (ADA), in conjunction with the Food and Drug Administration (FDA), has updated its guidelines on the safe use of radiography in dentistry. Journal of the American Dental Association recommendations advise against routinely using lead abdominal aprons or thyroid collars on patients during dental X-rays.
Lead aprons have been a common sight in dental offices and radiology departments for nearly a century, providing a protective barrier against ionizing radiation risks. A better understanding of radiation safety and advancements in X-ray technology have led to a reevaluation of their necessity, however.
According to the expert panel established by the ADA Council on Scientific Affairs, modern digital X-ray equipment reduces the risk of radiation exposure to other parts of the body significantly by restricting the beam size to the region of interest. Together with the minimal radiation dose emitted by contemporary machines, this focused approach, known as “rectangular collimation,” renders the need for additional shielding by lead aprons unnecessary.
Additionally, lead aprons and thyroid collars may unintentionally interfere with the imaging process. In the event that these shields are positioned incorrectly, they may obstruct the primary X-ray beam, requiring the patient to take additional radiographs and exposing him to more unnecessary radiation1.
According to the ADA, its recommendations are in line with those of other medical organizations. As of 2019, the American Association of Physicists in Medicine recommended the discontinuation of patient lead aprons, and as of 2021, the American College of Radiology also expressed this opinion. The groups agree that lead aprons are not as protective as they appear on the surface and their potential for compromising image quality outweighs any psychological comfort they may provide.
To minimize radiation exposure, the ADA emphasizes the importance of judicious use of radiographs. Dentists are encouraged to order X-rays sparingly in order to provide patients with the diagnostic information they require in order to enhance their care and improve their clinical outcomes. In situations where X-rays are deemed necessary, it is recommended that digital imaging be used over conventional X-ray film and that patient positioning be optimized to ensure the greatest possible image quality.
Among the changes in this update are a departure from traditional practices and a reminder of the significance of staying current with technological advancements and safety data. ADA’s decision to remove lead aprons from dentistry may require some adjustment and education for both dentists and patients, but it is based on a commitment to patient safety and the effective use of radiography in dentistry.
With the implementation of these new guidelines, practices will be able to optimize diagnostic outcomes while maintaining the highest standards of patient safety. As a result of the advancement in radiographic technology and the ongoing efforts to refine safety protocols within healthcare settings, lead aprons have been discontinued. As a result of these updated recommendations, the ADA reminds us that evidence-based practice is at the forefront of modern dentistry, ensuring that patient care evolves along with scientific advancements.
