Dental Radiographs (X-Rays) For Children

Do Children Really Need Dental X-Rays So Often?

Many parents ask me about the age at which children should have their first set of x-rays taken. The dental radiographs taken on kids show us tooth decay that cannot be seen with the naked eye. These areas of decay are tucked between the teeth where the teeth touch tightly (the area of the teeth that is cleaned by dental floss, not a toothbrush). For this reason, the first set of dental radiographs taken in the back of the mouth (which allows me to see the areas that tightly touch between the molar teeth) should be taken about 1 year after those molar teeth begin to touch. Because all children get their 2nd primary molar teeth at a different time (most around age 2, but this can vary by many months or even a year), the age at which a first set of posterior (back) dental x-rays should be taken will vary. For a child following an average tooth eruption schedule, their 2nd molars would erupt (come into the mouth) at 2 years of age, and gradually move forward until they are in full contact with the molar in front of them when the child is about 3.5 years old. This would mean that this child would be due for their first set of posterior radiographs around age 4.5 years. Many children are not yet ready to take these back x-rays at that young age, and so we may wait until they’re 5, so as not to cause them an unpleasant experience in the dental office.

If no cavities are seen on the first set of xrays, and the child is determined to be at low-risk for decay, the American Academy of Pediatric Dentistry (AAPD) recommends taking a 2nd set of posterior radiographs 12 months after the first set. These two sets of x-rays, as well as other observations made at the child’s visit (whether they have bleeding gums, visible plaque accumulation, inconsistent oral hygiene habits, etc…) help me to diagnose the child’s risk for developing dental decay (known as their ‘caries risk’). A caries risk assessment is performed at every visit, and can change over time, based on many factors. For children with the lowest caries risk, the AAPD recommends waiting up to 24 months before taking the next set of posterior x-rays. For children with existing decay or high caries risk, the AAPD recommends taking x-rays every 6-12 months (depending upon factors that are individual to the patient).

You may be wondering, as a parent, do you have the right to refuse dental x-rays? The answer to this is going to vary depending on which dental provider you are working with. For me personally, I see it as my responsibility to inform you of the risks of not taking the recommended x-rays and, if you accept those risks, documenting this in your child’s chart (for legal purposes) and forgoing the x-rays. As with any medical procedure, you have the right to refuse treatment after an informed consent outlining the alternatives, risks and benefits of the procedure have been discussed with your provider and you have been informed of, and accept the risks of ‘doing nothing’. During this discussion, I mostly try to emphasize that I am not able to fully rule out the possibility that your child has tooth decay, because without dental x-rays the ‘flossing areas’ (about 30% of the tooth surfaces in the mouth) cannot be visualized. I also try to convey that, by the time a cavity from one of these areas becomes visible on clinical exam, it is usually quite large and will require more extensive treatment.

I always follow the AAPD’s guidelines when determining a child’s schedule for radiographs, and base my recommendation on their caries risk. There is no “one size fits all” recommendation for radiographs in my practice, and in my opinion, the need for radiographs should not be based on a child’s age alone. I also follow the ALARA principle when it comes to exposure to radiation- ALARA stands for “as low as reasonably achievable”. Per the CDC, this principle means that even if it is a small dose, if receiving that dose has no direct benefit, you should try to avoid it. You should always feel empowered to ask your child’s dentist to justify why a radiograph needs to be taken.