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The Economist - back off the dental x-rays
I've often wondered about this...
Little and not often, please
Confirmation that dental X-rays can be bad for you
IF YOU are a suspicious type you may be disturbed by the fact that, despite reassurances of the safety of the procedure, dentists and their technicians, when administering X-rays, usually step out of the room while the deed is done. Not only that, they often drape a lead-lined apron over your body to protect your vital organs. Well, all but one: your brain.
A study by Elizabeth Claus, of Yale University, just published in Cancer, suggests your suspicions might be justified. Dr Claus thinks she has identified, in those who have had dental X-rays often, a significant rise in the admittedly small risk of developing a brain tumour.
In rich countries, five men in every 200,000, and twice as many women, develop tumours called meningiomas that affect the membranes surrounding the brain. Meningiomas account for a third of primary brain tumours. Only about 2% of them are malignant, but non-malignant does not mean non-dangerous. Even a ?benign? meningioma can kill. Around 30% do so within five years of diagnosis. Symptoms can include seizures and blindness, and treatment may involve surgery, chemotherapy or, ironically, radiotherapy.
Ironically, because past research studying the after-effects of exposure to things like atom bombs and radiation treatments for cancer suggests the most important environmental risk factor for meningiomas is ionising radiation. These days, however, the main source of ionising radiation for most people is neither fallout from bombs nor radiotherapy; it is dental X-rays. Despite that, surprisingly little research has been done on those X-rays? effects.
Dr Claus and her colleagues have tried to plug the gap. They studied 1,433 Americans who have had meningiomas and compared them with 1,350 others who have not. These others were chosen to match the study group?s age profile, sex ratio and dwelling place. The researchers then inquired about both groups? family, medical and dental histories.
In the case of their dental histories, participants were asked whether they generally had standard X-rays, known as bitewings, every year, or never had them, or fell somewhere in between. They were also asked how often they had had panoramic X-rays?so-called panorexes?taken of their entire mouths, and whether they had ever had braces, the fitting of which often involves a panoramic X-ray.
The researchers found that people who had had a meningioma were more than twice as likely as those who had not to have had at least one bitewing X-ray. And the more bitewings they had been given, the greater that likelihood was.
Even more troubling was the finding that people who had been given a panorex when they were under ten had 4.9 times the normal risk of developing a meningioma. To be fair, only 22 participants in the study had both had a panorex and developed such a tumour. But according to Dr Claus, the panorex was not common when most of the people in the study had been children. ?Nowadays?, she says, ?before getting braces all the kids have it.?
What these results mean in practice is debatable. The radiation dose from an individual dental X-ray, Dr Claus points out, has gone down by about half over the past 30 years or so. In addition, some dentists and orthodontists?though far from the majority?have turned to digital methods that expose patients to even lower levels. But others are using fancy new techniques like cone-beam computerised tomography which actually expose people to much higher levels of radiation.
Moreover, guidelines from the American Dental Association state that healthy adults should have a bitewing X-ray no more than once every two or three years, and that there is little reason to X-ray patients who do not have symptoms. These are policies which Dr Claus describes as ?quite reasonable?. But if what her participants told her is true, not all dentists are heeding their own professional body?s advice. Most of those who took part in the study reported having at least one X-ray a year. Dr Claus?s work, then, is a timely reminder that X-rays are dangerous, that dentists should use them sparingly and that patients who have suspicions about their use are not necessarily paranoid.
Re: The Economist - back off the dental x-rays
I thought you only needed xrays every five years so long as everything looked normal?
This article has caused DH to refuse his bite-wing xray at his cleaning yesterday.
Awesome.
I had thirty bazillion dental Xrays as a kid because my teeth were all sorts of jacked up. We'll just add this to the "reasons why you'll get cancer" list.
I actually made waves at my last appointment because they wanted a full set of X-rays and I didn't have time since I had to pick up my son from school. A big to-do was made about the fact that it had to be done at my next appointment.
I've become convinced that 99% of dentists are scammers and I do wonder why this is.
I had way too many of these as a kid especially. I noticed that in more recent years dentists have backed off of doing this unless there's specific reason for it which is good. I think the cone beam stuff they are talking about applies primarily to endodontics in which case you're pretty far down the rabbit hole with tooth trouble; it's not preventative.
The study is pretty small though. I'm personally not going to lose any sleep over the findings. There could be other reasons why the brain tumor problems are cropping up in a population that gets frequent dental exams (wealthier, maybe they use and are around more electronic gadgets in general, etc).
I'd be more worried about dentists still using mercury fillings and/or removing them recklessly. I've had a mouthful myself
It's ridiculous that using amalgam fillings is still lawful these days. People were getting their panties in a twist over some one time exposure in a vaccine but when it's leaking out into your mouth for years on end then it's a.o.k.... yeah right.
A usual, an ounce of prevention is worth a pound of cure. Unfortunately, most dentists either don't know, don't have time/don't bother to educate patients beyond the ol' brush and floss and don't eat candy. There's lots more that can be done to nip tooth problems in the bud and even malocclusion is 95%+ due to environmental factors and not genetics.
I agree that many are scammers.
When I was 9 I had a dentist tell me I had 9 cavities. He told my brother he had 11. It was odd, since we were fine 6 months prior to that. He tried to do them all at once but I refused. I remember telling my mom it was weird, "it was like he was happy I had cavities."
Turns out he was later found out to be committing insurance fraud.
I hate dentists, and now I have a crap ton of cavities and they need to be re-filled relatively often. Even now I still find myself having to ask if that is really necessary. Ugh.
/end traumatic tale
I get x-rays every six months. My dentist is really honest though, and I do have some issues with my teeth that he is keeping track of.
I wonder if an easy solution would be a lead cap to wear during x-rays?
While I agree that some dentists definitely are out to scam people, they aren't making money on the x-rays. They can find problems before they become larger and more expensive to fix, although I agree they could be far less frequent. I worked as a dental assistant from ages 17-19 and we caught quite a few small cavities through the routine bitewings that had we waited until they were visible without x-ray they would have become a crown instead of a small filling.
As far as the argument that the doctor/assistant leave the room while doing it as a reason not to get them, that's ridiculous. The amount of radiation a patient is exposed to during the x-rays is not huge, but the amount the doctor/assistant would be exposed to in the course of staying for every single patient would be a lot. It's the build up of exposure over time that has created the rules that the staff leave the room.
It's not necessarily that there are that many scammers (though I do agree some definitely are) it's that a lot are misinformed about the disease process, what to do about it or make assumptions about how people will address dental disease on their own.
I think decay is frequently over-treated and treated too aggressively. That's why one dentist will tell you you have 10 cavities and another will say 5. It's a subjective call. Small cavities especially can heal on their own given the right environment. And yeah, once you have a filling it becomes a lifetime maintenance issue even if you get the disease under control. Filling materials don't last forever and with each new one you'll lose some more tooth structure. You might lose enough that your tooth becomes structurally unstable and it cracks or chips and then you're into crowns. A crown prep can traumatize a tooth to the point you need a root canal. And if that fails then you're looking at re-treatment, extraction and implants. A little cavity goes from this $ to this $$$$$$ over time.
Everyone who uses a dentist should read the book Kiss Your Dentist Goodbye so that you can make more informed decisions about dental treatments. It's an easy read.
At the very least, know that fillings and scaling & rp are not addressing the cause of dental diseases; it's patching up symptoms similar to patching a water-damaged wall when you have a leaky pipe. At some point you have to fix the leak or you'll lose your wall. Don't take any dental work lightly.
As if to evidence how little I've paid attention to my dental work, I honestly had no clue that fillings = maintenance. Unfortunately I have crap teeth full of tiny crevices that my toothbrush can't reach, so I'm prone to cavities. I had silver fillings for ages, which were ugly but not problematic, hence my ignorance about the need for maintenance. When I moved and switched dentists, suddenly all these fillings had to be replaced. A couple of the replacements were warranted because I had cracks from the silver fillings, but the rest... eh, not so much.
I had one replacement in 2008 and was being told in 2010 that it needed to be replaced again as part of maintenance. I was furious and to this date haven't had it done. I have several preventative things that my dentist wants to do and I'm just so skeptical that he isn't simply being overly cautious and ultimately creating more long-term care and expense for me.
For better or worse, my tinfoil hat is large here.
The Out-Of-Date Bio | The Blog I've Started Updating Again
Yeah, 2 years seems like a pretty fast turnover unless it was done poorly, it was purposefully temporary and/or disease is uncontrolled. I've blown through an $800 restoration myself within 3 yrs. That was my rock bottom dental moment that really lit the fire under myass to turn things around.
Dentists should be required to inform people undergoing treatment what the pros and cons are for treatment, is it reasonable to wait-and-see and give an estimate of how long restorations will last with reasonable care.
Hey, I think you are near King of Prussia, no? PM me if you want info on the guy we go to. He's on the conservative side with treatment and I trust most of his advice. We actually drive over 2 hrs and pay out of pocket to go there. The whole staff is really friendly and terrific with kids.
I PMed you.
I'm so reading that book. I am convinced our current dentist is a total scam artist. We're actually looking for a new one now and canceled our most recent appointments b/c I was so convinced of it. I could write paragraphs on the ridiculous things they have suggested in the past two years.
Prior to this, we lived near where MH grew up so we used the same dental practice he went to as a kid and the dentist is a friend of his parents, part of the community, etc. I trust him a lot more b/c he never recommended tons of dental work (to the tune of close to $10k), and because of his relationship with MH's family. Too bad we live so far away now.