ADA Withdraws Lead Apron Recommendation

The American Dental Association (ADA) Council on Scientific Affairs no longer recommends the use of lead aprons and thyroid collars for radiographs. This is the first revision to dental imaging safety and radiation protection since 2012. According to the council, “These recommendations apply to all patients, regardless of age or health status (like pregnancy).”

These recommendations aim to enhance radiation protection in dental radiography and cone-beam computed tomography. Evidence has long suggested that using digital radiographs and restricting the beam size to the local area adequately protects radiation exposure to the body. According to the ADA, “Lead aprons and thyroid collars can also block the primary X-ray beam, preventing dentists from capturing the image they need.”

The guiding principle of radiation safety is “ALARA,” which stands for “as low as reasonably achievable”. ALARA means avoiding exposure to radiation that does not have a direct benefit to the practitioner. This principle was issued by the CDC in 1977. It encompasses three protective measures: minimize the time near a radioactive source to only what it takes to get the job done; maximize the distance from a radioactive source; use shielding. In this scenario, shielding is achieved by the use of a collimator. 

This revision has positive implications in patient care, as these measures imply a shift towards a more personalized exposure assessment for patients based on caries and periodontal risk. This challenges dentists’ traditional two-year full mouth series regimen. Dentists are encouraged to consider the necessity of each radiograph, promoting a more thoughtful approach to diagnostic imaging that prioritizes patient safety and effective care.

With no lead aprons to shield the patient, dentists are furthermore urged to prioritize patient care needs when considering diagnostic imaging. Dentists will now optimize diagnostic information with low exposure by utilizing digital radiography, restricting beam size, ensuring proper patient positioning, considering CBCT only when necessary, and staying up to date with relevant regulations.

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