"But Dr. Breiner, you are supposed to be holistic: why are you insisting that I have x-rays taken?
Holistic should not mean the suspension of common sense.
For me, holistic encompasses the physical and the non-physical, the intellect, instinct, intuition, the emotions, that which is rational and irrational, that which is of this world and beyond. It is good versus bad, the positive and the negative, benefits versus risk, Yin versus Yang.
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Holistic for me means that there is a reason for everything and that this means that in holistic medicine and dentistry that there is a place for drugs and x-rays and certain conventional treatment. I believe that when used judiciously the risks of dental x-rays are outweighed by the benefits.
With almost all of my patients being holistic, a number of them refuse x-rays. The problem in refusing x-rays I feel is threefold:
1. Just visually observing the teeth is like looking at an iceberg; one does not know what is hidden below the surface. This can lead to serious consequences. I have had several patients in the past few months who have repeatedly refused to have x-rays taken and now came in with a toothache. This forced them into a situation where they had to decide on whether to have the offending tooth extracted or root canaled. Periodic x-rays could have prevented this. One of the patients who adamantly refused x-rays came in with terrible jaw pain. He finally consented to a panoramic x-ray and a large cyst associated with a lower impacted wisdom tooth was found in the jaw bone. Luckily the warning pain came before the fracture of the lower jaw!
2. My license is placed at risk. The courts have ruled that even if the patient has signed a release that they refuse x-rays, and that they have been warned about the possible consequences of not taking x-rays, the dentist is still liable for problems occurring from not taking x-rays!
3. It is very upsetting for me when there is a problem that could have been prevented as in #1.
Let's talk about dental radiation X-ray dose
No one likes x-rays, but let me give some perspective about dental x-rays.
First let me briefly discuss the unit of measurement used with x-rays, the Sievert(Sv). The Sievert is the unit of equivalent dose and also effective dose. This deals with joules of energy and gets very technical and so I won't go into this in great detail. Just understand that the equivalent dose is the measure of the biological effect of radiation on human tissue and for x-rays it is equal to the absorbed dose.
The more Sv, the larger the dose. Comparing milli-Sievert(mSv) dosages of various x-ray exposures will help put dental x-rays into perspective.
Natural background radiation that we are all exposed to from the Sun and the Earth (mainly from Radon) is approximately 3.1 mSv/year. One chest CT is about 7 mSv. One mammogram is .4 mSv. One dental x-ray using digital equipment is .001 mSv. A digital dental panoramic x-ray is .002mSv. A seven hour airplane ride is .02 mSv. As you can see, the exposure for dental x-rays is very low and I believe the benefits far outweigh the risks.
How often do I recommend taking dental X-rays?
I generally recommend bitewings every two years and a panoramic x-ray every five years. Bitewings are mainly to detect decay between the teeth and a panoramic x-ray allows us to see around the roots of the teeth, the entire upper and lower jaw bones and the sinuses. These images allow us to better diagnose and treat a patient. The panoramic x-ray is especially helpful in seeing wisdom teeth, root canals, and even congenitally missing or non-erupted teeth.
New 3-D Cat Scan technology now available for dental imaging
Besides seeing airway problems, I can observe if the neck is out of alignment, if the sinuses are fluid filled, if a root canal shows an area of infection in the bone around the root, if there is an infection around an asymptomatic tooth, etc. Often these "hidden" infections will not be seen in a 2D view.
3D scanners and dental implants
If you are going to have an implant placed, a 3D image allows visualization of the sinus and nerves so that those areas can be avoided when placing the implant.
3D scanners and children
When looking for a 3D unit I made sure to get one which has very low radiation and in fact my unit is the only one approved by the FDA for children because of its low radiation. My Pax-i 3D Green CT exposure is only .133 mSv. A medical CT scan will be between 1.2 to 3.2mSv.
As you can see from the radiation comparisons dental x-rays certainly do not expose one to a lot of radiation. We also give a homeopathic remedy to counter even the small amount of exposure.
Like I said, there is a time and a place for everything and that includes dental x-rays.
© 2017, Mark A. Breiner, DDS
The information presented is for educational purposes only. Please consult a qualified dentist or health practitioner for diagnosis and treatment.