Regardless if your dental office is fully digital, or still taking traditional radiographs, the importance of having a proper x-ray protocol for your office is key to managing a successful and efficient dental practice, and ensures that your patients are getting the best dental care they deserve and desire.
Having practiced in Florida for over 13 years, I have had the opportunity to treat many patients from all over the world, who spend at least a good portion of the year in my community. With the increased mobility in our society, you may also find that your patients do the same.
As more and more offices convert to digital radiography, it is obvious to me from our requesting of radiographs from offices across the globe, that the frequency and type of radiographs vary widely from office to office, regardless of whether the radiographs are conventional or digital in nature.
An often overlooked management area in a dental practice is defining what your office considers the standard of care in terms of when and what type of dental radiographs should be taken for the various appointments and clinical situations that present.
Your standard of care
A custom tailored x-ray protocol for your office is necessary to ensure a consistent and clear message is sent to your patients regarding your use of dental radiographs in your office. More importantly, it tells your patients the reason and purpose for each radiograph you take.
The easiest way to research what will work for your office is to start with the stated position of the American Dental Association concerning the use of the radiographs for patient dental care. This rather large document also includes a handy chart giving you guidelines for what types of radiographs you would take on what types of different dental situations you would likely encounter on your patients.
A staff meeting concerning this topic is highly recommended, and makes for a good brainstorming session on how your office chooses to handle each case. Once a decision is made, the guidelines for all providers and radiograph takers is set, and all your patients now have a consistent office policy that you can tell them about, and every staff member will follow.
Suggestions
Below are some suggestions for the most frequently encountered clinical situations you and your fellow staff members will face on a daily basis:
- FMX or Pano/four BW’s every three years. An FMX is generally taken on periodontal maintenance patients and/or heavily restored ones. If the patient has not had any significant restorations and/or periodontal treatment for three consecutive visits, pano/four BW’s is sufficient. Also if patient is radiation phobic or anatomically difficult to do FMX, pano/four BW’s is sufficient. Digital radiography will enable you to reduce the radiation given to the patient by at least half, if you encounter a situation where the patient has an objection.
Very often, lack of finances is the objection, not radiation. This needs to be handled administratively prior to the appointment, and before any radiographs are taken.
- The situation noted above can be alternated with four BW’s every 18 months, unless we receive films from specialist or other sharing dentist. Do not take duplicate films unless patient has other dentist/specialist, or a certain area has to be observed, and may require referral.
- Children’s BW amounts, frequency, and size can vary with age. A panoramic radiograph should be taken at ages six, 12, and 18 years, or at other age intervals if orthodontic/pediatric referrals are being done. The panoramic shot can also be taken at less than six years of age if a genetic or missing teeth clinical situation presents itself. Copies are unnecessary unless child is being referred or going away to school.
- An emergency patient requiring a PA, FMX, or panoramic radiograph with referral should always have duplicates unless directed otherwise by doctor. A panoramic radiograph and FMX may be taken on same patient if patient is being referred for oral surgery, orthodontics, and implant evaluation, and it would assist in the diagnosis.
If the patient currently has a periodontist or other restorative dentist, copies should be sent or emailed directly to office as a courtesy, along with current six point probings if taken, and a practice brochure. Likewise, if films are requested from a periodontist to our office, current six point probings should be requested also. This is a great opportunity for other offices to see how well versed and efficient you are at your office, and shows your patient how much you care for their dental health.
NOTE: Original radiographs are the property of the practice and are never sent to the requesting party unless accompanied by a legal order, or it is to assist in a forensic investigation. A statement requesting the radiographs be returned upon completion of the investigation/litigation is to accompany both types of requests.
In summary, a proper and well thought out protocol is vital in your office setting for the selection and determination of when and why you take radiographs on your patients.
This protocol eliminates the guesswork on the part of your staff, shows your patients that you have a consistent and accurate policy that ensures their dental health, and provides a professional image of your office to other dentists who may share in the treatment of your existing patient base.