Prescribing and taking dental radiographs

Originally published in Dispatch 2017 Issue 2

Q: WHO CAN PRESCRIBE DENTAL RADIOGRAPHS?

A: The Healing Arts Radiation Protection (HARP) Act, 1990 requires that radiographs be prescribed by a person designated in the Act. In a dental office, only a dentist has the authority to prescribe dental radiographs.

Q: MUST DENTISTS EXAMINE A PATIENT BEFORE PRESCRIBING RADIOGRAPHS?

A: Yes. A dentist’s decision to prescribe radiographs must be justified. Accordingly, a dentist must review the patient’s health history and complete a clinical examination before prescribing radiographs.

Q: WHAT RADIOGRAPHS SHOULD DENTISTS PRESCRIBE FOR NEW PATIENTS, AS PART OF A COMPREHENSIVE CLINICAL EXAMINATION?

A: The fundamental concepts of justification and optimization, which encompass the ALARA principle (As Low As Reasonably Achievable), should be foremost when considering the use of ionizing radiation. In other words, the use of radiographs must be approached in a responsible way that maximizes diagnostic value given the clinical context, but without exposing patients to unnecessary amounts of ionizing radiation. This requires the dentist to exercise professional judgement to achieve the appropriate balance between these two considerations. Therefore, a dentist’s decision about the number, type and frequency of radiographs should be based on each individual patient’s dental history, clinical signs and symptoms.

• Where possible, copies of recent radiographs should be obtained from other practitioners who have cared for the patient.
• A clinical examination must be performed.
• Once any recent radiographs have been assessed and a clinical examination has been performed, if indicated, the dentist may exercise professional judgement to prescribe appropriate radiographs on an individualized basis to help formulate an initial diagnosis for the patient.

Q: WHAT RADIOGRAPHS SHOULD DENTISTS PRESCRIBE FOR RECALL PATIENTS?

A: Again, the fundamental concepts of justification and optimization apply and a clinical examination must be performed before prescribing additional radiographs. A dentist’s decision about the number, type and frequency of radiographs at recall appointments should be based on existing disease and the expected occurrence of disease. For example, the frequency of bitewing radiographs should be determined on the basis of caries risk assessment. A decision about radiographs should never be based on inflexible time periods alone (e.g., bitewing radiographs every six months).

Q: CAN A DENTIST PROVIDE A STANDING ORDER FOR RADIOGRAPHS TO BE TAKEN AT RECALL APPOINTMENTS?

A: No. The taking of radiographs requires a patient-specific prescription. However, a dentist can prescribe radiographs for a specific patient to be taken at a subsequent appointment in order to follow-up on a previously detected condition/pathology, or if the anticipated information may aid in confirming a diagnosis or evaluating treatment provided. The dentist should document the prescription for future radiographs in the patient’s chart.

Q: WHAT SHOULD A DENTIST DO IF A PATIENT REFUSES RADIOGRAPHS?

A: Patients have the right to consent to, or decline, radiographs. Whenever a patient, patient’s guardian or substitute decision-maker refuses recommended radiographs, the dentist should explain the rationale for their recommendation and the consequences of not taking them. If the patient, guardian or substitute decision-maker still refuses, then the dentist should document the informed refusal in the patient’s chart. If the dentist feels that the refusal compromises their ability to make an accurate diagnosis and/or provide appropriate treatment according to the standards of practice, the dentist is well within their rights to refuse to provide compromised care as dictated by the patient.