Overuse of Cone Beam CT Scans in Dentistry?

[Cary Feuerman, DMD]

The other day, the New York Times featured an article entitled "Radiation Worries for Children in Dentist's Chairs". The article mainly centers around the increasing use of Cone Beam CT Scans by dentists, including oral surgeons and orthodontists, to aid in the diagnosis and treatment of a variety of common dental problems in children such as malocclusion and impacted teeth. The main issue is that these children are being exposed to much higher doses of radiation as compared to those children who are being evaluated with more traditional diagnostic tools such as conventional panoramic and periapical dental Xrays (both digital and film), photographs, and study casts of the dentition.

The article states that many experts in dental radiation have raised alarms about what they see as their indiscriminate use. They worry that with few guidelines or regulations, well-meaning orthodontists and other specialists are turning to a new technology they do not fully understand, putting patients at risk, particularly younger ones. Some orthodontists now use Cone Beam CT scans to screen all patients, even though a number of dental groups in this country and in Europe have questioned whether the benefit of routine use justifies the added risk. The ADA has already responded and advises that dentists follow the ALARA principle (As Low As is Reasonably Achievable) to determine which diagnostic tools are best for each particular case.

There is no question that Cone Beam CT scans can help dentists and surgeons deal with complex cases involving dental implants, TMJ disorders, jawbone pathology, and other serious dental and medical problems. As a periodontist who has been placing dental implants for over 23 years, we have been using CT scans since the early 1990s to aid in diagnosis and treatment planning for complicated cases. The technology is an extremely valuable tool which helps us to provide our patients with a safe, predictable surgical outcome. But the vast majority of our smaller cases do not require the use of this technology, especially when we have extracted the teeth and repaired the bone with bone graft and guided bone regeneration procedures. These cases may be evaluated by more conventional means outlined above.

With the increasing prevalence of in-office CBCT scanners, usually at a cost of around $140,000, I sometimes wonder if they are being overused by some clinicians just to help pay for the cost of the machines. I would like to believe that this technology would only be used when absolutely necessary to justify the extra radiation exposure, but I have seen instances with patients referred for second opinions where conventional dental Xrays would have been adequate for proper diagnosis and treatment. On the other hand, I completely understand the concept that dentists and surgeons would like to have the best and most complete information available to them prior to treating their patients. In this litigious society, implant surgeons have oftentimes been told that utilizing CT scans in the diagnostic phase is actually the standard of care. So, therein lies a "Catch 22". In the end, we must rely on the judgment, skill and expertise of the treating dentist and surgeon to determine how best to evaluate cases. But, patients do need to be informed of the risks and benefits, especially when concerning children.

Do you think the NY Times article is valid? What are your experiences? Your comments are appreciated.

Cary Feuerman, DMD

Periodontal Associates