“I don’t want x-rays. I don’t want to be exposed to radiation. I take care of my teeth and I know there is nothing wrong.”

Many people are looking for ways to be more healthy, stay away from toxins or chemicals, and want to reduce their exposure to radiation. It’s so good to see people taking care of themselves, becoming more aware and being their own advocates for ensuring that they do what’s right for their bodies. Old school mentality of “do what you are told” is gone, and people are getting more educated, more aware, and more informed about health, prevention of disease, and risks of dental or medical procedures.

Dental x-rays have come under scrutiny in the last couple of decades, and we are finding that more and more patients are refusing to have dental x-rays taken when they come in for appointments. Some people are afraid that x-rays cause cancer, while others think that we, as dentists, take too many or take them too frequently. And many of us dentists have complied (myself included) with the occasional request to skip taking the x-rays that we have been taught to take.

And that poses a dilemma. On the one hand, if we don’t see anything visually during the exam of a patient, and the patient, in general, takes good care of their teeth, then what’s the big deal? The patient is clearly doing everything right when it comes to home care, and prevention and good oral hygiene is key to minimizing dental issues. But here is the “other hand” and where the difficulty resides for me, as a dentist. There are many problems that have no symptoms and no visual signs at the beginning stages. Here are some of these that only show up on x-rays, and have no symptoms in early stages.

1) Ameloblastoma – this is the most common odontogenic tumour accounting for about 11% of all odontogentic tumours. This usually occurs in the 20-40 years age group. Since drugs and radiation don’t have much of an effect on these, surgery and removal of this is required. The bigger it is, the more of the jaw needs to be removed. A panorex (the x-ray that goes around your head) is what we look at to see if there a presence of this or other tumours or cysts, and often, your regular cavity-checking x-rays (known as bitewings) are not enough.

2) Infection – not all infections result in obvious swelling or pain. There are times when an infection can grow yet you can have no symptoms. If not seen or diagnosed (and an x-ray, often a periapical – type of x-ray we take to check if we suspect an infection) it can go septic. Sepsis, a blood infection, is an overall body response to a threatening and deadly infection. Sepsis kills and disables millions of people each year and is a serious problem.

3) Correct number of teeth – in children, we often take x-rays of different kinds to monitor growth, presence or absence of adult teeth (when a child still has their baby teeth), as well as potential issues that could impact growth, proper jaw development, or tooth eruption. Why is this important? If caught and diagnosed early, growth, missing adult teeth, or poor jaw development, can be treated and helped at this age through simple orthodontic treatment. Intervention at the correct time and age is key to achieving not only the best outcome, but is also the simplest and less expensive. Without proper, up-to-date x-rays, we are unable to see, advise, and step in to help if needed.

4) Cyst – a cyst can form from tissue that surrounds a tooth and will have no symptoms when small. But cysts can grow and take over your jaw if not removed, so early intervention is key to less invasive procedures and disability.

5) Cavities – small cavities, especially those between teeth, can only be seen on x-rays. Visually, we can only see them once they get big and may already involve the root canal. So taking bitewings (cavity-checking x-rays) is key to catching these when they are small and easily restored, rather than waiting until you need a root canal.

These are just some of the most common things we, as dentists, see when we take x-rays of various types on our patients. There are so many other conditions that can only be diagnosed by taking x-rays and also taking them at various angles or position. And so here is where the dilemma becomes a Morton’s Fork. As your dental professional, if you don’t want x-rays and I influence you to do them, you will likely, or at least a part of you, resent me for doing that, especially when I find nothing wrong. You will think to yourself: “see, I knew I didn’t need x-rays so next time she wants me to take them, there is no way”. But if I don’t take them, now you are happy, relieved, feel heard, and feel like I listened to you and your concerns, and I did. Except if something goes wrong. If a couple of years later, you develop a swelling, or pain, or notice your teeth shifting a bit, and then we take a Panorex and find a massive growth that could result in surgery to remove half your jaw, and even if it’s something smaller that could have been caught two years prior, it is completely my responsibility and considered negligent by law and our governing body. And at that point, you will be thinking to yourself: “she is the dental professional so she should have warned me and she should have taken that x-ray”. We care so much for our patients and their well being, and we want to make sure our patients feel heard and are fully informed about their health and oral conditions. We are here to support you and customize our recommendations to make sure we take your wants and needs into account when prescribing x-rays and any other dental treatment. But having current information, including x-rays, based on what we see, think and suspect, is key to treating you well, preventing issues from becoming invasive or debilitating, and guiding you with proper and full diagnosis.