• Select x rays for individual’s needs, not merely as a routine
• Use the fastest image receptor possible: E- or F-speed film or digital sensors
• Collimate beam to area of interest
• Always use thyroid collars
• Child-size the exposure time
• Use cone-beam CT when appropriate 
• Use dose cone-bean CT option if available and appropriate 

So when we image, let us image gently: More is often not better.

There are many different types of x-ray images (pictures) that can be taken of children in the dental office to assist in diagnosis. These include the panoramic and orthodontic (cephalometric) extraoral images, intraoral images such as bitewings and periapicals (little films that go inside the mouth) and cone beam computed tomography (CBCT). All of these dental images use ionizing radiation (x-rays), and therefore parents may be concerned about the increased cancer risk (because of the x-rays) to their children. The following provides information on the risks of dental images in relation to their benefits.

For a thorough discussion of the issue of radiation safety in dental imaging, read this article.

Guidelines for Making Dental Radiographs (X rays):

• American Academy of Pediatric Dentistry Guideline on Prescribing Dental Radiographs for Infants, Children, Adolescents, and Persons with Special Health Care Needs
• American Dental Association guidelines for Dental radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure

The SedentexCT Guidelines 

Guidelines/statements on the use of dental Cone-beam CT

• AAOMR Position Statement in Implantology
• AAOMR Position Statement in Orthodontics
• European Association for Osseointegration Guidelines
• European Society of Endodontology Position Statement 
• AAE/AAOMR CBCT Use Guidelines
• SedentexCT Wiki 
• National guidance documents on dental CBCT
• Training Materials

• IAEA recources for professionals

Cone-Beam Imaging

Cone-beam imaging is a form of advanced imaging that provides 3D views of the face and teeth. Recent advances of low-dose cone-beam CT option exposes the patient to less or equivalent radiation to commonly used dental imaging modalities. 

For children, cone-beam imaging is occasionally used for orthodontic evaluation. More information about cone-beam imaging may be found at:

• The U.S. Food and Drug Administration (FDA) has posted an informational webpage on dental cone-beam computed tomography.  On this webpage, the FDA is promoting the safe use of cone-beam computed tomography in dentistry, particularly in the pediatric population. Recommendations to parents, patients and health care providers to help reduce unnecessary radiation exposure from dental cone-beam computed tomography are also provided on this web page.
• Clinical recommendations regarding use of cone beam computed tomography in orthodontics. Position statement by the American Academy of Oral and Maxillofacial Radiology
• European Guidelines: Cone Beam CT for Dental and Maxillofacial Radiology (link to http://ec.europa.eu/energy/nuclear/radiation_protection/doc/publication/172.pdf

The American Academy of Oral and Maxillofacial Radiology (AAOMR) is a member of the image gently alliance.  Please visit the AAOMR website at for more information on dental radiology.

Council on Radiation Protection Program Area Committee 4 - Presentation from March 9, 2014. Used with the permission of Dr. Joel Gray and the National Council on Radiation Protection and Measurement.

Enhancing Radiation Protection During Pediatric Imaging, Allan G. Farman; Oral Surgery, Oral Pathology, Oral Medicine and, Oral Radiology , Vol. 117 No. 6, June 2014 (Access to this article provided by Elsevier as a courtesy to Image Gently.)