• When new equipment is installed or substantially different practices are implemented;


• When a worker declares pregnancy to the dental employer;


• Personnel who are likely to receive an annual dose in excess of 100 mrem (1 mSv);


• Personnel who are likely to receive a weekly dose in excess of 25 mrem (.25 mSv); and/or,


• When handheld x-ray units are utilized at a practice for the first year to monitor exposure.


The majority of dental x-ray operators will not be exposed to the levels stated above due to maintaining a minimum of six feet from the x-ray source and utilizing barriers (stand- ing outside the room during the exposure) where dosimetry monitoring is needed.²,


⁴


However, a dosimetry program can help determine a baseline for dental personnel’s radiation exposure; if no exposure for a year is noted, the dosimetry can be discontinued. The NCRP states “All occupational exposures have been declining over recent decades for workers in all healing arts including den- tistry.”²


All equipment producing radiation must be surveyed at varying intervals by a qualified expert to determine output and safety. Scat- ter surveys are routinely performed when testing panoramic and cone beam CT units as well to ensure the safety of the dental staff.


In summary, the AAOMR and ADA recom- mend discontinuing the use of any shielding for patients moving forward. The NCRP and MRCP have not updated any recommenda- tions for dental shielding at this time, and thyroid shielding for patients is the current published recommendation as of Decem- ber 2023. All dental x-ray operators should still be prudent when making exposures by maintaining appropriate distance and using barriers.


Stephanie Patrick, BS, RT (R)(M)(QM) is a Qualified Expert with Heldebrandt Consulting and travels throughout Missouri performing radiation safety inspections for sites including dental settings. She has been in the radiologic sciences with experience in radiation


physics and safety for more than 30 years and enjoys providing educational radiology information to facilities. Heldebrandt Consulting is an MDA Solutions Center


Allied Business Participant. Find information about their services at solutions.modental.org/company/heldebrandt- consulting.


REFERENCES 1.


Journal of the American Dental Association. (Septem- ber 2023) Patient shielding during dentomaxillofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiology. Volume 154, Issue 9. Benavides, E., Bhula, A., Gohel, A., et al. jada.ada.org/article/S0002-8177(23)00391-4/fulltext


2. National Council on Radiation Protection and Mea- surements. (2019, December 19). Radiation Protection in Dentistry and Oral & Maxillofacial Imaging: Recom- mendations of the National Council on Radiation Protection and Measurements. NCRP Report No. 177.


3. Missouri Department of Health and Senior Services, Bureau of Diagnostic Service, Missouri Radiation Control Program. (2021, September 14). Usage of handheld dental x-ray units in the State of Missouri. health.mo.gov/safety/radprotection/pdf/usage-of-hand- held-xray-units.pdf


4. OSHA Review Incorporated. (2018, February 28). X- ray Dosimetry Monitoring in a Dental Office. oshareview.com/2018/02/x-ray-dosimetry-monitoring- in-a-dental-office/


5. American Journal of Roentgenology. (2019, Janu- ary 23). Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice. Volume 212, Issue 4. Marsh, R. and Silosky, M. ajronline.org/doi/full/10.2214/ AJR.18.20508


6. Missouri Department of Health and Senior Services, Bureau of Diagnostic Service, Missouri Radiation Control Program. (2015, August). Guidance for dental facilities, radiation badges and shielding. health. mo.gov/safety/radprotection/pdf/Guidance-for-Dental- Facilities-Radiation-badges-and-shielding.pdf


If you’re renovating your office


space or have new construction … … you need insurance coverage written specifically for this type of risk!


Your business owners policy is written for your dental practice exposure,


not a renovation. The same goes for new construction! Talk to your agent about the need for builder risk insurance if you plan to build a new practice location.


800-944-7550 / MDIS4DDS.COM ISSUE 4 | WINTER 2023 | focus 29


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