What dental hygienists should know before ditching the lead shield
Key Highlights
- The ADA recommends discontinuing lead shields due to potential image obstruction and retakes.
- Modern digital radiography and beam restriction significantly reduce patient radiation exposure.
- State practice acts may still legally require lead shield use despite ADA recommendations.
- Dental professionals must follow ALARA principles and only take radiographs when clinically necessary.
- Operator safety includes barrier shielding, dosimetry badges, proper positioning, and training for handheld x-ray devices.
You’ve likely heard that in February of 2024, the ADA released a statement with updated recommendations to enhance radiation safety in dentistry. These recommendations followed a review of studies conducted by radiation protection organizations, and studies that reported radiation dose to gonads, breasts, and thyroid glands from dental radiographs. The review found that with dose-reduction measures, dental radiographs have negligible risk.1
Lead shields in dentistry
The ADA review committee recommended that the use of lead shields be discontinued. The reason for this change is that lead shields have the potential to block the primary beam, preventing a diagnostic image.2 This leads to the need to retake the x-ray and expose the patient to additional radiation. Research shows advances in modern digital radiography equipment and restricting the beam size result in better protection for patients against radiation exposure to other parts of the body.3
Before you ditch the lead shield in your office there’s something you should know. While the ADA makes recommendations based on the best scientific evidence available, these recommendations do not supersede the regulations in state practice acts. As a licensed dental care professional, it’s your responsibility to know and understand the scope of practice in the state where you’re licensed.
If your state has a regulation that requires you to shield patients during radiation exposure, then you must follow that regulation. For example, in New Jersey, under §13:30-8.14 of the Dental Practice Act, the regulations require the use of lead shields during dental x-ray procedures.4 Therefore, dental professionals in NJ must use a lead shield until the practice act is updated.
Tip: Not sure where to find your state Dental Practice Act? The ADHA provides an online resource to guide dental hygienists to the governing body in each state at adha.org/resources/licensure-maps/.5
Protecting dental patients
Even though radiation exposure from a dental x-ray is low, it’s still the dental professional’s responsibility to follow the ALARA principle by limiting the number of x-rays taken.6 Consider the following recommendations to optimize safety and reduce patient exposure to radiation.
- Review the patient’s medical and dental history.
- Make every effort to obtain previous dental x-rays.
- Radiographs should be ordered based on diagnostic and treatment planning needs.
- X-rays should only be taken when the benefits outweigh the risks.
- Use digital receptors instead of conventional film.
- Restrict the beam size to only the area that needs to be assessed. Rectangular collimation is preferred.
- Properly position patients to obtain the best image.
Tip: The ADA provides radiographic examination guidelines that should be paired with the dental professional’s expertise to optimize patient protection by limiting radiation exposure.6
Dental operator safety
Research has shown that on average, dental providers receive an effective dose of 0.06 mSv per year.7 This is significantly less than the regulatory limit in the US, which is 50 mSv annually and 0.5 mSv for pregnant women.7
Barrier shielding and dosimetry monitoring are radiation safety recommendations for all dental care providers. Barrier shielding may include leaving the room or standing behind a wall. When barrier shielding is not possible, the operator should be six feet from the primary beam path.
Wearing a dosimetry badge will measure radiation exposure and help identify any potential risks and areas that need improvement to ensure safety of the provider. Additionally, equipment should be monitored to ensure that there is no radiation leakage.8
Dental professionals should also follow these radiation protection guidelines.8
- Never hold the receptor or the collimator during x-ray exposure.
- Always avoid the primary beam.
- Maintain adequate distance.
- Use proper positioning techniques.
When using a handheld device, it is of utmost importance for the operator to be trained in how to use the device safely and effectively. A study by Makdissi et al. showed that for someone taking 100 x-rays per week for 46 weeks using a handheld unit, the radiation dose to the trunk was not measurable and at waist level varied from 0 to 0.25 mSv.9
However, the position of any handheld device has a significant effect on the operator’s radiation exposure. Therefore guidance, training, and protocols must strictly be adhered to when using a handheld device.9
Tip: When possible, have a member of the team who is not pregnant take radiographs to reduce radiation exposure for pregnant staff.
Conclusion
If your office does not currently have a radiation safety policy, now is the ideal time to implement one. A good starting point is to review the ADA recommendations on radiography. However, it’s important to remember the ADA is not a regulatory authority.
Therefore, you must be familiar with and adhere to the radiation regulations specific to the state where you’re licensed. Once you have this information, you and your team can ensure compliance with all applicable federal, state, and local regulations, helping to optimize radiation safety in your practice.
Editor's note: This article appeared in the November/December 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
References
1. Benavides E, Bhula A, Gohel A, et al. Patient shielding during dentomaxillofacial radiography: recommendations from the American Academy of Oral and Maxillofacial Radiology. JADA. 2023;154(9):826-835.
2. ADA releases updated recommendation to enhance radiography safety in dentistry. American Dental Association. February 1, 2024. https://www.ada.org/about/press-releases/ada-releases-updated-recommendations-to-enhance-radiography-safety-in-dentistry
3. Versaci MB. Using thyroid collars during radiographic exams no longer recommended by ADA. American Dental Association. February 1, 2024. https://adanews.ada.org/ada-news/2024/february/using-thyroid-collars-during-radiographic-exams-no-longer-recommended-by-ada/
4. New Jersey Administrative Code, Chapter 30. New Jersey Consumer Affairs. September 30, 2024. https://dentalsearchnj.com/wp-content/uploads/2015/03/Chapter-30-New-Jersey-Board-of-Dentistry.pdf
5. Dental hygiene licensure maps. American Dental Hygienists’ Association. https://www.adha.org/education-resources/maintain-your-licensure/
6. Dental radiographic examinations: recommendations for patient selection and limiting radiation exposure. American Dental Association. Revised 2012. https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/library/oral-health-topics/dental_radiographic_examinations_2012.pdf?
7. Benavides E, Krecioch JR, Roger T, et al. Optimizing radiation safety in dentistry: clinical recommendations and regulatory considerations. JADA. 2024;154(4):280-293.
8. Iannuci JM, Howerton LJ. Dental Radiography, 6th edition. Elsevier, Inc. 2022.
9. Makdissi J, Pawar RR, Johnson B, Chong BS. The effects of device position on the operator's radiation dose when using a handheld portable x-ray device. Dentomaxillofac Radiol. 2016;45(3):20150245. doi:10.1259/dmfr.20150245
About the Author
Sue Scherer, MEd, RDH
Sue Scherer, MEd, RDH, has been a dental hygienist for over 23 years. She has experience as a chairside clinician, dental hygiene program instructor, CE speaker, author, professional relations manager, and marketing coordinator. Sue is an active member of the ADHA and NJDHA, and past president of the NJDHA. Sue is passionate about educating dental professionals to help improve their day-to-day clinical practice.