Forced to have X-rays

Dentist and Runner wrote:

Personally, I'd not take the x-rays and just make a note in the chart stating you declined, even though they were strongly recommended. Should be enough CYA for the dentist, and you wouldn't have to have your x-rays.

As a dentist, I'd hope you would know that this is not right. The standard of care for a new patient exam requires the necessary radiographs. Not including these can and has been judged to be malpractice. A patient can not sign a waiver giving you the right to perform malpractice.

Are you sure about this? We're not talking about a dentist agreeing to undertake treatment with inadequate diagnostic information, just agreeing to not utilize a certain type of diagnostic tool as a matter of routine exam. If the patient is made fully aware of the diagnostic shortcomings and potential consequences of missed pathology as a result and still refuses radiographs, it's hard for me to believe that he/she could be successfully sued for that. The dentist is doing the best he can given the boundaries that the patient is setting. Standard radiographs vary from practice to practice, there's not one universal standard that all dentists have to adhere to.

Dental x-rays can give you teeth cancer

and for real, they can give you brain cancer, which is worse than teeth cancer.

I wonder if there is such a thing as teeth cancer.

medium_pace wrote:

BTW, I work in the nuclear industry, we take radiation exposure very seriously.

OK- I gotta call troll on you due to this obvious nugget. Nevertheless, you've got a good point.

I refuse dental x-rays for myself and my children routinely. Yeah, the dentist usually gets flustered and trys to convince me of the necessity and low risk (i.e., they say the level of radiation is minimal akin to what you experience in a single year from background radiation), I refuse, they pressure, I resist, they express their reservations, I "say" I understand, they reluctantly agree, I thank them.

It takes a bit of negotiation, but in the end they end up doing what I want which includes cleaning teeth and checking for cavities.

Now, don't get me started on the fluoride buisness. That's another "dental treatment" I routinely refuse for my children. I see no good reason to bathe my children's mouths for 15 minutes with a known, potent neurotoxin.

15mph wrote:

Does someone have a good source for how much radiation exposure a dental xray may involve? I'd be interested in knowing the highest and lowest possible values, to see if the risk is really significant. When they put lead over my body, walk out of the room, and close a heavy door, it makes me feel like maybe there are some risks.

Lead: might as well protect the rest of the body, right?

Walking outside: There's a difference between one xray every 6 months and receiving a partial dose from 10 each day. It's a factor of a thousand or so.

Interesting figure here:

http://xkcd.com/radiation/

Looks like a dental x-ray (5 microsieverts) is equivalent to about 50 banana doses (0.1 mirosieverts each).

medium_pace wrote:

Obviously you are not being physically harmed by having a doctor stick his finger up your ass, but maybe you just don't want them to do it. It may very well be in your best interest for him to do it, but based on your response I assuming if the doctor said it was mandatory you would not have a problem with it, or anything else they wanted to do to you and said was "mandatory".

I not only don't have a problem with my physician performing that procedure, I insist on it.

The ADA recommends bitewing x-rays at only 2 to 3 year intervals for patients with no signs of cavities. Since many insurances will pay for bitewings 1x/year, many dentists will take them every year. That's against the ADA recommendation, and would fall under the "crook" category. If you want to be a lazy, greedy dentist, then take a full series. If you want to do what's right for the patient, contact his previous dentist and help them get his x-rays sent over to you (by law, the patient owns his x-rays).

I'm not saying taking a full mouth series as a new patient is malpractice - its what most dentists would do and can easily be argued as reasonable. I am saying that not taking x-rays and documenting as such is completely ethical. The patient is the customer. If he doesn't want x-rays, you shouldn't force him to take x-rays. That would trend much more towards malpractice. I completely agree with "Voice of Reason". Plus, I really doubt any dentist has been sued successfully by a cavity-free patient for not taking radiographs because the patient opted out. That's close to the equivilent of being sued by a patient who had a tooth extracted three years after the dentist told him to schedule an appointment to fix a cavity, but the patient never returned to get the tooth fixed. Its ultimately up to the patient to make his decision. The dentist's responsibility is to provide professional advice on how to proceed, and then possibly provide preofessional treatment.

ADA's stance:

The dentist must weigh the benefits of taking dental radiographs against the risk of exposing a patient to x-rays, the effects of which accumulate from multiple sources over time. The dentist, knowing the patient’s health history and vulnerability to oral disease, is in the best position to make this judgment in the interest of each patient. For this reason, the guidelines are intended to serve as a resource for the practitioner and ARE NOT INTENDED AS STANDARDS OF CARE, REQUIREMENTS OR REGULATIONS.

Source:

http://www.ada.org/sections/professionalResources/pdfs/Dental_Radiographic_Examinations_2012.pdf

GOML wrote:

Interesting figure here:

http://xkcd.com/radiation/

Looks like a dental x-ray (5 microsieverts) is equivalent to about 50 banana doses (0.1 mirosieverts each).

This could be a problem for the dude eating 30-50 bananas a day then.

I can't get any cleaning without x-rays and it's really bad that this is such a scam. I am an older woman and have been trying to be pregnant for a few years. I only have a little bit of time left. I got pregnant a few times via expensive fertilization efforts, and then lost them after a few weeks, and then after giving up with trying and the hormones etc, I got pregnant again twice last year for lost them again after several weeks. But this is my last year or so trying and all this time, for the past 3 years, my dentist has refused to clean my teeth without xrays, even though I tell her *I am trying to get pregnant, so I do not want to have xrays*. During this time, I've had 2 infections in my gums that might have been prevented with the regular 6 month cleanings. I really hate this scam, and wish there were more options.

You don't know s--t about medicine and should stfU.

medium_pace wrote:

They want to do x-rays. I say no it is not necessary. I do not agree with routine diagnostic dental x-rays and consider it my right to refuse them.

They inform me that they will do no treatment, no cleaning, the dentist will not even do a physical exam without an x-ray.

I think dental x-rays are mostly a scam to increase billing and they are poorly regulated. I am willing to "risk" my dental health to avoid the risk of unnecessary radiation exposure.

You are 100% correct.

I would tell them to shove their xrays you know where, and stay far away from them from now on.

Choosing to not go to a dentist is by far the better choice compared to having your head and teeth destroyed by the ADA and their incompetent dentists.

Interestingly, those people with the best teeth in their 80s and 90s have NEVER been to a dentist.

I routinely refuse dental xrays for myself and my family. Most reputable dentists have no problem with it. Find yourself another dentist.

I am a dentist and I deal with this question several times per week. Here is the deal with radiographs:

1. The ADA ALARA recommendations are adopted by the state board as the standard of care in your state. When adopted they become guidelines for practice. While the ADA does not have legal authority, the state board and powers that be are the ones kind enough to grant my license. They can take it away and have the authority to do so.

2. The ALARA guidelines represent the minimum standard of care for diagnosis. ALARA means "As Low As Reasonably Achievable" for radiation dosage. Practicing below this standard is negligent. You cannot sign a form allowing me to be negligent. It will not stand up in court should we miss anything or anything goes wrong. Any attorney will tell you that an informed refusal for diagnostic procedures is simply written documentation of the doctor's stupidity to be used by the plaintiff.

3. While you can refuse any treatment that I recommend, you cannot refuse a diagnosis and still be in my practice. Radiographs are not a treatment. They are used to procure a diagnosis. We are obligated to practice by the legal standard - not the medical standard which is broader. This is the doing of lawyers and the public. Not doctors. When people stop suing other people for their own stupidity, we might be able to practice better medicine like they do in other countries. Otherwise, this is the state of affairs in America.

Treatment cannot be rendered to a patient without a diagnosis supported by standard methods. Standard methods includes radiographs, charting, pictures etc.

You are welcome to argue all you want. You would not be treated in my office, or any reputable office, without radiographs. It has nothing to do with my boat payment. I have spent $390,000 over the last 8 years on digital low dosage equipment. To think that I could somehow be ripping you off for forty bucks like I would ever make that investment back is ridiculous. I made that investment, like most other doctors, to better treat my patients.

A sound and prudent doctor makes a judgment on what diagnostic information they need to treat you appropriately. If you choose not to allow it, the best course is probably to go your separate ways. After all, if you don't trust your dentist to decide when it might be important to take an x-ray, what in the world would happen if, G-d forbid, something big ever went wrong with your treatment?

Best of luck. BTW - he is under no obligation to see you just because he takes your insurance. There's no one in it probably because your plan sucks but that's up to your plan - not the dentists.

Hope to Clear this Up wrote:

You would not be treated in my office, or any repugant crook's office, without radiographs.

medium_pace wrote:

Interestingly, those people with the best teeth in their 80s and 90s have NEVER been to a dentist.

Not true.

I am in dentistry, as well. What is funny about this, is I routinely do not charge patients for radiographs. Patients will also request MORE radiographs, stating things like "don't you need a newer picture? Are you sure that x-ray is not too old to work off of?" I often quote guidelines and some still request the x-rays..and then in some circles, like this thread, people want NO x-rays! Interesting. We also get the crowns and "root canals" aren't ever necessary people. If you all are willing to negate all of the knowledge and expertise of your dentist for some stances you have taken based on something you just came up with, or something you heard from someone else, or something you googled...then it would behoove your dentist to not treat you. You are a unnecessary lawsuit risk and too much time would be wasted debating with you over every little thing. Or you can just listen, practice good hygiene keeping your teeth clean, and allow your dentist to assist you in having all of your teeth for the rest of your life. Guarantee nearly all, if not all, persons complaining about this stuff has had some dental issue they have dealt with that could have been prevented if they cleaned their mouths and listened to their dentist...

Mr. Obvious wrote:

GOML wrote:

Interesting figure here:

http://xkcd.com/radiation/

Looks like a dental x-ray (5 microsieverts) is equivalent to about 50 banana doses (0.1 mirosieverts each).

This could be a problem for the dude eating 30-50 bananas a day then.

I, too, am concerned about this.

Should I be limiting my daily banana intake (DBI) to lower my risk of radiation sickness? Is there a "safe" BDI?

It's not x-rays that will harm you, it's meat, dairy and eggs.