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Partnering with you to help create healthy smiles

Ensuring your x-rays are safe and effective

Radiology is a key component of your dental practice. One of the most important aspects of taking x-rays is to ensure is that it’s done safely, both for the patient and for you and your staff. It’s also vital to make sure that proper procedures and practices are followed.

As part of our quality assessment reviews, we evaluate radiology practices and equipment. These on-site reviews are part of Delta Dental’s quality assessment program for contracted dentists in California, mandated by the California Department of Managed Health Care, and may also be done in other states as needed.

To make sure you pass with flying colors, here are some guidelines.


Whether you take x-rays with conventional x-ray film or use digital radiography, label all x-rays with this basic information:

  • Patient name
  • Date the x-ray was taken
  • Treating dentist’s name

Remember, x-rays must be labeled to be useful. Keep them accessible for several years to make it easier to review past and present oral conditions.

If you take digital x-rays, printed hard copy versions may not contain the necessary basic information. Check your software and be sure to add the information yourself if necessary.

Remember: If you use conventional x-rays (as opposed to digital images), always keep the originals. Send only duplicate films or x-ray copies of diagnostic quality to insurance carriers, specialists and patients.

Additional identification

Further labeling is needed when x-rays are taken for these reasons:

  • Endodontics. Label final x-rays as such, especially if you keep test x-rays as part of patient records.
  • Pre-cementation. Note this when taking x-rays for crown and bridge procedures.
  • Duplicates. These are highly recommended and should be identified as such.

Radiation hygiene

Radiation hygiene affects the health and safety of the patient and staff. Professionally acceptable standards include the following:

  • Any examinations are conducted by a dentist, and x-rays are prescribed prior to being taken.
  • Proper processing and exposure techniques are employed.
  • X-rays are appropriate to patient status, per current FDA guidelines.
  • All x-ray equipment is inspected and certified according to state regulations.
  • Equipment certificates are current and equipment inspection dates are posted.
  • Lead (or equivalent) aprons and cervical collars are used on all patients.

Apron use

Anyone who is in the x-ray room at the time of exposure (and is not behind a protective barrier) must wear a protective apron of not less than 0.25-millimeter lead or its equivalent. (An apron of 0.5-millimeter lead is preferable.)

Although there’s been recent conversation about whether the use of lead aprons during x-rays is necessary, their use is still required by most states.

Today, there are multiple options available for protective aprons and thyroid collars.

  • You can choose those made with lead, lightweight lead or a lead equivalent (lead-free).
  • Lead-free aprons are lighter, making them more comfortable, and disposal is easier on the environment, too.
  • Most lead-free aprons and collars are rated at the lead equivalency of 0.30 millimeters, which satisfies state regulations. You can verify the lead equivalent thickness by checking the label on the hem of the apron.

Both lead and lead-free aprons require proper storage to prolong their life and effectiveness.

  • Aprons should be hung without creases to prevent cracking.
  • The surfaces can be cleaned with a strong detergent.

Quality of care standards

Professionally acceptable standards for x-rays include the following:

  • An adequate number of x-rays are taken to make an appropriate diagnosis and treatment plan, per current FDA guidelines.
  • Patient refusal of x-rays is noted.
  • Bitewings don’t overlap contacts or include cone cuts that affect diagnostic value.
  • Periapical films show apices of the teeth and surrounding bone.
  • X-rays are diagnostic quality, taken at appropriate intervals for assessing health and pathology.
  • X-rays have no artifacts, chemical stains or scratches.
  • X-rays have good contrast.
  • Hard copy X-rays are mounted, labeled and dated.

Outcomes of care

Acceptable outcomes are evaluated by reviewing your patient records for successful completion and effectiveness. X-rays may be reviewed in the following instance:

  • Operative/crown and bridge. Sufficient x-rays were taken to evaluate diagnosis and restorative treatment.
  • Endodontics. Signs, symptoms and radiographic evidence of need is provided. Rubber dam use is documented in notes and working x-rays. There’s final film evaluation to determine properly instrumented and filled canal or canals.
  • Periodontics. Follow-up x-rays are taken after periodontic treatment, and x-rays are available to review treatment decisions.
  • Oral surgery: X-ray or soft tissue exam supports treatment rendered.


By following these simple steps, you can help ensure that your x-rays are helpful, safe and meet state and federal standards.

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