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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 121-125

Compliance of dentists with safety standards of dental radiology


1 Department of Oral Medicine and Radiology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
2 Department of Oral Medicine and Radiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission31-Jul-2017
Date of Acceptance01-Jun-2018
Date of Web Publication16-Jul-2018

Correspondence Address:
Dr. Devika Singh
Department of Oral Medicine and Radiology, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_63_16

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   Abstract 


Objectives: To carry out a survey among dentists to assess the awareness about radiation protection, attitude of the practitioner toward radiation protection, methods of radiation protection being used, and type of radiographic equipment being used in dental practice. Materials and Methods: A research was conducted among 1000 dentists who were using dental radiology. A review of literature of several articles related to the research was done. After analysis of these articles was done, a 33 question-long questionnaire was prepared. The questionnaire was then distributed among the dentists. The dentists were informed about the anonymous processing of the questionnaires. Once the questionnaires were completed, they were collected in person, the answers were tabulated, and were then sent for statistical analysis. Results: A total of 1394 dentists were approached for this study; however, only 1000 dentists returned our questionnaire. The overall correct knowledge of dentists regarding safety standards of dental radiology was found to be 29.9%. The overall correct attitude of dentists regarding safety standards of dental radiology was found to be 76.3%. The overall correct practice of dentists regarding safety standards of dental radiology was found to be 19.8%. Conclusion: On the basis of the result of the study conducted, we concluded that the dentists should be made aware about the adverse effects of radiation exposure, and as the overall compliance of the dentist is low, Continuing Dental Education programs should be conducted in order to educate dentists who are already using X-ray machines and to keep them updated with the latest technology.

Keywords: Atomic Energy Radiation Board regulations, quality assurance, radiation protection, survey


How to cite this article:
Singh D, Sinha A, Agarwal N, Srivastava S, Mishra A, Singh N. Compliance of dentists with safety standards of dental radiology. J Indian Acad Oral Med Radiol 2018;30:121-5

How to cite this URL:
Singh D, Sinha A, Agarwal N, Srivastava S, Mishra A, Singh N. Compliance of dentists with safety standards of dental radiology. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2021 Dec 2];30:121-5. Available from: https://www.jiaomr.in/text.asp?2018/30/2/121/236735




   Introduction Top


Oral radiography is the art of recording images of a patient's oral structures on film by using X-rays (Roentgen rays). The rays were recognition of Wilhelm Konrad Roentgen, a scientist, who first discovered X-ray in 1895. The first dental radiograph was taken the same year by Dr. Otto Walkoff. Within 10 years, radiographs were being used for diagnosis of medical and dental conditions, for X-ray therapy, and for scientific studies.[1]

Soon thereafter, it was observed that lengthy exposure to the X-ray beam resulted in burns, skin alterations, and hair loss. In 1898, Dr. William Rollins, a Harvard graduate and Boston dentist, received a severe burn on his arm while exposing his hand to the X-ray beam. This event stimulated his interest and research in radiation protection.[2] As a result, he recommended several precautions: wear leaded glasses, enclose the X-ray tube in a leaded housing, record only the area of interest, and shield the rest. In addition, he suggested filtration of the X-ray beam and developed rectangular collimation to restrict the size of the X-ray beam.[2]

The guidelines titled, “The Selection of Patients for X-Ray Examination” were first developed in 1987 by a panel of dental experts convened by the Center for Devices and Radiological Health of the U.S. Food and Drug Administration. Even though radiation exposure from dental radiographs is low, once a decision to obtain radiographs is made it is the dentist's responsibility to follow the As Low as Reasonably Achievable (ALARA) principle to minimize the patient's exposure.[3] Although widely accepted selection criteria are lacking, there is general agreement about the methods to reduce radiation dose. Despite this, numerous surveys have concluded that patients are subjected to unnecessary radiation exposure during dental radiography.[4]

The question remains, however, how much knowledge, of each section of the dental profession, the general dental practitioners still possess once they are qualified and working in the field. Although a dental professional should always be prepared to improve his or her knowledge through continuous education, it is a well-known fact that this is more likely to occur if the continued education is mandatory for all dental professionals, for whatever local or federal reasons.[4] Safety is not an end in itself but a prerequisite for the purpose of the protection of people in all States and of the environment—now and in the future.[5]

Through this study, we will try to evaluate the compliance of dentists in today's society with radiation safety.


   Materials and Methods Top


A questionnaire containing 33 questions was divided into the following four categories:

  • Demographic data
  • Knowledge of the dentists regarding dental radiology protection protocol
  • Attitude of the dentists toward dental radiology protection protocol
  • Methods of radiation protection adopted by the dentists.


All the dentists who were using dental radiology on a regular basis were given the questionnaire.

A research was conducted among 1000 dentists who were using dental radiology. A review of the literature of several articles related to the research was done. After analysis of these articles was done, a 33 question-long questionnaire was prepared. The questionnaire was prepared so as to judge the practitioners on the above-mentioned criteria. The questionnaire was then distributed among the dentists who were using dental radiology on a regular basis. The dentists were informed about the anonymous processing of the questionnaires.

The questionnaire was distributed in various cities where the distribution and collection of the questionnaire was feasible. The cities where this research was carried out were:

  • Delhi
  • Ghaziabad
  • Lucknow
  • Kolkata
  • Patna.


Once the questionnaires were completed, they were collected and the answers were tabulated. The answers were then sent for statistical analysis. Continuous data were summarized as mean ± standard deviation (SD), while discrete data (categorical) expressed in number and percentage. Overall knowledge, attitude, and practice (KAP) were evaluated based on the total correct/incorrect KAP.


   Results Top


The present study evaluates the compliance of dentists with safety standards related to dental radiology. For the present study, we tried to contact as many dental professionals as we could and sent out 1394 questionnaire; however, the response rate was 71.7% and 1000 dental professionals returned our questionnaire, which were further evaluated. The age of dentists ranged from 21 to 56 years. Among dentists, 276 were females (27.6%) and 724 were males (72.4%). Most of the dentists were BDS (78.0%). All dentists were associated to some dental professions of which 44.6% were associated to some dental institution, 46.0% were practitioners, 4.2% were associated to both some dental institution and practitioners, and 5.2% were in other dental professions such as diagnostic imaging center.

The duration of practice/professions of dentists ranged from 0.1 to 22.0 years. Of total, 991 dentists used X-ray machine in their practices (99.1%) and 158 had their X-ray machine Atomic Energy Radiation Board (AERB) approved (15.8%).

The age of X-ray machine and frequency of taking X-ray per day of dentists ranged from 0.2 to 20.0 years and 1.0 to 50.0 number [Table 1].
Table 1: Basic characteristics of dentists

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Outcome measure

Knowledge

The correct knowledge of dentist about if they know about all the radiation protection protocol, know about the AERB regulation for dental radiology, radiographic technique delivers more radiation to the patient, taking any periapical radiographs from a pregnant woman, the most important organ in radiation protection in dental radiography, shape of the tube head of intraoral radiographic equipment was poor-to-moderate ranging from 6.6 to 62.2%, with highest being of about the radiographic technique delivers more radiation to the patient, i.e., full mouth and least being of about the shape of the tube head of intraoral radiographic equipment, i.e., A rectangular.

The overall correct knowledge of dentists regarding safety standards of dental radiology was found to be 29.9% [Figure 1].
Figure 1: Distribution of overall knowledge of dentists regarding safety standards of dental radiology

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Attitude

The correct attitude of dentist about the X-rays can be taken for pregnant woman, X-rays should be AERB approved, X-ray equipment should be checked periodically for consistency and radiation safety, is it important to wear lead apron and thyroid collar for patient protection, is it important to stand behind a protective wall during shooting, and all radiation protection protocol should be followed was moderate-to-high and ranged from 37.4 to 95.4%, with highest being of about is it important to wear lead apron and thyroid collar for patient protection, i.e., Yes and least being of about can X-rays be taken for pregnant woman, i.e., No.

The overall correct attitude of dentists regarding safety standards of dental radiology was found to be 76.3% [Figure 2].
Figure 2: Distribution of overall attitude of dentists regarding safety standards of dental radiology

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Practice

The correct practice of dentist about the periodic check-up for your X-ray equipment, technique use for periapical radiography, use of film holder while taking radiograph, radiographic film/sensor positioned during exposure, film used for periapical radiography, stand behind a protective wall during exposure, no barrier between you and patient, in which area do you stand according to the X-ray tube and what is your distance from the patient, take other precautions to protect yourself from radiation during exposure, type of radiographic examination usually prescribed in the initial visit, follow the variation in exposure time, and follow all the radiation protection protocol was very poor ranging from 4.4 to 50.4%, with highest being of about type of radiographic examination usually prescribed in the initial visit, i.e., Selective periapical view and least being of about stand behind a protective wall during exposure and keep the variation in exposure time, i.e., Yes.

The overall correct practice of dentists regarding safety standards of dental radiology was found to be 19.8% [Figure 3].
Figure 3: Distribution of overall practice of dentists regarding safety standards of dental radiology

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   Discussion Top


The radiographic examination is one of the principal diagnostic methods used in all fields of medical services and contributes to the promotion of the health, both individually and nationally. Radiographic examination plays an essential part of dental practice.[6]

Radiation used in radiology has harmful effects on biological systems.[7],[8] They produce some damage that is beyond repair. Although all medical interventions have potential benefits, but its potential risks should not be ignored. The cancer risks that arise with radiation have been known.[8],[9] So occupational radiation protection is necessity whenever radiation is used in the practice of medicine. Occupational radiation protection measures are necessary for all individuals who work in the diagnostic imaging departments. This includes not only technologists and nurses but also individuals who may be in a radiation environment only occasionally.[10]

Radiation protection is the science and art of protecting people and the environment from the harmful effects of ionizing radiation.[11] It is also described as all activities directed toward minimizing radiation exposure of patients and personnel during X-ray exposure.

Keeping this in mind, in our present study, we have tried to evaluate how much knowledge dentists in different parts of the country have, what is their attitude toward the need for radiation protection, and how well are they utilizing their knowledge and attitude in order to protect all those who are constantly being exposed to radiation.

In the present study, the compliance of 1000 dentists with safety standards related to dental radiology was evaluated. Out of these 1000 dental professionals, 724 were males and 276 dental professionals were female. The age of the participants varied from 21 to 56 years, and 780 candidates had the qualification of a BDS, while 220 were MDS. 460 out of these 1000 dental professionals were practitioners; 446 dental professionals were associated with some dental institution; 42 of these dental professionals were practitioners and at the same time were associated with some college; and 52 belonged to other category such as diagnostic imaging center. Around 991 dental professionals used an X-ray machine in their practice. Only 158 dental professionals were using machines which are AERB approved. The number of X-rays taken per day ranged from 1 to 50, and the age of the X-ray machine used ranged from 0.2 to 20 years.

Knowledge

In the present study, it was noticed that the dental professionals had a very low level of knowledge regarding radiation protection protocol. The reason for such poor knowledge could be attributed to the fact that maybe the dental professionals are not getting enough education regarding the harmful effects of radiation and the importance of radiation protection at the institution level, and thereby emphasizing the need for more extensive education system and more educative programs should be conducted so as to instill more knowledge among dental professionals. Such low level of knowledge could be due to the following facts:

  1. Dentists are not regularly updated about the harmful effects and the radiation protection protocol
  2. Regular Continuing Dental Education programs are not conducted to educate the operator
  3. The setups are not evaluated by AERB regularly to check if all the protocols are being followed.


When the overall knowledge of the dentists about the radiation protection protocol was evaluated, 70.1% of the dentists did not have adequate and correct knowledge. This result was contradictory to the study conducted by Eze et al. (2013),[12] according to which 27% of the dentists did not have good knowledge about the radiation protection protocol but similar to the study conducted by Enabulele and Igbinedion (2013),[13] according to which 75.6% of the students thought they did not have adequate knowledge on radiation protection. Such low level of knowledge about radiation protection protocol among dentists can be explained by the fact that the participants included in this study were not just dental radiologists but dentists from the other specialties as well, and in India they are no programs for reinforcement of these protocols as compared to the study conducted by Eze et al. where only diagnostic centers were included in the survey and AERB rules are more strictly implicated and followed in diagnostic centers and educational institutes and not in private clinics. Training in radiation protection should be a continuous process even after graduation from dental school because studies have shown that substantial amount of knowledge is lost by 6–12 months following course attendance, and to achieve long-term knowledge retention, early or repeated reinforcement may be necessary.[14]

Attitude

In our study, we observed that the general attitude of most of the dentists regarding dental radiation protocol was mostly positive; 23.7% of the dentists did not have a good attitude about radiation protection protocol. In a similar study conducted by Arnout (2014),[15] the values ranged from 25 to 93.9%. This could be due to the fact that majority of the dentists know that the radiations while taking X-rays are harmful to the human body and as a dentist they feel obligated and need to protect themselves and those around them.

Practice

When questioned about the radiation protection protocol being followed by the dentists in their practice, the results were quite contrary to the attitude of the dentists toward the protection protocol regarding the patients, assistants, and including themselves.

When the overall radiation protection protocol followed by dentists was evaluated, maximum dentists failed to adopt measures to protect the patient, assistant, and the operator from the harmful effects of radiation, only 19.8% of the dentists showed good radiation protection practice. This result was contradictory to the study conducted by Enabulele and Igbinedion (2013),[13] according to which 64.1% of the dentist followed radiation protection protocol. Such low level of safety measures can be justified by the fact that as seen in our study, majority of the dentists have a very low level of knowledge about harmful effects of radiation and how to protect oneself from these harmful radiations. This result when compared to other studies shows such variation was due to the low level of education and awareness.

Considering the results of this study, it is important for all radiology departments to continue professional development by holding more workshops, short-term training courses, preparation and distribution of posters on the protection and safety against ionizing radiation in order to raise radiology departments staff knowledge and performance to include the most recent trends in radiation protection.[16]


   Conclusion Top


Dentists should conduct a clinical examination, consider the patient's oral and medical histories, as well as consider the patient's vulnerability to environmental factors that may affect oral health before conducting a radiographic examination. This information should guide the dentist in the determination of the type of imaging to be used, the frequency of its use, and the number of images to obtain. Radiographs should be taken only when there is an expectation that the diagnostic yield will affect patient care.[3]

Based on our results and on reviewed literature, it is recommended that:

  1. All centers working with ionizing radiation should ensure a strict adherence to radiation safety practices to protect radiographers, patients, and the public from harmful effects of ionizing radiation
  2. Periodic quality assurance tests should become mandatory in all diagnostic X-ray facilities in the country
  3. Because knowledge alone, though very important, cannot translate to adequate radiation protection, radiographers must, therefore, update their knowledge often to include the most current trends in radiation protection and then make more concerted efforts to follow existing radiation protection protocols in their daily work routine.[12]


Dental practice has its own way of radiation exposure. The practicing dentist differs from medical colleagues as he exposes, processes, and interprets the radiograph. Though the exposure is minimal, it is very important to reduce the radiation to avoid the accumulated dose to the dentist in their lifetime.[17]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Dental Technician, Volume 2 – Dentist training manual for military dentists. October 1999, Page 1-1.  Back to cited text no. 1
    
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Williamson GF. Radiation Biology, Safety and Protection for Today's Dental Team; Continuing Education Units. April 19 2012; 1-29.  Back to cited text no. 2
    
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Dental Radiographic Examinations. Recommendations for Patient Selection and Limiting Radiation Exposure; American Dental Association Council on Scientific Affairs. Revised: 2012; 1-27.  Back to cited text no. 3
    
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Kaushal V, Joshi CP, Passi K, Maria Das J, Aggarwal L, Kheruka S, et al. Occupational exposure to staff of a major radiological center-trend in radiation safety. J Med Phys 1990;15:141-3.  Back to cited text no. 9
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Mojiri M, Moghimbeigi A. Awareness and attitude of radiographers towards radiation protection. J Paramed Sci (JPS) 2011;2:1-5.  Back to cited text no. 10
    
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Eze CU, Abonyi LC, Njoku J, Irurhe NK, Olowu O. Assessment of radiation protection practices among radiographers in Lagos, Nigeria. Niger Med J 2013;54:386-91.  Back to cited text no. 12
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Enabulele JE, Igbinedion BO. An assessment of dental students' knowledge of radiation protection and practice. J Educ Ethics Dent 2013;3:54-9.  Back to cited text no. 13
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Absi EG, Drage NA, Thomas HS, Newcombe RG, Cowpe J. Continuing dental education in radiation protection: Knowledge retention following a postgraduate course. Eur J Dent Educ 2011;15:189-92.  Back to cited text no. 14
    
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Arnout E. Knowledge, attitude and perception among Egyptian dental undergraduates, interns and postgraduate regard biological hazards and radiologic protection techniques: A questionnaire based cross-sectional study. Life Sci J 2014;11:9-16.  Back to cited text no. 15
    
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Ahmed RM, Elamin AMT, Elsamani M, Hassan WB. Knowledge and performance of radiographers towards radiation protection, Taif, Saudi Arabia; IOSR J Dental Med Sci (IOSR-JDMS) 2015;14:63-8.  Back to cited text no. 16
    
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Praveen BN, Shubhasini AR, Bhanushree R, Sumsum PS, Sushma CN. Radiation in dental practice: Awareness, protection and recommendations. J Contemp Dent Pract 2013;14:143-8.  Back to cited text no. 17
    


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