Updated March 1, 2024:
Health Canada’s Safety Code 30 (Radiation Protection in Dentistry – Recommended Safety Procedures for the Use of Dental X-Ray Equipment – Safety Code 30 (2022)) now states that lead aprons are not required during routine dental x-rays, with the exception of CBCT procedures.
We should stop using lead aprons. That’s what the American Academy of Oral and Maxillofacial Radiology published in the Journal of the American Dental Association on August 1, 2023, as evidence-based practice guidelines.1
We were trained to place lead aprons to protect the thyroid, breasts, gonads and fetus. The Academy created a committee that reviewed monographs, reports and studies, and found negligible radiation to these structures and reported no radiation-induced heritable effects in humans. They advised discontinuing the use of lead aprons during dentofacial imaging in all patients including children and pregnant women. This recommendation is supported by many national and international health care organizations.
When I read this, I thought, “How am I going to stop using lead aprons when patients expect it?” To figure out what I should do, I contacted my provincial regulator and dental association. My regulator advised me to contact the provincial Ministry of Health’s X-Ray Inspection Service (XRIS) and my dental association stated they already contacted them and sent me their response.
XRIS stated that under the Healing Arts Radiation Protection (HARP) Act2, the Radiation Protection Officer of a dental office (a dentist) must ensure that lead aprons are available for use. The HARP Act does not state clinical matters such as when lead aprons should be used as it is up to the dentist to make this decision. XRIS also referred to Health Canada’s recommendations for using dental x-ray equipment.3 They recommend using lead aprons; however, the recommendations are not enforced under the HARP Act. It is also important to note that the HARP Act and Health Canada’s recommendations were created before the Academy’s evidence-based article was published.
As lead aprons do not protect against internal scatter radiation and are unnecessary, I want to stop using them. The downside of using lead aprons is the cost, cross contamination, hair getting stuck to the adhesive tabs, time to place them and disinfect them, and the artifacts and obstruction of the image that may occur from their use. However, until the public is aware of the lack of protection lead aprons provide, I will continue using them.
The way to minimize radiation effects is to decrease the patient dose by: taking the lowest number of radiographs to make a diagnosis, using digital radiography, taking accurate images, optimizing exposure settings, using rectangular collimation and limiting the radiation field to the region of interest. Using lead aprons does not minimize radiation effects.
I recommend that Health Canada and the HARP Act update their documents and that the public is made aware that lead aprons don’t work. Then, we can retire our lead aprons.
References
- Benevides, E., Bhula, A., Gohel, A., Lurie, A., Mallya, S., Ramesh, A., & Tyndall, D. (2023, August 1). Patient shielding during dentomaxillofacial radiography. Journal of the American Dental Association. https://jada.ada.org/article/S0002-8177(23)00391-4/fulltext
- Ministry of Health. (2018, November 19). Healing Arts Radiation Protection Act. Ontario.ca. https://www.ontario.ca/laws/statute/90h08.
- Canada, H. (2022, June 30). Radiation Protection in Dentistry. Radiation Protection in Dentistry Safety Procedures for the Installation, Use and Control of Dental X-ray Equipment Safety Code 30 (2022) – Canada.ca. https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/radiation/radiation-protection-dentistry-recommended-safety-procedures-use-dental-equipment-safety-code-30.html
About the Authors:
Dr. Sanjukta Mohanta is a general dentist who graduated from the University of Toronto in 1999. She practices in Brampton, Ontario. She can be reached by email: sanjuktamohanta@hotmail.com
