Are We Taking Too Many Dental X-Rays? ADA Updates Imaging Guidance

Dental imaging has evolved rapidly over the past decade, with digital radiography, handheld units, and cone-beam computed tomography (CBCT) becoming increasingly accessible in everyday practice. While these technologies have strengthened diagnostic capabilities, they have also raised an important question for clinicians: when is imaging truly justified, and how much is too much?

An updated consensus statement from the American Dental Association (ADA) Council on Scientific Affairs, developed in collaboration with a multidisciplinary expert panel, addresses this very issue. The document serves as an update to the 2012 ADA–FDA recommendations on dental radiographic examinations and complements the 2024 ADA guidance on radiation safety.

What prompted the update

Since the original 2012 recommendations, dental imaging technology has advanced significantly, particularly with the wider availability of CBCT. Alongside these advances, concerns about cumulative radiation exposure — especially in children and young adults — have remained central.

Recognizing gaps in high-quality evidence, the ADA convened an expert panel of general dentists, pediatric dentists, public health experts, and oral and maxillofacial radiologists, supported by consultants from multiple dental specialties. Rather than issuing rigid clinical guidelines, the group developed consensus-based recommendations grounded in systematic reviews, existing guidelines, and expert clinical judgment.

Imaging should follow the examination — not precede it!

A key message running throughout the consensus statement is that radiographic imaging must always be justified by clinical findings. Patient medical and dental history, disease risk assessment, and clinical examination should come first. Previously obtained radiographs should be reviewed before prescribing new imaging, and duplicate examinations should be avoided.