Becoming More Like Medicine: Study Suggests Frequent Dental X-rays Increase Risk of Meningioma

photo by jparadisi

In recent years, I’ve had problems with dentists. Okay, it’s more like I have arguments with my dentist, who thinks I am the problem. We argue about the frequency of dental X-rays. I have maintained there is no reason to take bitewing X-rays every six months, and possibly ever, unless indicated by pain or symptoms.  Bolstering my side of the debate, I remind the dentist that I am a cancer survivor and yet, my doctor does not send me in for an X-ray when I develop a cough. In fact, I haven’t had a chest X-ray since my cancer diagnosis, and that was over a decade ago. Why do I need dental X-rays every six months?

With an exaggerated expression of patience, as if speaking to a difficult child, the dentist explains, “Dentistry is not like medicine. We do things differently.”

“Differently, as in you don’t use research to develop clinical standards?” I ask.

Next thing you know, I’m sitting through a very uncomfortable dental cleaning. What’s the name of that comedian who does the bit about dentists? He starts with,

“I go to the dentist, and he asks me if my gums bleed at home. I tell him no, but I don’t stick steak knives in my mouth at home either.”

 

I bring this up because the American Journal of Nursing published an article by Carol Potera, Older Dental X-rays Linked to Meningioma.

According to the article, adult patients diagnosed with meningiomas are nearly twice as likely to have had bitewing X-rays yearly, or even more frequently, than adults who are tumor free.”

It goes on to say that modern dental X-rays

“use much lower doses of radiation than those received by participants in this study,”

however, the study authors write:

“Efforts to moderate exposure to (ionizing radiation) to the head (are) likely to be of benefit to patients and health care providers alike.”

Finally, according to the article,

The American Dental Association, in its latest guidelines, asked dentists to weigh the risks and benefits associated with the use of dental X-rays at preset intervals.

Intuitively, I’ve known for a long time that frequent, routine dental X-rays are not a good idea. Now there is research to prove it.

The Woman from Human Resources is Right About This

An Unexpected Discovery photo: JParadisi 2009

     A friend of mine told me about his experience a few weeks ago at a dental appointment. He arrived on time for a scheduled cleaning with his hygienist. After waiting five minutes, the hygienist came to the door of the waiting room. My friend stood up to follow her, but the hygienist called the name of a woman sitting across the room instead. My friend sat back down. Puzzled, he assumed the hygienist would return for him shortly.  My friend works in health care. The doctor’s office he works for sometimes runs late, and patients wait. He figured it was Karma.  After staring mindlessly at the pages of a six month old tabloid magazine, he checked his cellphone for messages and noticed  half an hour had passed. He requested a day off from work for this weekday appointment. Anticipating it to last an hour he scheduled other appointments and mundane errands after the routine dental cleaning. He wasn’t going to finish his errands that day.     

     Finally, a dental technician called his name. Once he was in the exam chair, the technician told him the appointment changed. He was rescheduled for an exam with the dentist instead of the hygienist. The technician readied to take a full mouth of x-rays.  My friend asked about the cleaning  he  scheduled the appointment for, and the tech told him not to worry about it.  He told the tech that  he only had time for a teeth cleaning, and this was his priority for the appointment. Could he reschedule the exam with the dentist for a later date? Annoyance reverberated throughout the dental office like an earthquake measuring 8.8 on the Richter scale. Eventually his teeth were cleaned. The appointment lasted two hours. My friend left puzzled by the entire scenario. Weeks before this appointment, the office called him twice with reminders that he needed to call within 24 hours to avoid an office charge if he wasn’t there.  Why was his appointment changed without his permission, my friend asked?  Why wasn’t he at least informed a change was necessary with one of those phone calls?     

     There are lessons to extrapolate from my friend’s story into my nursing practice.  Occasionally my patients wait beyond their scheduled appointment times too.  Events occur or sometimes patients are late, causing unexpected delays. More intriguing is the chasm between the expectations of my friend and his dentist, leading to an unhappy encounter for each. I imagine that the dentist and my friend both felt disrespected.     

     How many times do patients say, “I didn’t realize this was going to take so long”? Immediately, we have different expectations for the appointment. I don’t remember any patient expecting a different treatment than the one I expected to administer though.     

     The story reminds me of how important communication is when managing expectations for both the patient and the care provider.  Unexpected changes without explanation during a medical (or dental) appointment are rarely appreciated.  The Human Resources woman is right about this:  managing expectations is an important factor in customer service and satisfaction.