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MyView: Headlines on dental radiographs

June 18, 2012

By Matthew J. Messina, D.D.S.

I spent most of a week in April dealing with the media fallout from the release of the Yale University study on dental radiographs and brain tumors. As a result of the extensive media coverage, we all will be explaining things to our patients for quite a while. My task as an ADA spokesperson is to put a story like this in perspective.

How common are the brain tumors? (Six per 100,000.) How did the researchers find a link between dental X-rays and brain tumors? (They asked people with brain tumors to remember how many X-rays they had over their lifetime.) Is there a problem with this type of study? (Yes, it’s called "recall bias.") Are dental X-rays now different than before? (Yes, the amount of radiation in current dental radiography is dramatically less than in years past.) What should patients do with this information? (Talk to their dentist about any concerns so that their dentist can give them accurate information and reassure them.)

The newspaper story as printed in the April 12 issue of the Cleveland Plain Dealer is about as good a result as we can get in a story like this. I spent 30 minutes with the reporter discussing the scientific study and its flaws. We also talked about the diagnostic value of radiographs and the risk to the patient of undiagnosed dental disease. I helped her to understand the ALARA (as low as reasonably achievable) principle in radiographic technique and how safe and low in radiation modern dental X-rays are.

The reporter listened to my arguments and used the information that I had provided. Her story included much of our message. Her article was balanced and accurate. It was not a press release, and certainly not a paid placement (infomercial), where we are able to control the entire message. As a spokesperson, I can only talk to the public through the filter of the reporter. We successfully got our message across. Unfortunately, it was on page A-4.

The story was above the fold on the front page of the Plain Dealer. The headline was "Dental X-rays Linked to Brain Tumors in Yale Study." Like a courtroom trial, the prosecution went first. Page 1 included the first six paragraphs of the article. Our defense was well presented, but after the "jump" to page A-4. It required that a person be committed enough to understanding the story to be willing to actually open the paper and read the article to the end. And that is one of the problems that we will always face as a profession.

Our answers to questions are rooted in the science. They are long and complex. Well-intentioned, but sterile and rather boring. Our opponent’s answers are short, and often emotional. "Dental radiographs are safe and effective as a diagnostic tool to allow the dentist to truly see what is going on in your mouth. They are valuable to identify decay, periodontal disease, and other pathology, as well as to monitor proper growth and development." vs. "Dental X-rays cause brain tumors."

Our real challenge is not even in countering the statements of our opponents. We face stiff competition for the time and attention of the public. The Internet gives us access to unlimited information. But it also permits skimming the surface rather than deeper study of complex topics.

Most people will read the headlines on Yahoo News or Google search results, without clicking to look deeper into the story. Network television and cable news have conditioned us to expect answers in nine-second sound bites.

How can we have a meaningful discussion if no one is willing to ask questions? Is there a level of critical thinking still evident in the country?

While I have concerns that as a society we are too willing to skim the surface of the information available to us, I am encouraged that as individuals we are willing to ask questions when things relate to us. Patients will ask about X-rays when it directly involves their health. This will create teachable moments for us in our offices. We just need to be ready.

If we ask our patients to be willing to ask the questions; to turn to page A-4, then we owe it to them to have answers, and to be willing to take the time to care and to explain. Today’s dental office is much more than a building where tooth dust is made. It needs to be a place of learning. Only then can we get past the headlines, and on to, as Paul Harvey would say ... the rest of the story!

Dr. Messina is the executive editor of ODA Today, the publication of the Ohio Dental Association and an ADA consumer adviser. His comments, reprinted here with permission, originally appeared in the May issue of that publication.