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Letters: Call for caution

August 20, 2012

Ever since the publication of Claus et al. (2012) in Cancer to report data suggestive of an increased incidence of meningioma associated with dental X-rays, there has been much attention in the public media about potential risks with exposure to ionizing radiation in the dental office. A number of letters in dental publications have strongly criticized the study and the reaction to it, most recently in letters in ADA News (May 21 and June 18).

While I agree that this study was based on a methodology that may be associated with considerable error (i.e., X-ray history based on patient self-reports) and included large confidence intervals, I am troubled by the apparent ease with which this study has been so summarily dismissed. There is no question of potential methodological issues, and there are no perfect datasets, but I find it difficult to accept that the methodological error was sufficiently skewed in the patient group vs. control to account completely for the observed differences. It seems more likely that the error term was fairly balanced between the groups, suggesting that at least some of the difference may be real.

I agree that more robust data are needed, but prudence in the interest of patient health dictates that the dental profession recognizes that this study has generated a hypothesis of considerable clinical concern. Further studies to test this hypothesis are in order. Caution is needed, and substantial efforts are needed to reduce dental exposure to ionizing radiation as much as possible consistent with good dental health.

Richard D. Finkelman,
D.D.S., Ph.D.
Kennett Square, Pa.