Introduction

Radiographic selection criteria guidelines were developed to assist the dentist in making informed decisions about diagnostic imaging for patients under their care. Since the 1980’s, several iterations of selection criteria guidelines have been issued. The guidelines were originally developed in 1987 by a panel of dental experts and the U.S. Food and Drug Administration (FDA) with subsequent updates by the American Dental Association (ADA) and the FDA in 2004 and 2012.^3,5,6 The most recent documents, Optimizing Radiation Safety in Dentistry: Clinical Recommendations and Regulatory Considerations, and American Dental Association and American Academy of Oral and Maxillofacial Radiology Patient Selection for Dental Radiography and Cone-beam Computed Tomography will be the focus of the forgoing discussion.^1,2

These publications are meant to be utilized in tandem to update the 2012 guidelines relative to radiation safety, imaging practices, exposure reduction measures, and regulatory requirements as well as to provide evidence-based decision-making guidance including clinical indicators for patient selection, the timing and frequency of diagnostic imaging, and the use of relevant imaging modalities for general and pediatric dental care practitioners.^1,2Limitations in the available evidence resulted in consensus recommendations rather than formal guidelines and are subject to new evidence that becomes available through further research or evidence-based review.¹

The discussion of the updates to the 2012 guidelines will begin with the regulatory requirements, radiation safety measures, radiation dose reduction measures, and imaging practices that inform and support diagnostic imaging. Subsequent to that foundation, the current evidence-based decision-making recommendations will be presented including clinical indicators for patient selection, the timing and frequency of diagnostic imaging, and the use of relevant imaging modalities including 2D and 3D imaging methods.¹The general framework for 2D imaging recommendations includes the following categories: type of encounter (new or recall), patient age designation (child, adolescent, adult), stage of dental development (primary, transitional, permanent dentitions and partially/completely edentulous), and vulnerability to risk factors (caries, periodontal disease). Recommendations for 3D imaging are addressed by using Specific Clinical Indicators that provide imaging guidance in particular clinical circumstances. The general framework of the guidelines includes these major categories:

• type of encounter - new or recall

• patient age designation – child, adolescent, adult

• stage of dental development – primary, transitional, permanent dentitions and partially/completely edentulous

• vulnerability to risk factors – caries, periodontal disease