Many aspects of providing quality dental care have become more challenging in recent years, and dental radiology — especially pediatric dental radiology — is no exception. Taking X-rays of children’s teeth is pivotal for evaluating dental development, monitoring any trauma that occurs and making a diagnosis in the case of disease. However, there are associated risks specific to this modality and population that are important for dentists to keep in mind.

Here are our risk management best practices for taking X-rays of children’s teeth.

1. Only take X-rays when needed to limit unnecessary radiation exposure.

One of the biggest concerns with dental X-rays is radiation exposure. Try to limit the number of images to the fewest needed to do your job, while keeping in mind that a misdiagnosis due to skimping on images can also expose you to liability. According to the University of Michigan School of Dentistry, the recommended frequency should be determined based on the patient’s needs, the clinical exam and the patient’s risk factors.

The frequency of pediatric dental X-rays depends on:

  • The age and stage of development of the child
  • Clinical findings and oral health
  • The child’s risk for periodontal disease
  • Potential signs of oral disease

Each visit, be sure to complete a thorough clinical examination and review the records from previous visits to know if your patient is due for an X-ray. Keep accurate and detailed records of all X-rays performed to limit exposing a child to unnecessary radiation.

2. Be familiar with the unique risks that radiation exposure poses to pediatric patients.

Radiation exposure poses extra risks for children because of the many years — and likely, many X-rays — ahead of them. After all, radiation risk increases with increased exposure. X-rays of teeth also means that the radiation will be near the child’s still-developing brain and heart, hence the importance of proper equipment and safety protocol.

According to Cedars Sinai, risks of radiation exposure due to taking X-rays of children include an increased risk of future cancer, although it’s worth noting that the radiation exposure of a standard X-ray is about equal to a few days of background environmental radiation that everyone is exposed to all the time.

The American Dental Association (ADA) has joined more than 80 health organizations in a movement called “Image Gently,” which is dedicated to educating providers and emphasizing the importance of safe pediatric imaging worldwide, particularly when it comes to adjusting radiation doses for children.

3. Find creative ways to keep pediatric patients still, even when they’re squirmy.

One of the best parts of working in pediatric dentistry is working with fun and energetic children, but they can also be squirmy, which definitely makes treatment more challenging. When it comes to X-rays, it is very important to find ways to keep children still. Given the longterm dangers of over-exposure to radiation, it’s best to try to avoid retaking X-rays because a child was wiggling.

If you experience a consistent lack of cooperation from the child, you must discuss these limitations with the patient or guardian and document these discussions in the patient record.

Here are ideas for treating a difficult pediatric patient during an X-ray:

  • Educate the parents or guardian on the importance of X-rays so they can prepare their child ahead of time. Remindchildren that X-rays don’t hurt and that they are needed to make sure their mouth is healthy!
  • Invite the parent or guardian into the room and communicate what you need. During the imaging, the guardian may be able to help coach the child to be still and relax.
  • Encourage parents to begin taking their children to a pediatric dentist at a young age. That way, the kids will become familiar with the dentist and feel more comfortable early on.
  • Kids love rewards and treats! Reward your patients with a prize after finishing the X-ray. It doesn’t have to be candy — small toys, fidget spinners or fun erasers can be just as motivating. This will reinforce positive behavior and help your pediatric patient be more inclined to accept and undergo treatment in the future.

4. Ensure your X-ray equipment is up to date and complies with New York State regulations.

Another important factor is your X-ray equipment. As a dentist taking X-rays of children’s teeth, it’s imperative to use equipment that is up to date, in compliance with state regulations and is the correct size for smaller patients.

Here are some best practices to follow that will allow you to both minimize your patient’s exposure and demonstrate good radiological practices to protect yourself from litigation:

  • Double check your film and equipment before starting to ensure you’re being efficient and don’t need to re-expose the pediatric patient due to faulty equipment or technique.
  • Always make sure your patients, regardless of age, are wearing protective gear such as lead aprons and thyroid collars.
  • Make sure the facility and equipment — including X-ray machine, radiation monitoring equipment and radiograph processing equipment— are regularly inspected per state ordinances.
  • Perform regular tests and maintenance to ensure that your equipment is working properly.

5. Be familiar with radiation safety requirements.

Keeping up with radiation safety requirements is key to protecting patients and avoiding potential liability. There are very specific regulations and laws regarding the use of radiation which may vary in each state. Here are a few key points about X-rays that the ADA recommends you keep in mind:

  • Permits — Ensure that your team and facility have the proper permits and licensing required to administer X-rays as required by New York State guidelines.
  • Importance of Dosimetry Badges — Make sure your office or facility uses dosimetry badges, which help detect and measure radiation levels and exposure.
  • Training and Certifications — Check that your clinical and non-clinical staff are up to date on all training and certifications in accordance with federal and New York State guidelines.
  • Radiation Shielding — Verify that your dental office has the proper design and radiation shielding needed to protect all staff and patients.
  • Record Keeping — Keep detailed records of all the X-rays you take. As with all record-keeping, this is the best way to protect yourself in the event of potential litigation.

Read more about federal regulation of radiation exposure.


It’s important to understand the risks associated with taking dental X-rays of pediatric patients. However, it’s equally important to understand the pivotal role you play in keeping your patients healthy and safe by following best practices and federal guidelines in your practice.

Dental professionals can stay up to date on the latest risk management guidance on the MLMIC Dental blog. Follow us on Twitter and LinkedIn to keep up with important news in the field of dentistry.

As always, we want to be a resource to you. If you ever have a question about X-rays or radiation exposure, MLMIC policyholders can contact a team of risk management professionals 24/7 at no additional cost by calling (844) MMS-LAW1 or emailing

Photo by Cottonbro Studio.