and Lee et al.
reported that most people
are uninformed about the hazards of radiation before
medical imaging. This may be due to either the lack
of an explanation or poor information retention and
it does not explicitly imply that the information on
radiography was not being provided. Reassuringly
however, parents who believed the risks were
explained to them also agreed that the beneﬁts of the
radiographs outweig h the risks (p = 0.007).
There are several methods to eff ectively communi-
cate radiation risk and address parents’ concerns. One
such method is to compare radiation exposure from
radiographic procedures with the background equiva-
lent rad iation time.
Given that natural background
radiation in Australia is 2 mSv annually, routine non-
digital bitewing radiographs give an effective dose of
0.002 mSv which is equivalent to 8.8 hours of radia-
tion exposure from nature.
include comparison with typical doses from air travel,
doses from other medical imaging procedures such as
a chest radiograph or by comparison with safety levels
prescribed for occupational exposures.
The above methods provide a comparison only and
they do not reﬂect radiation risk per se. However,
these risks are theoretic; epidemiological research has
been unable to establish that there are effects of statis-
tical signiﬁcance at doses below a few tens of millisie-
Dentists need to assure patients that they are
committed to obtaining excellent clinical results with
the lowest possible radiation risk, and that the poten-
tial beneﬁts of modern medical imaging procedur es
almost always far outweigh the associated risks.
With regards to parental knowledge of radiography,
many parents were uns ure of the answers (44%), with
a much lower percentage of respondents answering
questions incorrectly (16%). This suggests a lack of
provision of information rather than misinformation
about dental radiography. Ludwig and Turner found
similar ﬁndings and they concluded that while the
public understand the harmful effects from the sun,
knowledge on the effects of radiation from medical
testing is very limited.
Baumann et al.
also found that with regards to CT scans,
knowledge of radiation exposure and risks was
Over half of the respondents (58.6%) knew that
‘exposure from a dental X-ray is too small to put their
child at any signiﬁcant harm’. This is closely compara-
ble to Ludwig and Turner’s ﬁndings that 63% of
responders seldom or never worried about radiation
exposure when having imaging procedures,
Busey’s et al. ﬁndings whereby 98% of respondents
were not worried about the radiation from a CT scan.
The limitations of this study were primarily con-
cerned with the population sampling method and the
low response rate. As the schools were chosen for
convenience from the Perth metropolitan area, the
sample is not an accurate representation of the general
population. A reasonable proportion of the Western
Australian population reside in rural and remote
and this population was not sampled. There
was also a skewed distribution of socioeconomic sta-
tus within the study due to the sampling method and
this made correlation of this variable unreliable. Fur-
thermore, over half the respondents were university
educated and approximately 60% had experience of
dental radiographs. This skewed demographic may
have affected the results and therefore the relatively
positive attitudes towards dental radiographs found in
this population may not extend to the general popula-
tion. The low response rate may have been improved
if direct communication was made with the parents
(e.g. an anno uncement made at an assembly) and fol-
low-up reminders had been placed in newsletters. It is
unknown how many children were giving their par-
ents the newsletter or how many parents read the
Furthermore, it would be useful for further research
to investigate parents’ sources of knowledge, or what
parents believe the risks are as these were not investi-
gated in this study. It is also unknown whether par-
ents are aware of the varying radiation exposure from
different types of images.
In conclusion, most parents had a positive attitude
towards dental radiographs although they had limited
knowledge about radiography. This study emphasizes
the importance of providing accurate and appropriate
information so patients and parents have a better
knowledge and understanding of dental radiographs.
It is imperative for den tal health professionals to
understand their role in shaping positive attitudes
towards dental radiographs.
The authors acknowledge Drs Alana Ang, Anabel
Chan, Damini Chawla, Khaled Chiri and Millicent
Taylor for their input in fabricating the questionnaire
and collecting the data, and Dr Lara Andrews for her
contribution towards the introduction. We would also
like to acknowledge Dr Bernard Koong and Dr Peter
Readman for their valuable contributions towards
reviewing the appropriateness of the questionnaire,
and the Perth metropolitan primary schools that par-
ticipated in this study on a voluntary basis.
1. Abbott P. Are dental radiographs safe? Aust Dent J 2000;
2. Turpin D. British Orthodontic Society revises guidelines for clini-
cal radiography. Am J Orthod Dentofacial Orthop 2008;1:1–2.
168 © 2013 Australian Dental Association
R Chiri et al.