In the United States, it is common to have dental X-rays as part of your regular checkup or when you have tooth pain. These X-rays use a small amount of ionizing radiation to take a picture of your teeth, bones and gums in order to show tooth decay, impacted teeth, bone loss, and other mouth problems. Since ionizing radiation exposure is known to increase the risk of certain kinds of cancer, scientists have recently studied whether dental X-rays increase your risk of brain tumors.
An article was just published in the peer-reviewed medical journal, Cancer. It reported the results of a large study that examined the association between dental X-rays and the risk of the most common type of brain tumor (meningioma). The study was headed by researcher Elizabeth Claus, M.D., Ph.D. at the Yale University School of Medicine, in collaboration with the University of California at San Francisco School of Medicine, Brigham and Women’s Hospital, University of Texas M.D. Anderson Cancer Center, and Duke University of Medicine.
Recent news coverage sensationalized the results of this study, possibly alarming people and dissuading them from having dental X-rays. So here are the basics of the report. This research was a case-control study that compared the histories of 1433 people who had a confirmed meningioma brain tumor (the “cases”) with 1350 people without a brain tumor (the “controls”) who were matched to have the same age, sex and state of residence as the brain tumor cases. All participants were 20 to 79 years old, lived in the United States, and were enrolled in the study between May 2006 and April 2011. Both groups were contacted by telephone and interviewed for about an hour. This phone interview included questions about the onset, frequency and type of dental care they had received over their lifetime.
The researchers were interested in three types of dental X-rays:
- Bitewings – a small X-ray view that shows the upper and lower back teeth simultaneously, where the patient bites down on a small holder filled with the X-ray film. Bitewings are frequently used during regular checkups to look for cavities.
- Full-mouth – a series of about 14-21 X-ray films that are used to view the entire mouth for dental problems, usually performed during a person’s first visit to the dentist.
- Panoramic – a single X-ray that shows a broad view of the entire mouth to provide information about the teeth, jawbones, sinuses, and other tissues of the head and neck. Panoramic X-rays are taken occasionally, often to evaluate wisdom teeth, using a machine that moves around the patient’s head.
This large case-control study showed that people with a brain tumor reported having dental X-rays significantly more frequently over their lifetime than the controls without a brain tumor. However, the differences were only significant for bitewing and panoramic type dental X-rays, and not for full-mouth X-rays which actually expose the mouth to a greater dose of radiation. This inconsistency demonstrates that further research is needed to prove any link between dental X-rays and brain tumors.
The biggest issue with this study is that participants were asked to recall their own history of dental X-rays throughout their lifetime, which makes the results less reliable. In particular, there is a fear of “recall bias” – the people with brain tumors may have been focusing on the potential causes of their cancer and therefore may have been more likely to recall dental X-rays than the control group, potentially biasing the results. Although more work, the researchers should have acquired the participants’ dental histories directly from medical records.
While this study does suggest that regular dental X-rays may be linked to an increased risk of developing a brain tumor, it does not prove an actual link. There could be other factors that contributed to this association. In order to establish a causal link, the researchers should consider performing a different kind of study that follows a group of people over time to see who develops a brain tumor.
More importantly, the recent sensationalized news headlines ignored the important fact that brain tumors are rare. Men and women in the United States have a 0.61% lifetime risk of being diagnosed with any type of primary malignant brain or central nervous system tumor, implying a 0.21% lifetime risk of developing meningioma. For instance, this is much smaller than the 12.2% lifetime risk of a woman developing breast cancer.
So this research study should not scare people away from having dental X-rays when recommended by their dentist. The American Dental Association recommends that dentists now evaluate the benefit of X-ray exposure for each patient, reducing the frequency of routine X-rays for healthy patients. In addition, dental X-rays now expose patients to less radiation than in the past.