Clinical considerations and potential liability associated with the use of ionizing radiation in orthodontics

Ionizing radiation is a known carcinogen. Its damaging effects can be deterministic or stochastic. Deterministic effects occur only after radiation exposure thresholds are reached, but stochastic effects are random, and there is no known threshold below which harmful effects will not occur. Therefore, the use of ionizing radiation in orthodontic treatment should bring a benefit to the patient that outweighs the risks. No legally binding statutes, rules, or regulations provide explicit radiographic prescription protocols for orthodontic practice. The objective of this article was to discuss guidelines and risk management strategies for appropriate and defensible use of ionizing radiation in orthodontics. Guidelines are discussed for radiographic acquisition at different points along the orthodontic treatment timeline. In addition, risk management strategies and best practices are presented regarding adequate and defensible radiographic interpretation. These guidelines are not rigid and do not establish standards of care; they should be modified as necessary for each patient and each clinical encounter.