How often do you really need dental xrays? How to decline them?
September 13, 2016 3:57 PM   Subscribe

How often do you really need to get teeth x-rayed? How can I stop the dentist from talking down to me about this when I don't want them?

I read an article in the economist and an article in the NYT that said dental xrays are overused. I get my teeth cleaned every six months, and each time the dentist tries to convince me to get xrays done. The articles recommend xrays for a healthy adult at once every 2 years.

How can I decline this more effectively? I've been to 3 different dentists in the last 6 years, and all of them get really annoyed when I don't want xrays. It's expensive because my insurance doesn't fully cover it and I don't want the extra radiation. I think they want to prescribe them because they make extra money off them versus just a cleaning for a person with no cavities.

I am so annoyed about dentists lecturing me and berating me when I can't talk back because their hands are literally in my mouth. Please halp.
posted by hyperion to Health & Fitness (27 answers total) 3 users marked this as a favorite
Honestly, you need a new dentist. Do you have Yelp or similar in your area?

But the trick to refusing unwanted medical/dental care is to repeat, "I'm afraid that's out of my budget. I've been getting the x-rays roughly every two years, because that's all I can afford."
posted by schroedingersgirl at 4:07 PM on September 13, 2016 [6 favorites]

Do you use the same dentist each time? Mine only does x-rays once a year, although I bet that coincides with how frequent my insurance will pay. I've only ever had one more frequent x-ray on one specific tooth they were concerned about.
posted by TheAdamist at 4:07 PM on September 13, 2016 [3 favorites]

Get a new dentist and ask specifically about their X-ray timing philosophy and general approach to filling and drilling before you book an appointment.
I get yearly X-rays, and as I have a very non-interventionist dentist, it probably saves me money in the long run: After several years of documenting my teeth, they know that there are points of interest that need monitoring, but as those points haven't worsened at all over the course of 5 years, they haven't had to do any new drilling whatsoever.
posted by Cold Lurkey at 4:14 PM on September 13, 2016

Every dentist I've gone to always asks me to get them and I always say, "I'll do them next time." That usually works. When they press and say they need them, I'll just say, "No, I'm going to decline today." If they try to tell me it's low radiation, I'll say, "Sorry, I don't want to do them today." And I just keep saying that. If years have passed and it's time to get them done, sure, I'll do them, but they seriously want to do it way more often than is necessary.
posted by AspirinPill at 4:26 PM on September 13, 2016 [10 favorites]

Agree that you just need to keep looking for a new dentist. Mine does X-rays every 1-2 years depending on my individual situation and how things have been going.
posted by FireFountain at 4:28 PM on September 13, 2016

Step 1 is find a dentist who you like and get along with who discusses your dental care options while your mouth is unoccupied, first of all

But, when is the last time you had x-rays? It's not really clear if you have had any within the six year period you mentioned, and most dentists probably will give you some hey, you actually do need x-rays once in a while pushback
posted by prize bull octorok at 4:30 PM on September 13, 2016 [5 favorites]

The frequency of X-rays isn't one-size fits all. If you never have cavities, once every two years is fine. If you're prone to them or have problematic areas, once every 6 month visit could be appropriate.

It's unclear when you last had a dental X-ray... your 3 doctors over 6 years comment could be interpreted as you avoiding X-rays for more than 6 years. If that's the case, finding a new doctor isn't going to help as ANY competent dentist is going to tell you that you need them.

I would try to find a dentist whose personal style is compatible with yours. And trust that they know more about the practice of dentistry than you do...
posted by danny the boy at 4:51 PM on September 13, 2016 [6 favorites]

"I only want my xrays done every 24 months, because my insurance doesn't fully cover them. Please make that note in my files."

If your dentist responds in any way except "OK!" then you do need to find another dentist.
posted by raisingsand at 4:52 PM on September 13, 2016 [4 favorites]

I don't know if there are any dentists still using film X-rays, but my dentist uses digital X-rays and the dosage is supposed to be 40-60% less than film X-rays.
So, find a dentist using digital X-rays (and tell him you want X-rays only every 2 years).
posted by H21 at 4:52 PM on September 13, 2016 [4 favorites]

Do you get your previous x-rays sent to the new dentist? That's really the only time I've been pressed (new dentist without have any of my old records), and even then it wasn't serious pressure, just an additional comment from the hygienist that the dentist likes to have them, so if possible have them sent over before my next annual appointment. Dentist didn't lecture me at all. Maybe you've had a bad run? Ask friends for their recommendations if yelp hasn't helped you in your search.
posted by ghost phoneme at 4:57 PM on September 13, 2016

Once every 12-24 months sounds right for X-rays. However every time you switch dentists they are going to want new X-rays right away and *then* every couple of years. In the last 6 years I would expect you to have 3 sets of X-rays taken but given the switching it could easily be 6 times.
posted by saradarlin at 4:57 PM on September 13, 2016 [5 favorites]

Right -- it's partly the switching. If you can get them to send over X-rays to your new dentist, you might get less push.
posted by chesty_a_arthur at 5:11 PM on September 13, 2016 [2 favorites]

My mother has been a dental assistant and now an office manager for 30+ years. She said:

Full mouth series should be done every five years. Bite wings (four of them) and two front teeth should be done yearly. That's the standard of care.

I know from personal experience that in order to get my preferences acknowledged or needs met, I need to remind them every time (and because my mom's office is where I go, she also reminds anyone who works on me). Things I say no to: polish and fluoride treatment during cleanings and inexperienced techs doing bitewings and panos (I have a small mouth and TMJ). I also take about 2-3x more novocaine than most people to get numb.

I also know that my teeth will get cavities even with flawless oral hygiene, so I get more frequent cleanings and x-rays.

The bottom line is that good dentists/assistants listen to their patients and work with their insurance to make the most of their policy. If you don't feel like yours is listening, find another one. Most dentists will ask you to do x-rays on your first visit to the practice, unless they can get current x-rays from another provider. They should be able to get them in advance of your appointment if you ask ahead of time.
posted by guster4lovers at 5:23 PM on September 13, 2016 [1 favorite]

Get up out of the chair and walk out. You're not strapped down. Just leave. It's the only thing that works--and hoo boy, does it work.
posted by Violet Hour at 5:34 PM on September 13, 2016 [4 favorites]

guster4lovers has it exactly WRT x-ray frequencies. Your plan description should clearly state someplace how frequently it will pay for x-rays of all types. If you can't find this information, call your insurance company's member service line or check their member website.

A lot of this can depend on what type of plan you have and whether or not your dentist is in your network. Let's assume it's a dentist in a DPPO network, which is a very common setup. If so, your dentist has contractually agreed to provide treatment within the guidelines of your plan. If they're not doing that and are pushing you to accept treatment outside of what's covered by your plan, consider making a complaint to your insurance company. If their contractual agreements and provider relations staff have any teeth, that shit will stop right quick. This goes double for a dentist in a DHMO network.

Really, though, you should probably find a new dentist. Your insurance company's member website or service line should help you find someone in-network that's close to your work or home, and what their hours are. Good luck!
posted by Orange Dinosaur Slide at 6:08 PM on September 13, 2016

I'm not sure where you are, but if in the US, I'd be suspicious of the term "standard of care." The American Dental Association has an in-depth PDF on dental x-rays, taking many factors into consideration, but they make the following statement: "the recommendations are intended to serve as a resource for the practitioner and are not intended to be standards of care, nor requirements or regulations." So I don't know where the supposed "standard of care" is coming from - it's not from the ADA. You can get to the PDF from here.

I just changed dentists, by the way, partly because the hygienist couldn't come up with anything better than "standard of care," which to me is just saying you need them because you need them (and my dentist was moving toward semi-retirement, so he was never actually there on days I got my teeth cleaned - otherwise, I would have been happy to discuss it with him).
posted by FencingGal at 6:57 PM on September 13, 2016 [3 favorites]

I have told my dentist that unless there is a situation or visible indication that indicates otherwise, I only want x-rays every three years. Not only has he been compliant, he agrees that every year, at least for someone whose dental situation has been consistently stable, is unnecessary.
posted by elf27 at 7:22 PM on September 13, 2016

The FDA's recommendation is for X-Rays ("posterior bitewings") every 6 to 18 months in adults with teeth who have had cavities in the past, as well as X-Rays on a first visit.
Adults who exhibit clinical dental caries or who have other increased risk factors should be monitored carefully for any new or recurrent lesions that are detectable only by radiographic examination. The frequency of radiographic recall should be determined on the basis of caries risk assessment.15,59,60 It should be noted that a patient’s risk status can change over time and that an individual’s radiographic recall interval may need to be changed accordingly. 61 Therefore, a posterior bitewing examination is recommended at 6 to 18 month intervals.
posted by the antecedent of that pronoun at 8:12 PM on September 13, 2016 [1 favorite]

If you're a woman and tell them you think you might be pregnant, they'll drop it like it's hot.
posted by Eyebrows McGee at 11:39 PM on September 13, 2016

You can avoid saying yes or no by asking them to note in your chart that you will be getting x-rays every 24 months starting on X date. This is how I tend to avoid discussions about whether or not I should have undercarriage protection with various providers of services. Or you can ask for a note in the file that says you require cleanings only.

I don't know why you'd need an x-ray if you have never had a cavity first. I would decline them also. I don't think you should point to money unless you want to--it doesn't sound like money is really the reason. It might be part of the reason, but it sounds like mostly you don't want to pay unnecessary medical charges for something with its own dangers.

That's how you get out of the annoying discussion. But you need a better dental office overall so look for a 'positive environment'.
posted by A Terrible Llama at 3:43 AM on September 14, 2016

Response by poster: To clarify - I've been getting them every 6 - 12 months for the past 6 years. In that period of time I've had 1 cavity. My changes in dentists have been partly due to insurance changes and partly due to their annoyances with me when I ask about not getting x-rayed.
posted by hyperion at 4:54 AM on September 14, 2016

Unfortunately dentists don't tend to share old dental records with new dentists so if you are regularly changing dentists it's fair to assume s new dentist would like to see current X-ray to know what they are dealing with. That said if you stick with one good dentist you shouldn't need them more than once a year or two unless there's some unknown issue that requires X-ray. I have implants & multiple bad teeth/deep fillings and see the same specialist every 6mths & he takes X-rays maybe every 2years to check on bone movement etc, and I would assume I am a higher risk/higher frequency X-ray patient, I guess every individual & set of teeth are different though. Definitely seconding the above suggestion if you are female you can always say you may be pregnant and that will end any discussion of X-rays immediately!!
posted by Under the Sea at 6:08 AM on September 14, 2016 [1 favorite]

Anecdata: I get mine done every 24 months (per a guideline I found online when I was researching this -- which of course I can't find now, but given my dental situation, that's in line with this guidance from the ADA). My dentist used to try to do them every 12 months and I always fought it. Finally I asked her -- "I haven't had a cavity for over a decade; why do you need to do this every year?" and she said "Because that's what your insurance will pay for."

Yeah. No. Now I get them every 24 months. If I get push back I explain that I'm concerned about the radiation dose and I don't have significant cavity problems, so I'm not doing them more often than that.
posted by pie ninja at 6:09 AM on September 14, 2016

Fyi, the digital x-rays most dentists use these days have up to 60% less radiation than the old kind. They are very low risk. (Also, I am very much for self-advocacy, and I get mistrust of dentists, but asking them to not rely on x-rays is asking for treatment based on 19th century evaluation methods. Dentists do know some things patients don't. Can't imagine going to a GP and saying, "no blood tests for me, thanks, just don't like em".)
posted by cotton dress sock at 7:05 AM on September 14, 2016 [2 favorites]

You've been getting them when you don't want to? You need to stick by your guns.
posted by bq at 7:11 AM on September 14, 2016

I have a history of cavities, and my dentist ordinarily would have me get X-rays yearly. Recently, now that my cavities are more under control, she told me, unprompted, that I only need to have X-rays done every 18 months. I have never gotten them twice in one year. Agreed with those that say it's fine to push back or find a new dentist over this.
posted by Aleyn at 5:21 PM on September 14, 2016

I have some of the literal worst teeth in the world and a gag reflex from hell, and dentists only make me do it once a year. Them bugging you to do it every time if you aren't me (and they don't even do it to me!) is just bizarre.
posted by jenfullmoon at 5:32 PM on September 20, 2016

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