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Monday, January 3, 2011

Don't Get Dental X-ray Advice from Dr. Oz!

Dr. Oz is at it again. He must be running low on ideas for his TV show. You'd think there is PLENTY of material out there in the medical world to fill his shows into perpetuity. But, noooooo.... He's spouting off nonsensically again about dentistry - a field in which he has ZERO training. He's as qualified to talk about dentistry as I am about his specialty - heart surgery.

This time Dr. Oz is telling people they should avoid dental x-rays. His reason is a piece of "research" that purportedly links increased thyroid cancers to dental x-rays. There's a reason I put the word, research, in quotes. Here's an excerpt from the article he apparently referenced (but failed to include in his show):

The researchers studied 313 thyroid cancer patients in Kuwait where dental treatment is free and where the incidence of thyroid cancer is relatively high compared to Britain. They said the results of their study, although the largest case-control study on the subject, should be treated with caution because the data were necessarily based on self-reporting by the participants. Comprehensive historical dental x-ray records were not available from the clinics.

Pay particular attention to what is bolded in the excerpt above.  313 patients is a VERY small study.  The data is based on SELF-REPORTING.  That's not science, folks.   And, the real kicker that is quite stunning to me...  they are saying the cancer is related to dental x-rays, BUT they don't have ANY records of what kind, how many, if any, x-rays taken on each patient.  WHAAAAAAAAT?

There's an adage in science:  "Correlation does not equal causation."  To illustrate what that means, I submit the following analogy:

I did a study of 313 rabbits from Arkansas.  They ate a lot of carrots.  And, they all died.  I can't tell you how many carrots they ate, or how often.  I didn't keep any records.   But, the rabbits really seemed to like carrots.  So, I think they ate a lot, especially since they didn't have to pay for the carrots.  But, eventually, all the rabbits in the study died.

My "obvious" scientific (not!) conclusion is that carrots are LETHAL.  Don't eat carrots.  And, if a restaurant tries to force them on you in a salad, you should tell them that a famous TV hair stylist said you shouldn't eat carrots.  Carrots KILL!

Of course, we would be hard-pressed to logically conclude that carrots are dangerous. But, if a famous TV celebrity doctor blessed by Oprah says, "A study showed that carrots can kill you," you can bet people will watch. And, you can bet the celebrity doc won't give any details about a flawed "study."

Dental x-rays are a necessary part of a complete dental examination.  X-rays reveal decay that we cannot see with our eyes.  X-rays reveal bone loss from periodontal disease.  X-rays reveal abscessed teeth.  X-rays also reveal cysts, tumors, and even cancers.  If any of those conditions go undetected, they will invariably get worse and more difficult to treat.
Dental x-rays are the "standard of care."  That means any dentist who treats patients with out the proper examination, including x-rays, is practicing below what is accepted as a bare minimum of competency.

So, you see... we dentists must practice within at least the parameters of what is considered the standard of care.  An Oprah-endorsed TV personality (even a heart surgeon) is NOT the arbiter of how dentistry is practiced.  While he is a popular celebrity, Dr. Oz is NOT an expert on dentistry.  However, your dentist IS.  Some may argue that the dentist has a vested (financial) interest in doing x-rays.  But, I will counter that argument that it is minuscule compared to Dr. Oz's financial interest in gaining viewers by offering provocative topics to discuss on his TV show.  The more viewers he gets, the more he makes on advertising during his show.  We're talking MILLIONS of dollars, folks.  Rest assured that your dentist isn't "making his / her money" by over-prescribing x-rays. 

If you're interested in some real numbers, refer to the table below**   (You can view the table as a larger image by clicking on it.)  I've highlighted in green, the typical exposure level from annual dental x-rays:  0.008 millisieverts.  Now look at the first source listed in the table, "Natural Background."  The figure is 2.4 millisieverts.  So, you get 300 times MORE radiation from just being alive and walking around than you do from dental x-rays in any given year.

It sure makes for sensational TV when a famous Oprah-fied doctor says, "going to your dentist is dangerous."  But, it's a tremendous disservice to the public and outright misinformation.  But, that's television, facts be damned.

Your dentist should be happy to discuss the reasons for prescribing dental x-rays.  Don't be afraid to ask.  But, if you insist on no x-rays, in most cases, you can expect your dentist to decline seeing you as a patient.  That's the simple truth, and that's reality.  To provide dental care without x-rays is simply wrong, and it puts the dentist in a seriously liable and indefensible position.

I won't pretend to give you advice on heart surgery.  I wish Dr. Oz would stop giving unqualified dental advice.

**Source: Radiologic and Nuclear Medicine Studies in the United States and Worldwide: Frequency, Radiation Dose, and Comparison with Other Radiation Sources—1950–2007
November 2009 Radiology, 253, 520-531