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Dental imaging has evolved rapidly over the past decade, with digital radiography, handheld units, and cone-beam computed tomography (CBCT) becoming increasingly accessible in everyday practice. While these technologies have strengthened diagnostic capabilities, they have also raised an important question for clinicians: when is imaging truly justified, and how much is too much?
An updated consensus statement from the American Dental Association (ADA) Council on Scientific Affairs, developed in collaboration with a multidisciplinary expert panel, addresses this very issue. The document serves as an update to the 2012 ADA–FDA recommendations on dental radiographic examinations and complements the 2024 ADA guidance on radiation safety.
What prompted the update
Since the original 2012 recommendations, dental imaging technology has advanced significantly, particularly with the wider availability of CBCT. Alongside these advances, concerns about cumulative radiation exposure — especially in children and young adults — have remained central.
Recognizing gaps in high-quality evidence, the ADA convened an expert panel of general dentists, pediatric dentists, public health experts, and oral and maxillofacial radiologists, supported by consultants from multiple dental specialties. Rather than issuing rigid clinical guidelines, the group developed consensus-based recommendations grounded in systematic reviews, existing guidelines, and expert clinical judgment.
Imaging should follow the examination — not precede it!
A key message running throughout the consensus statement is that radiographic imaging must always be justified by clinical findings. Patient medical and dental history, disease risk assessment, and clinical examination should come first. Previously obtained radiographs should be reviewed before prescribing new imaging, and duplicate examinations should be avoided.
Judicious use of CBCT remains central
Appropriate indications include complex endodontic cases, dentoalveolar trauma, suspected root fractures, implant planning, assessment of impacted or supernumerary teeth, and evaluation of anatomical relationships that may influence treatment decisions. When CBCT is indicated, clinicians are advised to use the smallest field of view and lowest diagnostically acceptable exposure.
Importantly, dentists who prescribe or acquire CBCT scans remain responsible for interpreting the entire scanned volume, including incidental findings beyond the primary area of interest. Referral to an oral and maxillofacial radiologist is recommended when interpretation exceeds the clinician’s expertise.
Across all areas, the principle remains consistent: clinical benefit must outweigh radiation risk. For pediatric patients in particular, imaging frequency should be tailored to age, stage of dental development, and individual disease risk, with careful dose optimization strategies in place.
In an era of rapidly advancing technology, the guidance serves as a timely reminder that appropriate imaging is not about using more tools — but using the right ones, at the right time, for the right patient.
