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 Table of Contents  
Year : 2019  |  Volume : 4  |  Issue : 2  |  Page : 27-31

Parent's attitude and knowledge toward dental radiography in children

Department of Public Health Dentistry, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission06-Oct-2021
Date of Acceptance06-Oct-2021
Date of Web Publication29-Nov-2021

Correspondence Address:
Dr. Manju
Department of Public Health Dentistry, Thai Moogambigai Dental College and Hospital, Mogappair, Chennai - 600 107, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijosr.ijosr_15_21

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Introduction: Radiographs are an essential part of most clinical dental examinations and diagnoses. Radiographs often add critical information to the clinical examination revealing developmental and eruption problem in addition to caries, pulp, and periapical pathology. Radiographic guidelines exist to avoid unnecessary exposure, as well as to identify individuals for whom radiographic examination will be beneficial. It is unknown whether radiation fears are exaggerated or whether parents recognize and accept the associated risks. The aim of this study is to determine the parental knowledge and attitude toward dental radiography in children. Materials and Methods: A self-administered questionnaire is prepared and distributed to 42 parents with children who are to be radiographed in the Chennai population and covering parental level of radiation and sociodemographics was applied which is used to assess attitude toward dental radiographs. Results: Sixty-five percent parents have a positive attitude toward dental radiographs on their children. However, the majority of parents lack knowledge (20%) regarding dental radiography, especially regarding the risks involved. Conclusion: Most parents had a positive attitude toward dental radiographs, although they had limited knowledge about radiography. This study emphasizes the importance of providing accurate and appropriate information, and hence, patients and parents have a better knowledge and understanding of dental radiographs.

Keywords: Children, health, knowledge, radiation, radiograph

How to cite this article:
Sharmila S, Manju. Parent's attitude and knowledge toward dental radiography in children. Int J Soc Rehabil 2019;4:27-31

How to cite this URL:
Sharmila S, Manju. Parent's attitude and knowledge toward dental radiography in children. Int J Soc Rehabil [serial online] 2019 [cited 2023 Dec 6];4:27-31. Available from: https://www.ijsocialrehab.com/text.asp?2019/4/2/27/331463

  Introduction Top

Professor Wilhelm Conrad Roentgen, a Bavarian physicist, accidentally discovered X-rays on November 8, 1895. The first dental bitewing radiograph, whose exposure time was about 25 min due to combination of unreliable generator output and relatively low sensitivity of receptor, was performed on himself by Dr. Otto Walkhoff in 1896, which was glass plated it by hand with photographic silver emulsion.[1] This cumulative effect of long and repetitive radiation exposure led to the irreparably damaged tissues of the radiography's early pioneers,[2] this raised an issue to decrease the radiation exposure to the public and the operator. As a result the radiation doses have been greatly reduced needed to make radiographic images over the past century.[1] Today, various factors such as fast lm, collimation, filtration, and standardization of X-ray lm processing, have greatly helped us in quality assurance programs and achieving a reasonable radiographs by keeping radiation hazards at bay.[2] As technology advances in dental radiology, operators must maintain current knowledge and adapt their skills for the best treatment of the patient. Radiography is a highly technical held, essential to the modern dental practice. The intraoral radiographic image, when correlated with the case history and clinical examination, is one of the most useful and powerful diagnostic aids available to the dental practitioner. Although the radiation doses used by dentists might be low for individual examinations, patients are exposed to repeated examinations overtime, and many people are exposed during the course of dental care.[3] Broad range of exposures used in dental offices ranging from 5 μSv bitewing to 14–24 μSv for extraoral imaging such as panoramic radiography are encountered. Thanks to such varied techniques, per capita dose of radiation has increased in today's population, nonetheless, our awareness regarding the same has also increased.[4] Hence, the major concern of dentist is to reduce the radiation exposure to the patient and surrounding environment, without compromising the quality of image.[4] Therefore, proper techniques must be employed to reduce radiation exposure to the patient through the use of protective aprons, digital radiology, high speed lms, and proper technique thus decreasing radiographic retakes and additional exposure.

Due to the faith entrusted by the parents on the dentists regarding their children's care, it is the moral responsibility of the dentist to inform about the biohazards associated with radiation to the parents. Children are more vulnerable to radiation than adults which is due to the fact that there is a longer life expectancy, and thus, a greater potential for radiation-induced cancers to manifest. Furthermore, the cumulative nature of radiation exposure over a patient's lifetime increases the importance of explaining radiation risks to parents.[5]

Dental radiographs play an important role in the detection and management of oral diseases and a useful diagnostic aid in the oral examination of children. While radiation exposure in the dental setting is relatively low, it is one of the most frequently undertaken radiographic procedures and is often repeated several times during childhood and adolescence. When visiting the dentist, parents entrust the dentist with the care of their children, and therefore, they have the right to understand the often complex risks and benefits of a procedure, including the taking of radiographs. Radiographs often add critical information to the clinical examination, revealing developmental and eruption problems in addition to caries, pulp, and periapical pathology. Radiographic guidelines exist to avoid unnecessary exposure, as well as to identify individuals for whom radiographic examination will be beneficial.[6]

Radiographs should be taken only when there is an expectation that the diagnostic yield will affect patient care. The American Academy of Pediatric Dentistry recognizes that there may be clinical circumstances for which a radiograph is indicated, but a diagnostic image cannot be obtained. For example, the patient may be unable to cooperate or the dentist may have privileges in a health-care facility lacking intraoral radiographic capabilities. If radiographs of diagnostic quality are unobtainable, the dentist should confer with the parent to determine appropriate management techniques (e.g., preventive/restorative interventions, advanced behavior guidance modalities, deferral, and referral), giving consideration to the relative risks and benefits of the various treatment options for the patient. Because the effects of radiation exposure accumulate over time, every effort must be made to minimize the patient's exposure. Good radiological practices (e.g., use of lead apron, thyroid collars, and high-speed film; beam collimation) are important. The dentist must weigh the benefits of obtaining radiographs against the patient's risk of radiation exposure. Dental X-rays are very safe and expose your child to a minimal amount of radiation. When all standard safety precautions are taken, today's X-ray equipment is able to prevent unnecessary radiation and allows the dentist to focus the X-ray beam on a specific part of the mouth. High-speed film enables the dentist to reduce the amount of radiation the patient receives. A lead body apron or shield will be placed over the child's body. Make sure the shield covers your child's neck to protect the thyroid gland. Keywords for good practice are appropriate selection criteria for the use of radiography, optimized radiation protection and utilization of the total amount of information in each radiographs.[7] The aim of this study is to determine parents attitude and knowledge toward dental radiography in children.

  Materials and Methods Top

Data were collected from 42 parents with children in North Chennai population using a structured questionnaire consisting of eight survey items. The survey was conducted in Private Dental College, Chennai, India. Patients who visited the hospital and required radiographic examination were selected for the survey. In the questionnaire, details were asked about their knowledge on dental radiograph.

Inclusion criteria

  1. Father
  2. Mother
  3. Guardian.

Exclusion criteria

  1. Dental practitioners
  2. Dental assistant.

In the questionnaire, details were asked about the experience in exposing X-rays in children, parents level of education, knowledge about the risk, and the importance of X-rays. The data thus obtained were subjected to the statistical evaluation.

  Results Top

A total of 42 parents with children participated and answered the questionnaire. The majority of respondents accompany their children to their dentist and were aware that exposure from a dental radiograph was too small to put their children at any significant harm, whereas most were not aware that radiation exposure from the environment is higher than radiation from dental radiographs. Of those respondents where parents accompanied their child and radiographs had been taken, 60% felt that the risks of dental radiographs were not explained to them, but 40% said that the dentist explained the reasons for taking dental radiographs [Figure 1].
Figure 1: Risk of X-rays explained to children

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Parents with children who have had previous dental radiographs were more likely to perceive dental radiographs as “useful,” “pleasant,” “good,” and “unpleasant” [Figure 2]. Parents with children who visited the dentist regularly (every 6 months) were also more likely to perceive that the benefits outweighed the risks.
Figure 2: X-rays on children

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A higher level of parental radiographic knowledge was associated with a higher level of formal education (65%) and having children who have had previous dental radiographs reported as “useful” (40%) and parents who admitted to lacking knowledge about radiographs perceived them as unpleasant. Parents with average knowledge and who has done undergraduate have reported that X-rays are “unpleasant” [Figure 3]. Regularity of dental visits by the parent and type of dental service were found to have no significant associations with attitude or knowledge.
Figure 3: Level of education

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  Discussion Top

A key insight gained from this study is that while knowledge about dental radiographs is low, parents have a positive attitude toward radiographs. This suggests that attitude is not primarily derived from knowledge. On study, a survey done by Fishbein M et al. in Australia reported that parents with high levels of knowledge about radiographs stated that they thought dental radiographs were safe and beneficial. Conversely, parents who answered the knowledge-based questions incorrectly perceived radiographs as being “harmful.” Attitudes develop over time and are organized around three main types of beliefs: 1-descriptive beliefs these are based on direct experiences and are of most value; 2 − inferential beliefs these are based on an inference process, where by a belief is inferred from other beliefs; 3 − informational beliefs these are based on information derived from an outside source.[8] This study found that descriptive beliefs, based on parents experiences with radiographs taken for their children, may have shaped parental attitudes.[9] This study indicated that parents who participated in the survey have had positive experiences when radiographs have been taken, and these previous experiences have impacted on the parental attitudes. For example, parents with children who have had previous dental radiographs and parents who have the perception that radiographs are “good” and “useful” were significantly associated with each other. While the majority of parents had the importance of dental radiographs explained to them, significantly fewer parents reported that they had been informed of the radiation risks (40%). Furthermore, over half the respondents were university educated and approximately 60% had experience of dental radiographs. This skewed demographic may have affected the results and therefore the relatively positive attitudes toward dental radiographs found in this population may not extend to the general population.[6],[10] The low response rate may have been improved if direct communication was made with the parents and follow-up reminders had been placed in newsletters. It is unknown how many children were giving their parents the newsletter or how many parents read the school newsletter. Reassuringly, however, parents who believed the risks were explained to them also agreed that the benefits of the radiographs outweigh the risks. Dentists need to assure patients that they are committed to obtaining excellent clinical results with the lowest possible radiation risk, and that the potential benefits of modern medical imaging procedures almost always far outweigh the associated risks.[11],[12]

Dental radiographs play an important role in the diagnosis and treatment planning. The modalities at the disposal of dentists range from intraoral radiography to cone-beam computed tomography. In the field of dentistry, radiation exposure for diagnostic purpose is minimal.[13] However, it is one of the most frequently undertaken radiographic procedures, which is repeated several times during childhood and adolescence. Thus, it is the parent's right to know the associated radiation risks. As per the literature available, there are not many studies done to assess the knowledge and attitude of parents regarding dental radiography for their children. Thus, it is unknown whether the fears associated with dental radiography are overstated or the parents are aware about the risks and accept them.[14],[15]

In a study done by Babu et al.,[16] the knowledge of the parents toward dental radiography was found to be relatively low. More than half of the participants were oblivious to the facts such as the damage to the body from dental radiographs is not permanent (58%) or the exposure from dental X-rays is too small to put their child at any significant harm (54%). Fifty-six percent of the participants were unaware that the exposure to radiation from the environment (e.g., the sun) is higher than the radiation from dental X-rays. However, 58% of the parents knew that radiation from other medical procedures such as chest X-ray is more and, also that if the child wore a lead apron during dental X-ray procedure, it would provide protection against possible radiation damage.[16] Chiri et al. in their study also reported a low knowledge of the parents regarding dental radiography.[6]

Children from low income and disadvantaged families have a disproportionately higher prevalence of untreated dental caries and lower dental care utilization than higher income group children. A reduction of oral health disparities requires a comprehensive oral health promotion strategy for better oral health among low-income group children. This strategy includes programs such as oral health education, preventive and comprehensive dental care, and social and organizational interventions to address multiple barriers to access and utilize dental care.[8] For these interventions and programs to be successful, the caregivers should be motivated to take action by being aware of their children's oral health conditions and the need for prevention and early interventions. A better understanding of how well caregivers perceive their children's oral health status may improve utilization of dental care services.[17]

The radiation dose should be kept as low as can reasonably be achieved both for patient and operator. Usually, there will be no damage of clinical significance caused by low level X-rays used in dental radiography. However, the hypothesis in modern radiation protection is that any dose of radiation has the potential to cause biological harm. “It is impossible to relate any specific dental exposure to any specific cancer. All we can say is that the evidence indicates that even very small doses carry the potential for causing cancer” (Smith, 1987). The probability of long-term effects (stochastic effects) of radiation increases with the dose of exposure, but the severity of the consequential effect when it occurs, such as cancer, is not affected. That means that the probability for cancer is related to radiation dose, but when the disease unfortunately breaks out, the severity of the disease will not depend on the radiation dose. The younger the individual, the higher the vulnerability to radiation is because of the large number of cell divisions occurring in small children. Children also have a higher proportion of the bone marrow located in the skull than adults have. Smith (1992) has shown in a calculation of risk estimates that about one induction of malignant disease per 1,000,000 dental exposures of 5 year old children can be expected. The International Commission on Radiological Protection, 1991 has proposed the estimate for a single small dose at the age of 5, which is used in calculations. The risk is reduced when the fastest films available, or digital radiography, are used due to the lower dose needed.[18],[19] The image quality could be as good as that of conventional films but depends on the digital system used. At the moment, there are large variations in quality between the different systems. In a recent study, dentists considered the user-friendliness of the handling of the two different digital systems before taking a radiograph as less than for the conventional film (Berkhout et al., 2002). The patient's comfort was also mentioned as unfriendly, especially when the systems were used for children. In the case of digital radiography, the elimination of the chemistry of film processing after taking the radiograph was considered an advantage. Digital images are best viewed on a good computer screen and often loose quality when printed. Such images are like any computer files and may be stored on disks and easily transferred to other computers. In the future, “expert” systems may provide decision support based on automated image analysis (Firestone et al., 1998; White, 1999). In conclusion, digital radiography has advantages over conventional radiography, but the bulky sensor systems with attached cable and the need for a computer are clinical inconveniences. No studies concerning the use of digital radiography in children are available, but it seems likely that at present time the advantages of these systems are cancelled out by the disadvantages such as acceptance of the sensor or phosphate plate by the child.

  Conclusion Top

Most parents had a positive attitude toward dental radiographs, although they had limited knowledge about radiography. This study emphasizes the importance of providing accurate and appropriate information so patients and parents have a better knowledge and understanding of dental radiographs. It is imperative for dental health professionals to understand their role in shaping positive attitudes toward dental radiographs. Dentists need to assure patients that they are committed to obtaining excellent clinical results with the lowest possible radiation risk and that the potential benefits of modern medical imaging procedures almost always far outweigh the associated risks.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Farman TT, Farman AG. Evaluation of a new F speed dental X-ray film. The effect of processing solutions and a comparison with D and E speed films. Dentomaxillofac Radiol 2000;29:41-5.  Back to cited text no. 1
Campbell DJ. A brief history of dental radiography. N Z Dent J 1995;91:127-33.  Back to cited text no. 2
Lee BD, Ludlow JB. Attitude of the Korean dentists towards radiation safety and selection criteria. Imaging Sci Dent 2013;43:179-84.  Back to cited text no. 3
Madalli VB, Annigeri RG, Basavaraddi SM. The evaluation of effect of developer age in the detection of approximal caries using three speed dental x-ray films: An in-vitro study. J Clin Diagn Res 2014;8:236-9.  Back to cited text no. 4
Frush DP. Radiation risks to children from medical imaging. Rev Med Clin Condes 2013;24:15-20.  Back to cited text no. 5
Chiri R, Awan S, Archibald S, Abbott PV. Parental knowledge and attitudes towards dental radiography for children. Aust Dent J 2013;58:163-9.  Back to cited text no. 6
Espelid I, Mejàre I, Weerheijm K; EAPD. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent 2003;4:40-8.  Back to cited text no. 7
Fishbein M, Ajzen I. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading: Addison-Wesley; 1975.  Back to cited text no. 8
Looe KL. Parental knowledge and attitudes towards dental radiography for children. Br Dent J 2013;215:561.  Back to cited text no. 9
Aravind BS, Joy ET, Kiran MS, Sherubin JE, Sajesh S, Manchil PR. Attitude and awareness of general dental practitioners toward radiation hazards and safety. J Pharm Bioallied Sci 2016;8:S53-8.  Back to cited text no. 10
Kelly SE, Binkley CJ, Neace WP, Gale BS. Barriers to care-seeking for children's oral health among low-income caregivers. Am J Public Health 2005;95:1345-51.  Back to cited text no. 11
Sohn W, Taichman LS, Ismali Al, Reisine S. Caregivers perception of child's oral health status among low-income African Americans. Pediatr Dent 2008;30:480-7.  Back to cited text no. 12
Ashok NG, Kumar VJ. Patients perception on dental radiographs: A questionaire-based study. Int J Orofac Biol 2017;1:28-31.  Back to cited text no. 13
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Looe HK, Pfaffenberger A, Chofor N, Eenboom F, Sering M, Rühmann A, et al. Radiation exposure to children in intraoral dental radiology. Radiat Prot Dosimetry 2006;121:461-5.  Back to cited text no. 14
Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: The impact of 2007 international commission on radiological protection recommendations regarding dose calculation. J Am Dent Assoc 2008;139:1237-43.  Back to cited text no. 15
Babu NV, Bhanushali PV, Amitha HA, Moureen A, Akshatha BS. Assessment of Knowledge and Attitude of Parents Regarding Dental Radiography for Children. International Journal of Scientific Study 2017;4:12-6.  Back to cited text no. 16
Preston-Martin S, White SC. Brain and salivary gland tumors related to prior dental radiography: Implications for current practice. J Am Dent Assoc 1990;120:151-8.  Back to cited text no. 17
Ludwig RL, Turner LW. Effective patient education in medical imaging: Public perceptions of radiation exposure risk. J Allied Health 2002;31:159-64.  Back to cited text no. 18
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  [Figure 1], [Figure 2], [Figure 3]


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