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2.24.06 Issue #207  

Patient Acceptance and X-rays

Jean Gallienne RDH BS
Hygiene Consultant McKenzie Management

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In reviewing your records before the morning meeting, you have noted which patients will be due for x-rays. The reason you were able to do this is simple. Your office has established an x-ray protocol.

For instance, when it comes to a recall patient with periodontal disease, the doctor may want a full mouth series of x-rays every three to five years. This may be a panoramic and bitewings or periapicals. Your office may have even determined that at one interval doctor wants periapicals and at the next three or five-year interval the doctor may want a panoramic and 4 vertical bitewings. Then depending on the health of the patient, the doctor has informed the staff if 4 bitewings are to be taken once a year or twice a year.  A healthy adult or child may only require a full mouth series every 5 years.

The office protocol was developed by the doctor or doctor and staff based on guidelines posted by the American Dental Association on January 20, 2005 and revised in November, 2005. The guidelines for prescribing dental radiographs can be found on their web page at These guidelines are to be used as an adjunct to the dentist’s clinical and professional opinion on how and when to take radiographs on their patients, always keeping in mind to follow the “As Low As Reasonably Achievable” (ALARA) principle.

The protocol is established in order to give clinicians a working protocol. However, there will always be those patients that are exceptions to the office protocol. For instance a forty year old that does not have any bone loss, cavities, or recession, and has never had a filling may only require four bitewings every two years, unless a change in their risk factor is noted. The x-ray protocol was developed in order to limit the questions and confusion on when x-rays are needed on a patient.

Granted, the way the patient is approached with the need of x-rays will determine acceptance of treatment or if the treatment is declined. Having scripts and going over the verbiage that is the most successful at staff meetings will help with the patient agreeing to have x-rays taken. Below are some of the recommended scripts that have proven to be successful:

  • "Mr. Jones, I need to get your x-rays now.
  •  I am going to get your x-rays now as the doctor requested.
  •  As the doctor requested I am going to get your x-rays now."

The hygienist will not want to ask permission. That is just saying to the patient that it is not really a required treatment but optional, and that is why the hygienist is asking permission.

Of course there will always be exceptions to the office protocol and those patients that respond back with some of the following comments:

"Will my insurance cover them?"  “Mr. Jones, we cannot be sure that your insurance company will cover them. You have to keep in mind that dental insurance isn't really insurance at all. It is actually a money benefit provided by your employer to help you pay for routine dental treatment. Most benefit plans are only designed to cover a portion of the total cost. However, many insurance companies do cover x-rays because they are considered preventive treatment. The doctor has determined that for clinical reasons we need to have these x-rays taken. Without them we will not have all of the information we need to be able to make a thorough diagnosis." This and many other questions are answered in the pamphlet, “My Insurance Covers This RIGHT?”  Any time a patient questions if insurance will cover something it is best to educate them about why the treatment is needed and about insurance. Handing a pamphlet to them in addition to verbally explaining to the patient is a great way to approach the questioning patient.

Another scenario may be, "Mr. Jones, I am going to get your x-rays now as the doctor requested." "Why do I need x-rays? I don't need x-rays. My old dentist never took these x-rays"  "Well, Mr. Jones, I cannot answer for your previous dentist, but we want to make sure that your bone levels are healthy, your teeth are cavity free, and that you are dentally healthy. Without these pictures we will not be able to perform as comprehensive or thorough exam." 

This verbiage is designed that you may modify the above words and find the conversation that best suits you.

The recommendations set in your office protocol are subject to clinical judgment and may not apply to every patient, but it is a good  script to go by for the entire office, and a good place to start when it comes to determining if patients are due for x-rays and how to approach the objective patient.

If you are interested in enhancing the skills of your hygienist or having Jean speak to your study club or dental group email

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2006 Location Sponsor Information Topic Speaker
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Mar. 29 Long Island, NY Suffolk County Dental Society 312-440-2908 Breakdown Sally McKenzie
Mar. 31 Las Vegas, NV Dental Town Meeting* 877-777-6151 Pred. Empl. Success Sally McKenzie
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