Does my patient still need a lead apron or not?

In February, the Journal of the American Dental Association published new recommendations aimed at enhancing radiation protection in dental radiography and cone-beam computed tomography (CBCT). They did this in partnership with the FDA. See article

One of their key recommendations is that lead aprons and thyroid collars are no longer recommended for patients during dental x-ray exams.  The main reasoning is they found a higher risk of the aprons and collars getting in the way of the imagery, which can result in more retakes

Other medical organizations have been making similar points for some time. In 2019, the American Associations of Physicists in Medicine concluded that the use of patient lead aprons should be discontinued as they were both unnecessary for safety and had the potential to jeopardize the quality of images. In 2021, the American College of Radiology also recommended discontinuing lead shielding.

Some thought leaders in radiology and medical physics have also made statements that lead aprons and other lead shields provide no additional benefit to the patient except for some psychological comfort.

So why would a dental office continue to use lead aprons?  There are at least two reasons:

First, your state (or local) laws may still require it.  The ADA position is simply a recommendation, and it does not overrule regulations that still require it.

Second, there may still be a comfort level from both staff and patients that may be hard to overcome because moving away from lead aprons may be a challenging cultural shift. Many patients and dental professionals have been conditioned to think that radiation is scary and dangerous.  Therefore, they may perceive that NOT using aprons is reckless behavior.

Furthermore, patients may see staff and doctors continue to wear shielding when in the X-ray room. There may be good reason for this as they work around x-ray modalities every day, and they enjoy no diagnostic benefits of getting the X-ray. However, this may create more concern in he patient’s mind, and may mean that the staff may have a hard time convincing them. 

In this case, it may be simply more reassuring to give the patient what they want and provide an apron for them.