When a pediatric dentist recommends an X-ray, many parents have an immediate question:
How much radiation will my child receive, and is it safe?
Dental X-rays, also called dental radiographs, use a low level of ionizing radiation to create images of teeth, roots, jaws, and surrounding structures. Although radiation exposure should never be treated casually, modern dental X-rays are considered a valuable diagnostic tool when they are selected carefully and performed using child-appropriate techniques.
Current guidance from the American Academy of Pediatric Dentistry, American Dental Association, and U.S. Food and Drug Administration emphasizes the same approach: take an X-ray only when it is expected to provide useful clinical information, and use the lowest exposure needed to produce a diagnostic image.
Why Do Pediatric Dentists Use Dental X-Rays?
A visual dental examination provides important information, but it cannot reveal everything happening inside or between a child’s teeth.
Dental X-rays may help a pediatric dentist:
- Find cavities between teeth that touch
- Examine a tooth’s roots and surrounding bone
- Evaluate an injured tooth
- Check the position of developing permanent teeth
- Identify missing, extra, impacted, or unusually positioned teeth
- Monitor jaw and facial growth
- Evaluate an infection or area of swelling
- Plan orthodontic or other dental treatment
- Assess the results of previous treatment
For example, a cavity between two back teeth may not be visible from the chewing surface. A bitewing X-ray can show that area before the decay becomes large enough to cause pain or significant tooth damage.
X-rays are therefore not simply pictures taken for a dental record. Each recommended image should answer a clinical question or help guide care. The latest American Academy of Pediatric Dentistry guidance identifies diagnosis of oral disease and trauma, monitoring growth and development, and evaluating treatment outcomes as appropriate reasons for pediatric dental imaging.
Are Dental X-Rays Safe for Children?
When used appropriately, the individual risk from a necessary dental X-ray is small, while the information it provides may be important for diagnosing or treating an oral health concern.
Dental X-rays emit relatively low doses of radiation. Advances in imaging technology and technique have reduced exposure compared with older methods. Even so, no exposure to ionizing radiation should be considered entirely unnecessary or unlimited. A pediatric dentist should balance the expected diagnostic benefit against the small potential risk before recommending an image.
This benefit-and-risk approach is especially important for children because:
- Their developing tissues are more sensitive to radiation than adult tissues.
- Their smaller bodies require imaging settings appropriate for their size.
- They have more years ahead in which the effects of repeated exposures could accumulate.
These differences do not mean children should avoid necessary X-rays. They mean pediatric imaging should be carefully selected, adjusted for the child, and limited to the area that needs to be examined.
Children Do Not Need X-Rays on a Fixed Schedule
There is no universal age at which every child should receive a first dental X-ray. There is also no single schedule that is appropriate for all children.
The decision depends on the child’s:
- Age and stage of dental development
- Spacing between the teeth
- Current oral health
- History of cavities
- Cavity risk
- Brushing and eating habits
- Symptoms or areas of concern
- History of dental injury
- Medical and dental history
- Orthodontic or growth considerations
- Previous dental images
A child with spaces between all of the primary teeth and no signs of decay may not need the same images as a child whose back teeth touch closely and who has a history of cavities.
Similarly, a child with tooth pain, swelling, an injury, delayed eruption, or unusual tooth development may need an image even if another child of the same age does not.
The American Dental Association’s 2026 patient-selection recommendations emphasize that dentists should conduct a clinical evaluation and review available previous images before deciding whether new radiographs are needed. There is no “one size fits all” interval between dental X-rays.
Common Types of Dental X-Rays for Children
Different images answer different questions. A pediatric dentist should select the smallest and simplest type of image that can provide the necessary information.
Bitewing X-Rays
Bitewings show the crowns of the upper and lower back teeth in the same area. They are commonly used to look for cavities between teeth and evaluate the supporting bone.
A child whose teeth touch closely may benefit from bitewings because the contact areas cannot be examined directly.
Periapical X-Rays
A periapical image shows the entire tooth, including its crown, root, and surrounding bone.
It may be recommended when a child has:
- Tooth pain
- A dental injury
- Swelling or suspected infection
- An unusual change in tooth color
- A concern involving a tooth’s root or development
Panoramic X-Rays
A panoramic X-ray produces a broad image of the teeth, jaws, and surrounding structures.
It may help a dentist evaluate:
- Developing permanent teeth
- Missing or extra teeth
- Impacted teeth
- Jaw growth and development
- Certain injuries
- Orthodontic development
A panoramic image offers a wide view, but it does not replace bitewings or periapical X-rays when detailed images of the teeth and their surrounding structures are necessary.
Cone-Beam Computed Tomography
Cone-beam computed tomography, commonly called CBCT, creates a three-dimensional view of the teeth and jaws. It can provide valuable information in selected cases, but it generally involves more radiation than routine two-dimensional dental images.
Current professional recommendations state that CBCT should be used judiciously and only when lower-exposure imaging will not provide the diagnostic information needed. It should not be used as a routine screening image for every child.
How Pediatric Dental Practices Limit Radiation Exposure
Radiation safety begins before the X-ray machine is turned on. The most effective way to limit exposure is to avoid taking an image that is not anticipated to help with diagnosis or treatment. Dental teams can also reduce exposure through several practical measures.
Reviewing the Child’s History and Previous Images
A dentist should review the child’s symptoms, clinical findings, cavity risk, development, and available dental records before prescribing new images.
When useful, images from a previous dental office may prevent unnecessary duplication. However, an older image may not answer a new clinical question, especially after an injury or when a condition has changed.
Using Child-Appropriate Settings
Children are not simply smaller adults. Imaging equipment and exposure settings should be adjusted for the child’s size and the specific area being examined.
The FDA recommends using the lowest radiation dose that produces an image of adequate quality for diagnosis.
Using Modern Image Receptors
Digital sensors and other modern image receptors are able to obtain diagnostic images with less ionizing radiation. The result is less exposure to the patient compared to slower, traditional film systems.
Zionsville Pediatric Dentistry uses modern digital X-rays and dynamically attempts to prescribe images only when necessary as part of its preventive-care approach.
Limiting the Size of the X-Ray Beam
Collimation restricts the X-ray beam to the area that requires examination. Rectangular collimation can reduce the amount of tissue exposed during many intraoral dental images.
Current ADA recommendations identify limiting the beam size as one of the most effective ways to reduce unnecessary exposure.
Positioning the Child Carefully
Correct positioning helps the dental team obtain a useful image the first time. This reduces the chance that an image will need to be repeated.
A pediatric dental team may explain the process in simpler language, select an appropriately sized sensor, and help the child remain comfortable and still for the brief exposure.
Using Three-Dimensional Imaging Selectively
CBCT should be reserved for situations in which a three-dimensional view is expected to change diagnosis, treatment planning, or clinical management. A two-dimensional image should be used when it can adequately answer the question with less exposure. Zionsville Pediatric Dentistry does not utilize CBCT, but may refer you to other dental specialists that may use this technology.
What Does "As Low as Reasonably Achievable" Mean?
Dental professionals often use the term ALARA, which stands for “As Low as Reasonably Achievable.”
In practical terms, ALARA means:
- The X-ray should have a valid clinical purpose.
- The smallest appropriate area should be imaged.
- The exposure should be adjusted for the child.
- The lowest dose that produces a diagnostically useful image should be used.
- Unnecessary repeat images should be avoided.
The goal is not simply to produce the lowest possible exposure under any circumstances. An image that is too light, incomplete, or unclear may need to be repeated. The goal is to obtain the necessary diagnostic information with the least reasonable exposure.
Why Did Recommendations About Lead Aprons Change?
Updated recommendations from an American Dental Association expert panel state that routine thyroid and abdominal shielding is no longer recommended during dental imaging. A shield can sometimes move into the X-ray beam, cover an area the dentist needs to see, and cause the image to be repeated.
Modern beam restriction, appropriate patient selection, correct positioning, and child-sized exposure settings provide more meaningful protection from unnecessary radiation. The American Academy of Pediatric Dentistry’s current guidance also addresses updated recommendations on patient shielding.
Not using an apron does not mean radiation safety is being ignored. ZPD will continue to follow the full Indiana Administrative Code on radiographic health. If Indiana law makes changes reflecting this new science, and does not require lead apron shielding, ZPD will always respect a family’s decision to use or not use lead apron shielding.
What Are the Risks of Skipping a Necessary Dental X-Ray?
Avoiding every X-ray does not necessarily eliminate health risk. It can replace the small radiation risk with the risk of missing a dental condition that cannot be visualized during an examination.
Without an indicated image, a dentist may be unable to identify:
- Decay between touching teeth
- Infection around a tooth root
- Damage following an injury
- Abnormal tooth development
- Missing or extra permanent teeth
- An impacted tooth
- Certain changes in the maxilla and mandible (the upper and lower jaws)
A condition that is found early may require less extensive treatment than one discovered after pain, infection, or significant tooth damage develops.
The safest decision is therefore not automatically “no X-ray.” It is the option that offers the best balance between useful diagnostic information and minimized exposure for the individual child.
The FDA states that the benefit of an appropriately selected X-ray generally outweighs its small radiation risk when the image will help answer a clinical question or guide treatment.
Questions Parents Can Ask Before an X-Ray
Parents should feel comfortable discussing dental imaging with Dr. Melissa, her team, and other specialty offices you may be referred to. Helpful questions include:
- What are you looking for with this image?
- How could the result affect my child’s care?
- Is there a previous image that could provide the same information?
- Which type of X-ray is being recommended?
- Are the exposure settings adjusted for children?
- Is a two-dimensional image sufficient?
- Why is CBCT needed in this situation?
- What can we do to help prevent a repeat image?
These questions are not a challenge to the dental team. They support informed, shared decision-making. The ADA and FDA encourage clinicians to explain the benefits and risks of imaging to parents and patients.
When Might a Child Need an X-Ray Sooner?
Parents should contact a pediatric dentist when a child experiences:
- Persistent tooth pain
- Swelling of the face or gums
- A dental injury
- A tooth that becomes unusually dark
- Unexplained bleeding or drainage near a tooth
- Difficulty opening the mouth
- A tooth that is not erupting as expected
- A visible spot or defect that cannot be fully evaluated
- Pain while chewing
An X-ray may or may not be necessary. Dr. Melissa will first consider the child’s symptoms and perform a clinical examination.
Prompt evaluation is particularly important after dental trauma because damage to a tooth’s root or surrounding bone may not be visible from the surface.
Dental X-Ray Safety for Children: The Bottom Line
Dental X-rays use ionizing radiation, so they should be recommended thoughtfully rather than taken automatically. However, modern dental radiographs use low exposures and can reveal cavities, infections, injuries, and developmental concerns that a visual examination cannot detect.
Current pediatric dental guidance supports an individualized approach:
- Take X-rays only for a clear clinical reason.
- Review existing images to determine usefulness.
- Adjust exposure settings for the child’s size.
- Limit the beam to the area being examined.
- Use digital or other appropriately sensitive receptors.
- Avoid unnecessary repeat images.
- Reserve CBCT for cases that require three-dimensional information.
Dr. Melissa at Zionsville Pediatric Dentistry can consider your child’s oral health, cavity risk, symptoms, previous images, and stage of development before recommending dental X-rays.
Parents should receive a clear explanation of what the image is expected to show and how it may affect care.
Frequently Asked Questions
How much radiation is in a child’s dental X-ray?
The amount depends on the type of image, equipment, exposure settings, area examined, and the child’s size. Routine two-dimensional dental X-rays generally use low doses. ZPD’s use of digital radiography also helps to reduce radiation exposure.
CBCT produces a three-dimensional image and typically involves more exposure, which is why it should be reserved for appropriate clinical situations.
Does my child need dental X-rays every six months?
Not necessarily. X-ray timing should be based on the child’s clinical findings, cavity risk, dental development, symptoms, and previous images—not automatically on the date of their next re-care appointment.
At what age should a child receive a first dental X-ray?
There is no single recommended age for every child. The first image should be taken when it is expected to provide information that cannot be obtained adequately from the examination alone.
Are digital dental X-rays safer than traditional film?
Modern digital receptors can produce diagnostic images using less radiation than slower traditional film. The total exposure also depends on the equipment, settings, beam size, positioning, and type of image.
Can dental X-rays cause cancer?
Ionizing radiation can slightly increase lifetime cancer risk, and that risk increases with higher or repeated doses. However, the individual risk associated with low-dose dental imaging is considered very small. Necessary images should still be selected carefully and performed with exposure-reduction techniques.
Does radiation remain in my child’s body after a dental X-ray?
No. The X-ray beam passes through the area being examined during the brief exposure. A standard dental X-ray does not place radioactive material in the body or make the child radioactive.
Why does the dental team leave the room?
Dental professionals take many X-rays over the course of their careers. They stand behind a protective barrier or at a safe distance to limit their cumulative occupational exposure. The child receives only the brief exposure needed for the selected image.
Can I refuse an X-ray for my child?
Parents can ask questions and decline an imaging recommendation. However, your dentist should explain why the image is necessary and whether safe diagnosis or treatment is possible without it. In some situations, proceeding without necessary diagnostic information may not be clinically appropriate and can allow certain negative dental conditions to remain undetected.
Should I keep a record of my child’s previous X-rays?
Yes. Let a new dental office know where previous images were taken so the team can request them when appropriate. Existing images may help avoid duplication, although new images may still be needed if the older ones do not show the necessary area or no longer reflect the child’s current condition.
References
- Prescribing Dental Radiographs for Infants, Children, Adolescents, and Individuals With Special Health Care Needs — American Academy of Pediatric Dentistry, latest revision 2025.
- X-Rays/Radiographs — American Dental Association, including 2024 radiation-safety guidance and 2026 patient-selection recommendations.
- American Dental Association and American Academy of Oral and Maxillofacial Radiology Patient Selection for Dental Radiography and Cone-Beam Computed Tomography — Journal of the American Dental Association, January 2026.
- Optimizing Radiation Safety in Dentistry: Clinical Recommendations and Regulatory Considerations — Journal of the American Dental Association, 2024.
- Pediatric X-Ray Imaging — U.S. Food and Drug Administration.
- Dental Cone-Beam Computed Tomography — U.S. Food and Drug Administration.
- X-Rays — MouthHealthy, American Dental Association.
- What Parents Should Know About the Safety of Dental Radiology — Image Gently Alliance.
- The Role of X-Rays in Pediatric Dentistry — My Children’s Teeth, American Academy of Pediatric Dentistry.
- Facts About X-Rays — Centers for Disease Control and Prevention.
- Medical X-Ray Imaging — U.S. Food and Drug Administration.
- Preventive Dental Care — Zionsville Pediatric Dentistry.
- “Patient shielding during dentomaxillofacial radiography” — JADA, September 2023.
- Update on Dental Radiation Shielding — IDA News.
