I was diagnosed with hypothyroidism in 2016 and since then have used a thyroid shield for all dental x rays.
During my dental appointment (new dental surgery) last week, I was due to have 3 x rays of individual teeth. I requested a thyroid shield but was told that the practice doesn't use them anymore as they're not necessary due to low risk.
This didn't sit well with me so we rescheduled my x rays for this weeks appointment so that I could access reliable information about this.
Even if there is a small risk of a thyroid flare or worse health outcomes from radiation from x rays, I would rather avoid it as managing thyroid health is tricky / a fine balance at the best of times! I'm very sensitive to medication (take adrenalin free anaesthetic after a prolonged recovery time / reaction to adrenalin based anaesthetic previously) and environmental health triggers. I'm of the mind that prevention is better than cure.
Does anyone have any up to date information on this issue please? Any research papers? Are dental practices obliged to provide thyroid shields for patients with hypothyroidism?
All replies very much appreciated. Thank you 🙏🏻
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Hypogo
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In my experience, panoramic X-rays are sometimes done with much older machines. They also result in much higher doses because they take so much longer and are directed at much more tissue.. So I think there is still a case for shielding with them.
Thank you so much for taking the time to reply helvella I'll take a look at the links that you've recommended.
Do I have any legal rights to request a thyroid shield as a preventative measure even if it isn't standard practice at my new dental surgery?
Even though risk is low, I'd like to reduce it as far as possible. Even in terms of it triggering a thyroid flare as my thyroid health is not currently optimal and I'm struggling with fatigue and low levels of daily functioning currently as it is.
And you have every right to refuse any treatment at all - including X-rays.
But you could create difficulties regarding your relationship with your current dentist and the practice. They should just accept your choice unless they consider no X-ray makes their treatment more difficult or dangerous. Whether they do or not depends!
(I have no evidence that it affected me, not even made up my mind if it did, but in the few years before ending up with hypothyroidism, I did have several panoramic X-rays. Due to severely impacted wisdom teeth - diagnosis, treatment, and follow-up. One of the machines looked like it was a refugee from the 1940s! I just wonder.)
I have point blank refused unless a shield is provided. None has been so I won’t have them. Safe doses are an ever lowering value. With two close relative having primary nhl of the thyroid I can’t see the sense in having unnecessary X-rays zapping my neck no matter how weak.
If the dentist said there something really dodgy looking that needed investigation I’d give in.
I can empathise and completely identify with your point of view TSH110 If a protocol is available to minimise risk - no matter how small the risk is perceived to be - I think it's best practice to implement this in the interest of supporting the health of the patient and their thyroid health.
Even if it’s old the machine should be properly inspected and maintained (it is highly regulated) and the xray beam should deliver the same dose as a more modern xray unit
I had a hell of a time with an impacted wisdom tooth extraction took dental surgeon 45 mins to lever it out the nurse said “congratulations we have delivered a tooth!” When he finally prized it out. I was sitting there hearing cracking and crunching with him battling with it I nearly passed out at one point! I remember thinking the only person in a worse situation than me is him! He showed me the tooth after it had a huge extra prong on the root that was hidden in the xray and was what had caused all the problems. He sent me to the pharmacy and told me to take the tablets straight away at the pharmacy itself as the anaesthetic was about to wear off! I didn’t felt great but did as he said. I was in bed for days but felt no pain. I asked for more a week later on my return but was told they were steroids and I wasn’t allowed any more. That’s when I felt pain. I was glad to be shut of it, it used to half erupt and go up and down in the socket plus it was infected and disgusting. Used to drive me nuts. That surgeon deserved a medal 🥇
Before I was treated for hypo it used to feel like my teeth were marching around my head. I was shocked to read that they can all fall out as a serious symptom. It really messes with teeth.
Bless you! @TS110 Hormonal issues really do impact teeth. I've had a lot of dental issues that coincided with hormonal dysregulation prior to diagnosis and treatment of hypothyroidism and with the onset of Peri menopause.
Omg how awful! Mine levered it one way then the other until the hook came free and allowed it to be removed. I had no idea impacted meant it had horns on the root.
I did worry rather when he said he was drilling away some jaw bone but that was at the beginning not mid way through. It was my last wisdom tooth to go and the most incalictrant.
The second (right lower) was significantly better.
And I continue to get minor "groans" from my uppers which are still there. Despite being told they are much easier to remove, I'm hoping they'll never need to go!
A year or two earlier, I had mentioned slight discomfort but my then dentist thought it was nothing. Next appointment, she did an X-ray to reassure me. Then she realised it was an awkward one...
But that dentist was near where I then worked, and had huge difficulty in referring me to a dental hospital near where I lived - a two-hour drive away. And I wouldn't be working there by the time any appointment came through. Out-of-area referrals being pretty much banned. I got a nasty letter from the health people - but she took up the cudgels and got it sorted. (One of the most pleasant dentists I've even had!)
The top ones are easier to extract but still made me feel very unwell for a couple of days they weren’t impacted or the other bottom one but pulling teeth out of your jaws is a pretty brutal thing to do close to the grey matter too
It's an incredibly low dose, equivalent to one day's background radiation radiologyinfo.org/en/info/s... . The only consideration is that the dose is focussed on the area around the tooth as opposed to the whole body. If you fly on a European holiday you will get five to ten times as much radiation as a tooth x-ray.
I dislike meta-analyses as they group together diverse studies without detailed discussion of each paper. They also tend to exclude the majority of studies which can lead to bias.Although the review is recent it looks at studies from the past and these studies no doubt include subjects who have had x-rays over past decades. So, we are looking a long time back when doses were much higher with subjects who presumably had poor oral health.
It’s very hard to determine how high doses were in the past. Early dental radiography soon after Röntgens discovery was pretty terrifying with 25 minute exposures 😳 for teeth. Especially damaging for the operators Kelly’s story is horrendous but also admirable in equal measure. Panoramic machines existed from the 40’s but don't seem to have been heavily adopted in dental practices. It seems widespread use is a comparatively recent development again dose levels are hard to determine from the 90’s onwards but since 2005 uk gov records indicates dose has remained about the same for panoramic but reduced for single tooth xray.
I would have thought the war generation would have better dentition not worse than today and they are pretty much the oldest living now. The rubbish kids eat and drink now has to be an all time low for dental health, and necessitate ever greater numbers of dental X-rays.
One shocking fact I know is my grandmother was given a 21st birthday present of having all her teeth extracted and a set falsies and it was not uncommon. She was born in 1900. It does indicates teeth could be a real menace and expense for the poor. I even heard rich people had poor people’s teeth implanted 🤮
No matter re the study and its limitations which I accept could be manifold, my instinct tells me ALARP is a very sensible approach where any X-rays are concerned and a shield for dental X-rays is hardly asking for the moon.
The most common reason under 5's attend A&E now is to have a rotten tooth surgically removed 😳 This is due to a high sugar diet as you mentioned and the lack of access to NHS dentists.
I appreciate that it may be a low dose. However, the location of oral x rays can cause scatter to thyroid tissue which is highly susceptible to radiation from my understanding.
I have a background in risk management as a former social worker. Nothing is without risk, however, considered, calculated and managed risk tends to lead to better outcomes for individuals in my experience.
Individual vulnerability and sensitivity isn't factored into generic guidance. Over the past 20 years I've experienced numerous food intolerances and sensitivity to medications, anaesthetic containing adrenalin and chemicals in cleaning products and toiletries that most people have no issue with. I need to consider these factors when considering my own potential sensitivity to radiation in terms of long and short term health.
It would be good to measure the scatter dose in the thyroid area although it must be small as only a fraction will scatter and by the inverse square law it will be substantially less than the dose the tooth receives. Maybe some study has done this, I haven't looked.I don't know of any evidence the thyroid is nore sensitive to radiation. If so I would expect a lot more thyroid cancers as we receive a dental dose every day from background levels. Also, I remember using a Geiger counter at school in the 1960s and getting high counts, and being told by the teacher they were much higher a few years ago due to the atom bomb testing. Consequently we would expect to see a rapid decline in thyroid cancer in recent years in those born after the mid-sixties.
If you get into the potential of individual susceptibility to low risk events you are looking at the product of two rare risks which is a very small number. I wouldn't worry about it.
As an aside I don't understand the concept of a thyroid shield for dental x-rays. Any scattered radiation will come from inside the oral cavity and a shield would contain and reflect radiation rather than let it disappear out into the room. A shield would work if the beam wasn't focused and the x-rays were emitted some distance from the patient.
I should have mentioned that I only had the usual single tooth x-rays in mind. Larger doses such as cone bean CT scans have more radiation but of course are only done when there is greater need.
I've read reports about thyroid tissue being much more susceptible to the effects of radiation and thyroid cancers being more prevalent in areas of high radiation and in the aftermath of radioactive spills.
The scatter volume varies / is dependent on the location of the teeth being x rayed from what I've read. Certain areas / teeth positions cause more scatter than others outside of the oral cavity.
From my understanding, shields absorb any excess rays rather than reflect.
My dentist asked me to ask my GP for advice on this. My GP has told me that I know more about thyroid function and health than they do. My dentist doesn't seem at all clear on this matter either which is why I said I'd look into it.
My dentist minimizes risk to pregnant women by completely avoiding x rays of pregnant women. This suggests there is still a risk significant enough to warrant minimising, even though it is stated to be low.
I like to reduce the toxic load on my thyroid health wherever I have the option to exercise control over this. There are so many things beyond our control in terms of endocrine disruptors in daily life. It's not so much a worry as the intention to take responsibility for my own health and safeguard it where possible / where medical evidence isn't clear by taking preventative measures.
Thanks for your feedback though. I appreciate it. It's good to be able to hear different viewpoints to inform my decision 🙂
I had X-rays a month or so ago and I noticed my dentist didn’t even leave the room this time although his nurse did. In the past when I have had X-rays they would both go outside the door until it was done. So perhaps they are not as powerful as they were in the past.
I wonder if they don’t have a shield because quite honestly I can’t see what difference it would make if they gave you one.
Just found this - not sure how reliable a source it is but it would fit in with what your dentist seems to be thinking verywellhealth.com/lead-apr....
The difference is the ironing radiation would be blocked from the thyroid and spinal column by the shield if one were used. Simple & effective but mine don’t even have them
The dose from panoramics has remained similar but individual tooth X-rays have dropped in dose according to 2017 uk government data
A shield blocks any radiation scatter. I became aware of this after my hypothyroidism was diagnosed from a thyroid forum or Thyroid UK? Can't remember I've read and researched so much to learn how to manage my condition in the intervening years!
My new dentist said they've never used thyroid shields or lead aprons for pregnant women. They just won't x ray pregnant women until after they've given birth to reduce risk. This fact suggests to me that use of a thyroid shield / lead apron would minimise risk and is still best practice.
Having worked in dentistry for many years we never even had a thyroid shield or been asked for one. As staff we had no protection, just ran out the room when taking X-rays, and think how many we were exposed to day in and day out, never did me any harm 🤷♀️
running out of the room is protection, their strength drops hugely with distance from the source
The amount of radiation exposure is not inversely proportional to the distance from the radiation source, but is inversely proportional to the square of the distance. This means that double the distance from the radiation source can reduce the radiation exposure not to 1/2 but to 1/4.
I’m aware of that but having X-ray machines in various rooms within the building meant we were still exposed to radiation multiple times a day where ever we were.
I think it's a question of choice and informed consent.
If you were aware of the risks and happy to have that level of exposure, that's just as valid as someone who chooses to follow a protocol to minimise risk.
It’s only a statistical risk not an inevitability exposure to radiatun will cause problems later on, unless it’s truly massive exposure. There is one group of scientists who believe low dose radiation is perfectly safe. They could be right but then again they could be wrong. Early dentists using X-rays were very badly affected because they had no idea they could be dangerous. Seems sensible to me to limit how much dose you get given what’s known now. I thought employers had a duty to protect their staff when using X-rays and should follow proper protocol. Leaving the room is a pretty good way to limit dose, the xray machines should be located to minimise exposure too, such as being placed away from the door. That said, in one survey only 57% of those working in hospital endoscopy departments were bothering to wear provided xray protection. What people can’t see isn’t regarded as potentially hazardous. Why chance it?
I had to move cities to access dental treatment and a GP at the end of last year. I can't access dental treatment on the NHS so I've had to go private like so many people now, so I definitely don't want to have any problems with my dentist! 😲
I'd just like to know my rights. So often as thyroid patients we don't listen to our own gut instincts and are fobbed off so have to self advocate, self source thyroid replacement hormones and self manage our health without support - often when we're very poorly and in no fit state to do so. It gets wearing at times 🙄 Apologies if I came across as argy bargy rather than wanting to advocate for the best interests of my health! 🙈😂 It wasn't my intention at all and I really appreciate your input🙂
I've found a few articles that support 'as low a risk as possible' (ALARA) protocols which is very much along the lines of my thinking so thanks for the signposting! It's been a great help! 🙂
I know what you mean about old x ray machines! Scary stuff! 😬It's great that we have resources like this now to learn about and question procedures that may have a short or long term impact on our health 🙏🏻💜
I just refuse and my dentist is fine about it given the family history of thyroid cancer he said he agreed with my thinking.
ALARA or ALARP every time with those things. Theoretically even one low dose xray could cause genetic damage and cancer so the less you can have the better.
Even dentistry recognises dental X-rays are not without risk and it hasn’t even been thoroughly studied. It might be low dose but a high number of exposures is not good, Also they make money out of them encouraging uneccesary exposures. I think they are not something that should be done on a routine basis with no good reason and so does this short:
I'll inquire what the purpose of the 3 x rays are and if they're essential to my treatment plan.
I'll ask my dentist if their satellite surgery has a thyroid shield, if they could loan one from a local dental surgery or invest in one for essential x rays. I think that this is a reasonable request.
I'd struggle to do this. I'm on a low income and money is very tight currently.
Hypothyroidism & long term chronic health issues have meant that I had to reduce my working hours to part time after being unable to work at all at intervals prior to diagnosis and self treatment.
A significant proportion of my income funds my health needs (that should be funded by NHS) - Armour thyroid and vitamin D, K2, B complex & iron supplements. I also received a dental bill of £1200 last week and have to pay £800 this week.
I don't think it's much to ask for dental surgeries to provide shields if it minimizes risk for thyroid patients.
It shouldn't be the patient's ability to pay that allows them to access this protocol as it is with so many aspects of healthcare currently. Particularly relating to women's health issues.
So many women that I know in menopause are fobbed off with antidepressants but completely unable to access the HRT that they actually need. Just like many of us have struggled to access thyroid health support as so many GPs are ignorant about these health issues due to lack of training.
I can understand your concern as the thyroid tissue is considered to be sensitive to radiation, but I think you will be OK.
I worked in medical imaging for 30+ years and I would have asked for a thyroid shield 20 years ago, but not now.
The only thing I would ask is if they are using digital technology or traditional xray film. Digital technology uses a fraction of the radiation that is needed for tradition film imaging .Safety standards are so much higher now and doses so low for all xrays, that there is hardly any scatter, and there has to be genuine justification for any imaging done. ( It’s such a bother processing them they would not be doing them without good reason)
Pantomograms give more radiation, and generally a thyroid shield will cover some of the lower teeth in the image , so not recommended. For a dental xray in the chair, there is such a small dose that I wouldn't worry, but if they have a shield it would be kind of them to use it for your peace of mind, otherwise ask if you can place your hands over your thyroid- that will be enough to absorb any scatter radiation, and it won't harm your hands.
Taking into account the type of radiation used for xrays as opposed to radiation therapies, you would need a lot more than 3 images taken in a short period of time to cause more harm than going for a long walk on a sunny day.
I am now especially wary of x rays.My thyroid was probably becoming less efficient over a period of some years but…
I’m convinced that the radiotherapy I had for breast cancer was what pushed things over the edge and made me quite unwell. By the time I was diagnosed with hypothyroidism I had a TSH of 42. I cannot understand why thyroid shielding is not available on demand, both at dentist surgeries and also radiotherapy units.
I'm so sorry to hear of your experiences 🫂 I hope that you're doing much better now.
I completely agree. We should have a choice to take preventative measures to limit the toxic load on our bodies and sensitive tissues like the thyroid.
I haven’t had dental X-rays in 15 years (but I really do need to soon). My 14 yr old son has braces and they do X-rays several times throughout the process to check progress and reevaluate the treatment plan. I insist he wears the neck/thyroid guard and they are happy to comply. My son has been taught to always ask for it or otherwise decline X-rays in the future for when he is an adult too. Lots of thyroid issues in my family, not worth the risk regardless of who things it’s “totally safe”. Good for you for postponing instead of giving in and second guessing yourself!
Aww thank you for the feedback. I really appreciate it! 🙏🏻 🙂
Good for you for raising your son to self advocate for his own health needs from an early age!
I've learned to trust my instincts and self advocate after suffering hypothyroid symptoms that impacted my daily functioning, work life, relationships, caused me to be unable to conceive and went undiagnosed from my 20's until I became very ill and bed bound when I was 41. I was repeatedly told by doctors that debilitating fatigue / a wide range of other hypothyroid symptoms was just a result of getting older - from my 20's!🙄
Hypothyroidism runs right through the maternal line of women my family. I'm happy to be overcautious in safeguarding my health after past experiences. Worst case scenario I'm being overcautious but this protocol gives me peace of mind. Which counts for a lot!
I'll request a thyroid guard and this might also help other people with thyroid issues attending my dental surgery.
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