Thursday Troubleshooter

Dentist won't confront patients who refuse x-rays

July 11, 2017

Originally Published On:

Dentistry IQ

According to The Dentalaw Group, a dental malpractice resource center, failure to diagnose periodontal disease is one of the leading causes of dental malpractice litigation.1 To properly diagnosis a patient’s periodontal health, radiographs and comprehensive six-site periodontal charting is needed. Typically, hygienists are responsible for completing the periodontal charting and collaborating with the dentist to provide recommendations for scaling and root planing.

Radiographic evidence of bone loss is best determined with adequate and current radiographs,1 most typically a full-mouth periapical survey, including horizontal or vertical bitewings. Radiographic evaluation of the distribution and severity of bone loss, bone density, root anatomy, and approximation to other teeth provides specific information that will help in determining a proper diagnosis of the patient.1 The ADA recommendations for providing radiographs can be found in the table below.

The current situation of the office is unethical, below the standard of care, and putting the licenses of each clinician at risk for lawsuits. The dentist may not fully comprehend the risks of practicing dentistry in this manner. Therefore, it is important that you express your concerns to him about the patients, provide personal and scientific rationale for the proper films, and not operate below clinical and ethical standards.


Table 1: ADA. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. Available at Accessed July 3, 2017.

1. The DentaLaw Group. Dental Malpractice Resource Center. Available at Accessed July 3, 2017.