Guidelines for Exception-Based Use of Lead Body Shielding in Dental Radiography
While ADA and the Food and Drug Administration now advise against routine use of lead aprons and thyroid collars( PDA recommends the use of thyroid collars as an industry standard unless they interfere with diagnostic procedure) during dental X-rays due to safety of modern digital imaging and beam restriction techniques, certain clinical scenarios warrant thoughtful exceptions to uphold patient safety and trust.
These exceptions are consistent with the ALARA( As Low As Reasonably Achievable) principle, which encourages clinicians to:
• Minimize exposure when justified by clinical need
• Use shielding selectively to reduce anxiety and enhance patient trust
• Balance diagnostic benefit with patient-specific risk factors
EXCEPTION 1: Patients receiving recent high-dose radiation treatment
Clinical Context: Patients who have undergone high-dose radiation therapy( e. g. for cancer treatment) within the past two to three months may have heightened sensitivity to ionizing radiation
Recommended Action:
• Evaluate cumulative radiation exposure and clinical necessity of imaging
• Consider lead shielding as a precautionary measure, especially if multiple radiographs are required
Document rationale for shielding in the patient’ s chart to support ALARA compliance.
Lead Shielding Maintenance Guidelines for Dental Offices / Clinics
For facilities that retain lead aprons and thyroid collars to address exceptional clinical scenarios, the following care and inspection standards must be upheld to ensure safety and effectiveness:
Storage
• Hang aprons flat on heavy-duty, garment-specific hangers or wall-mounted hooks
• Avoid folding, creasing, or draping over chairs or equipment, as this can damage the internal lead layer
• Hang by both shoulder panels to evenly distribute weight and prevent tears
Cleaning
• Clean aprons daily or after each use using a soft-bristle brush and mild soap
• Do not use bleach or harsh chemicals, which can degrade the outer material
• Allow to air dry completely before storing
EXCEPTION 2: Patients Expressing Apprehension – Pediatric & Pregnant Patients
Clinical Context: Despite low radiation doses in dental imaging, pediatric and pregnant patients may often express concern about radiation safety.
Recommended Action:
• Respect and validate patient concerns
• Offer lead shielding for reassurance, even if not clinically necessary
• Educate patients on the safety of modern imaging while emphasizing your commitment to minimizing exposure
Document rationale for shielding in the patient’ s chart to support ALARA compliance. In accordance with the outlined guidelines, all clinicians should retain:
• Thyroid collars for routine use
• One properly maintained lead body shield for use during clinical exception scenarios
Any additional shielding equipment beyond these items may be disposed of in compliance with proper waste disposal regulations.
Inspection
• Conduct annual fluoroscopic inspections to detect cracks, tears, or attenuation flaws
• Document inspection results and retire any shielding with compromised integrity
• Follow manufacturer-specific guidelines for testing and replacement intervals
PDA will continue to monitor and share any changes to regulations or guidance.
Note: Lead aprons are considered hazardous waste due to their toxicity. Lead aprons must be recycled or disposed of as hazardous waste by a licensed waste hauler. Please see PDA’ s Waste Management Guidelines for disposal options.
NOVEMBER / DECEMBER 2025 | PENNSYLVANIA DENTAL JOURNAL 31