Exposing Radiographs

Added to Handbook: November 2015

PURPOSE

To provide guidelines around the initiation, exposure, interpretation, and sharing of radiographs for dental hygienists. 

BACKGROUND

The College recognizes the exposure of radiographs as part of the CDHBC Scope of Practice as defined in the Dental Hygienists Regulation. The regulation states that registrants of the CDHBC may “assess the status of teeth and adjacent tissues and provide preventative and therapeutic dental hygiene care for teeth and adjacent tissues.”  

Part of the assessment phase included in the ADPIE process of care involves a periodontal assessment, which may include a radiographic component. Quality radiographs assist in determining the extent of the periodontal disease based on alveolar bone levels as well as possible causative factors such as hard deposits. This, in combination with other assessment information, assists the dental hygienist in formulating a dental hygiene diagnosis in order to develop a dental hygiene care plan with client specific interventions. 

Dental hygienists have the education to interpret normal radiographic findings related to dental/oral anatomy and dental materials, and understand how to interpret radiographic findings that fall within the Dental Hygiene Scope of Practice. Registrants also have the education to refer clients to the appropriate dental or medical professional when abnormal findings are observed on the radiograph that fall outside the Dental Hygiene Scope of Practice, or when further follow up is required.

Radiographs are considered a legal component of the client’s treatment record.  As such, they must be maintained in accordance with governing legislation including the CDHBC policies.  As outlined in the CDHBC Practice Standard 8.6: ”When a dental hygienist owns the client’s records, dental hygienists must retain records in a secure manner for no less than 16 years after the last client appointment.” This aligns with the Limitations Act, which requires client records to be maintained in a secure manner for a period of 16 years after the last visit. 

POLICY

Dental hygienists may self-initiate the exposure of radiographs and subsequently interpret radiographic findings as they pertain to the Dental Hygiene Scope of Practice. Radiographs are considered an adjunct assessment tool that supports the dental hygienist in formulating the dental hygiene diagnosis and treatment plan. The decision to expose a radiograph should be made based on the individual needs of the client in conjunction with relevant assessment data (e.g. not based on a standing office policy). Registrants are not allowed to self-initiate a radiographic exposure for any purpose that falls outside of the Dental Hygiene Scope of Practice without a prescription from a dentist.  

The dental hygienist must obtain consent from the client prior to exposing a radiograph. Authorization must also be obtained from the client and documented in the client treatment record prior to sharing any radiographs with a dentist or another dental hygienist. Security measures should be in place when sharing radiographs via email.

Client exposure to radiographs should follow the principle of ALARA (as low as reasonably achievable). Therefore, attempts must be made whenever possible to obtain recent radiographs from another dental health care provider to avoid unnecessary exposures. Registrants must ensure the quality of the exposures.  

The dental hygienist is responsible for documenting the number of radiographic exposures as well as the radiographic findings in the client’s treatment record. Radiographic findings must also be discussed with the client. Any findings on the radiograph exposure that fall outside of the Dental Hygiene Scope of Practice must be referred for consultation to the client’s dentist and/or other appropriate health professional. This referral must be documented in the client’s treatment record. 

The dental hygienist who owns the client’s records, including radiographs, is responsible for keeping these in a secure manner for a period of no less than 16 years.  

There may be a time when a client refuses the radiographs that have been recommended. This is a client’s right; however, the client must be informed of the rationale for taking the radiographs as well as the risks associated with refusing radiographs. This information must be documented in the client’s treatment record and initialed by the dental hygienist. The College has an interpretation guideline titled Informed Refusal to Consent, which should be consulted to ensure all components for informed refusal of a service are taken into consideration.  

Cone beam tomography captures a 3D image of the client’s head and neck region. Such images are not required when determining a dental hygiene diagnosis.  As such, dental hygienists are not allowed to self-initiate cone beam tomography. A dental hygienist may only expose this type of image under the direction of a dentist and with proper education as defined in the CDHBC Scope of Practice Statement. As the majority of the image captured falls outside the scope of dental hygiene practice, the dental hygienist should ensure that the dentist completes the interpretation of the image. 

REFERENCES