Dental radiography is an essential part of dentistry as it is a crucial diagnostic tool and image of the human teeth that the dentist uses to evaluate the oral health. Previously, dental imaging was prevented during pregnancy, particularly during the first trimester (the earliest phase of pregnancy), to keep the developing fetus safe. As a result, oral health may be compromised during pregnancy, and medical imaging examinations for accurate diagnosis and management of various dental conditions may be required. Pregnant women are typically hesitant to have dental radiography taken, which may delay necessary treatment and negatively impact the health of both the fetus and the mother.
When the measurements of radiation protection are applied during dental imaging for pregnant women, the imaging will be safe with no risks [24]. Radiation doses can be largely minimized by different measures [2]. The best way to decrease radiation doses by a factor of 10 is by applying F-speed film (digital sensors) in integration with rectangular collimation for bitewing and full mouth radiographs [25].
A small percentage of the participants had knowledge that dental radiographs can be obtained over any trimester but with the application of radiation protection techniques. Almost two-thirds of the respondents reported that it was prevented in all trimester pregnancies. Most participants thought that CBCT and panoramic radiographs were avoided during pregnancy. Less than 19.5% of the participants were confused about the radiation protection applications that should be applied during dental radiographs. The majority of participants had mistakes or misconceptions, for example, about the presence of a particular lead apron designed for pregnant patients or that double layers of lead aprons are required. Although the risks from dental imaging are low to nonexistent even without the use of fetal and gonadal lead shields [26], it is recommended that even if the lead shielding is unimportant, it provides the patient with comfort and a sense of protection [26,27,28].
A potential justification about the awareness of risks from dental imaging is the shortage of public radiation knowledge programs. Moreover, it is possible that patients are not knowledgeable regarding radiation protection and hazards from their dentists. A previous research study by Al Faleh et al. [23] mentioned that about 40% of the patients were not informed regarding the radiation risks by their treating dental practitioners. Most of the patients did not in the least inquire about protection measures before taking an imaging. Also, patients’ loss of information could be a throwback to incomplete knowledge between dentists. A comprehensive literature review mentioned that there is global concern about dentists’ knowledge in terms of dental radiographs over pregnancy. Various research and review studies have reported that the awareness of dentists, dental students, and interns about radiation and its safety is insufficient [16, 18, 29,30,31]. Another research study, Aboalshamat et al., reported that 67% of dentists believed periapical imaging was safe only over the second trimester (spanning week 14 to week 27). 69% of the participants underwent panoramic imaging while pregnant [30].
However, 2% of dental practitioners knew that a dental radiograph was safe in all trimesters of pregnancy, whereas 44% believed it was unsafe in any trimester [29]. Moreover, a research study in Jordan discovered that more than half of the Jordanian dentists believed that panoramic radiographs were avoided during pregnancy, while less than 33% did not know if they were safe or not [18]. Llea et al. [16] pointed out that more than two-thirds of dental practitioners would ask for dental imaging only for emergency needs. It may be that dental professionals have no knowledge about the considerable dose reduction linked with digital imaging compared to conventional film. A shortage of information could cause great anxiety for both dental practitioners and pregnant women searching for dental treatment during pregnancy.
Information regarding radiation doses from dental radiographs proportional to the background radiation dose was insufficient. The comparison in doses between the periapical imaging and the background radiation was not assured among most participants. As a comparison, the dose of single bitewing imaging obtained with a suitable collimator (rectangular collimator) and photostimulable plate is less than the dose of one day of background radiation [25]. The National Council on Radiation Protection and Measurements mentioned that the dose for fetal from full-mouth intraoral imaging is 4–6 times less than the dose of background radiation during a mother's pregnancy [2].
Regarding congenital deformities, a very small percentage of participants knew that such hazards were not linked to dental radiographs, while more than half of the respondents knew that the hazard of radiation-induced congenital deformities from dental imaging was very high. In a similar way, Razi et al. [32] reported that only 28% of dentists realized that radiation exposures from diagnostic radiographs do not affect congenital deformities or fetal mental problems. Concerning fetal deformities, the International Commission for Radiation Protection states that the fetal absorbed dose must be equal to or greater than the threshold dose of 100–200 mGy. This is quite more than the fetal absorbed exposures from diagnostic imaging, in addition to nuclear imaging. In studies applied to humans and animals, there is no proof that the range of radiation dose from diagnostic imaging (i.e., less than 50 mGy) is related to a raised hazard of teratogenic impacts [24, 33, 34].
The danger of infant cancer is complex to estimate from low-level doses, such as dental radiographs [25]. In this study, participants lacked assurance regarding the oncogenic hazards of dental radiographs. The remaining, nearly one-third of the participants, thought that the hazard was large; less than one-third thought that the hazard was low; and the remaining nearly one-third thought the hazard did not exist at all. The note that radiation can lead to cancer is obtained from previous studies of the atomic bombs that happened at Hiroshima and Nagasaki and other group studies. Furthermore, epidemiologic studies have not been successful in establishing a link between the dose and cancerogenic effects [25, 33, 34]. The fetal head dose from a single computer tomography (CT) scan has been measured in the range of 0–0.005 mGy [33, 34].
The limitations of this study are diverse for several reasons, such as the absence of revealing the causality; applying snowball sampling, which weakens the potency to popularize the results; this study may be able to self-chosen bias due to the kind of recruiting participants that may venture both internal and external legality.
The future recommendations of this research study are guaranteed to evaluate obstetricians’ view of radiation dose and hazard linked with different dental radiographs during pregnancy. In addition, further research will be proposed to estimate the efficacy of an educational intervention tailored to teach people about radiation exposure and danger to their advantage.
