Dental x‐rays and risk of meningioma

Abstract

Context Ionizing radiation is a consistently identified and potentially modifiable risk factor for meningioma, the most frequently reported primary brain tumor in the United States. Objective To examine the association between dental x-rays, the most common artificial source of ionizing radiation, and risk of intra-cranial meningioma. Design and Setting Population-based case-control study design. Participants The study includes 1433 intra-cranial meningioma cases aged 29-79 years diagnosed among residents of the states of Connecticut, Massachusetts, North Carolina, the San Francisco Bay Area and eight Houston, Texas counties between May 1, 2006 and April 28, 2011 and 1350 controls that were frequency-matched on age, sex and geography. Main Outcome Measure The association of intra-cranial meningioma diagnosis with self-report of bitewing, full-mouth, and panorex dental x-rays. Results Over a lifetime, cases were more than twice (Odds ratio (OR) = 2.0, 95% confidence interval (CI), 1.4-2.9) as likely as controls to report having ever had a bitewing exam. Regardless of the age at which the films were received, persons who reported receiving bitewing films on a yearly or greater frequency had an elevated risk with odds ratios of 1.4 (95%CI: 1.0-1.8), 1.6 (95%CI: 1.2-2.0), 1.9 (95%CI: 1.4-2.6), and 1.5 (95%CI: 1.1-2.0) for ages <10, 10-19, 20-49, and 50+ years, respectively. Increased risk of meningioma was also associated with panorex films taken at a young age or on a yearly or greater frequency with persons reporting receiving such films under the age of 10 years at 4.9 times (95%CI: 1.8-13.2) increased risk of meningioma. No association was appreciated with location of tumor above or below the tentorium. Conclusion Exposure to some dental x-rays performed in the past, when radiation exposure was greater than in the current era, appears to be associated with increased risk of intra-cranial meningioma. As with all sources of artificial ionizing radiation, considered use of this modifiable risk factor may be of benefit to patients.

Assessment of Apical Periodontitis by MRI: A Feasibility Study

“…Due to the underlying physical principle, all X-ray (XR)-based imaging techniques have limited capabilities in soft tissue characterization and are supposed to be limited in the differentiation between chronic and acute periapical lesions that may have an impact on the treatment strategy. Furthermore, the related ionizing radiation with its well-known risks [16] limits the application of CBCT for longitudinal monitoring especially in young patients. Magnetic resonance imaging (MRI) has shown excellent results for soft-tissue visualization without any harmful radiation.…”

The Image Gently in Dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children

“…10 The typical effective doses associated with intraoral examinations such as the bitewing (5 mSv) and full-mouth series (range, 34-388 mSv) or extraoral imaging such as panoramic radiography (range, 14-24 mSv) 5,11 are substantially lower than those typically provided by conventional head CT (median, 2000 mSv; range, 300-6000 mSv). 12 Nonetheless, recent concerns over radiation risks associated with these procedures have also been raised in dentistry, 13 particularly in association with intracranial meningioma 14,15 and thyroid cancer. 16,17 Although the validity of these epidemiologic studies has been called into serious question, 18,19 the contribution of xray exposure from dentistry to per capita annual dose may well be increasing, as is the case in diagnostic imaging in general, which now accounts for almost 50% (3000 mSv) of annual per capita radiation dose in the United States (6200 mSv).…”

Dental x‐rays and risk of meningioma

“…1 This study has a number of issues that were not adequately addressed and that may have compromised the validity of its findings.…”