Brain tumors linked to dental X-rays
April 10th, 2012
12:01 AM ET

Brain tumors linked to dental X-rays

A study published this week in the journal Cancer shows that people who have had dental X-rays are more likely to develop a type of brain tumor called meningioma than those who have not.

This does not prove that dental X-rays cause tumors. But it supports previous research about the connection. Dental X-rays have also been implicated in thyroid cancer. But there's still significant doubt about the existence of any direct relationship between meningioma and dental X-rays, and dental professionals were quick to call for more research, saying the study was less than perfect.

"It’s a cautionary tale ... we do know that radiation can cause tumors, and we have to be judicious with its use," said Dr. Donald O’Rourke, an associate professor of neurosurgery at the University of Pennsylvania who was not involved in the study.

Meningiomas are the most frequently occurring tumor in the head. They are located in the meninges, the tissues covering the brain. The vast majority are "benign" - or noncancerous - but, depending on their location, could cause blindness or other serious neurological damage. Those in the skull base are more difficult to remove in their entirety. Depending on the tumor, surgery may not be required.

Dr. Elizabeth Brooks Claus, director of medical research at Yale University's School of Public Health, led the Cancer study, which focused on patients whose tumors required surgery. The patients were mostly Caucasian because of the regions from which they came; Claus' group plans a follow-up looking at more African Americans, who have a statistically increased risk for meningiomas.

The average age of the 1,433 patient participants was 57, which means their exposures to dental X-rays were likely of a higher radiation doses because of older technology, Claus said. But they ranged between 20 and 79 years old, and came from select parts of the United States. Researchers also looked at data from 1,350 people with similar characteristics who had never had a meningioma.

The meningioma patients had more than a two-fold increased likelihood of having ever experienced a dental X-ray test called a bitewing exam. Depending on the age at which the exams were done, those who'd had these exams on a yearly basis, or more often, were 1.4 to 1.9 times more likely to have had a meningioma.

Four of these X-rays is about the same amount of radiation you're exposed to in a typical day: .005 .millisieverts, according to the American College of Radiology.

Panorex exams, which involve images of all of the teeth on one film, were also linked to meningioma risks. If study participants had panorex exams when they were younger than 10 years old, their risk of meningioma went up 4.9 times. One of these around-the-head X-rays carries about twice as much radiation as four bitewing X-rays.

"My impression is that people get more dental X-rays more frequently than the American Dental Association says," Claus said.

For an adult without cavities and no increased risk for cavities, who is not new to his or her dentist, x-rays are recommended every two to three years. For a child without cavities who's not at increased risk, the interval is every one to two years, according to this chart from the Food and Drug Administration.

There's currently a low threshold for dentists to order dental X-rays, says Dr. Keith Black, director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles, who was not involved in the study. Even if X-rays are not necessary for a procedure, dentists often request them as part an annual exam. Black hopes dentists will pay attention to this research linking the X-rays to brain tumors.

There are important uses for dental X-rays in making decisions regarding certain procedures. But if the teeth are otherwise healthy, Black recommends against the radiation.

There is a latency period - a lag time - of about 20 to 25 years with meningiomas induced by radiation, O'Rourke said. Only about 1% to 5% of meningiomas are cancerous, but in people with known increased radiation exposure, that risk can go up, he said.

But Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, which publishes the journal Cancer, points out that the study relied upon individuals' memories of how many dental X-rays they'd had, including in childhood, so there is room for error in that regard. And, again, it does not prove that X-rays directly cause tumors.

There are, however, estimates that up to 1% of all cancers in the United States are due to medical radiation, Brawley said.

In response to the study announcement, the American Dental Association also mentioned the study's reliance on individuals' memories.

"Studies have shown that the ability to recall information is often imperfect," said a written statement from the ADA. "Therefore, the results of studies that use this design can be unreliable ..."

The ADA also pointed out that the study included people who received dental x-rays decades ago from older technology that exposed them to more radiation. "The ADA encourages further research in the interest of patient safety," said the statement.

If you've already been getting annual dental X-rays, there's nothing you can do to mitigate whatever risk you already have. But Black said this research is important to keep in mind when making decisions in the future, and for children.

soundoff (488 Responses)
  1. Piranha

    You ever wonder, why, dentists run out behind the door to turn on the X-ray gun pointing at your mouth? So they can be safely away from the radiation!. And why do they ask you questions when their fist is jammed inside your mouth. And when they say this will only hurt a bit, tears welled in your eyes. They should say, this will hurt like a mother f....r so be ready.

    April 12, 2012 at 13:35 | Report abuse | Reply
    • Nah

      You're right. Because they deal with X-rays all day and every day, while you do not.

      Please stop being dumb.

      April 12, 2012 at 14:28 | Report abuse |
    • Needed That

      Yup, needed that comic relief, yet some truth to it. e are all Beta testers for gawd what else.
      I'm sure we'll find out later. It's worth living; the surprises are deathly hilarious!

      April 13, 2012 at 04:26 | Report abuse |
    • ipayattention

      what about mercury amalgm (or however you spell that) pretty sure we have known for many years that it screws up your stomach....but it is still used today.....funny thing is it's usually used on lower income individuals.......i would love some sort of science like rebuke from some random know it all troll out there....but i think in the end you will just find im 100% right....get back to me =)

      April 13, 2012 at 11:24 | Report abuse |
  2. Larry Merrill

    Well, at least I will have a nice smile while dealing with my brain tumor!

    April 12, 2012 at 15:16 | Report abuse | Reply
  3. Dr.Smile

    you really want us to grope in darkness when checking your teeth? X-ray examinations as an annual routine are dangerous nonsense in most cases, no reasonable dentist would object to that, but what about invasive procedures? Come on, show a little confidence, just do as you're told and everything's gonna be alright, we doctors do appreciate good compliance!

    April 12, 2012 at 17:21 | Report abuse | Reply
  4. Dr H

    I am absolutely disgusted by this study and the widespread panic it has caused in our office. Have any of you actually taken the time to read this horrible article entirely? It is available online for free through Wiley. This was a very poorly conducted study. There were 3 types of dental xrays studied (bitewings, panorex, and full mouth xrays). While the study says that the panorex and bitewing xrays caused increased risk for meningioma, the full mouth xrays did not pose any significant increased risk!!! For those that don't know, a full mouth xray means the bitewing xrays PLUS 14 additional xrays!! Now if bitewing xrays are so bad, how do they not cause cancer when taken with an additional 14 xrays?!! The reason this was not discussed in the news is because it would show you how dumb this article is...it is a very poor study demonstrating how recall bias works!

    Also, for those of you saying that dentists are taking xrays to make money, just stop. I would never EVER take an xray on a patient that I didn't think was absolutely necessary and in the best interest of the patient. I couldnt sleep at night. I genuinely care about my patients. Why would I risk 4 years of dental school plus 2 more years of residency to make a little extra money? It makes no sense. I treat my patients exactly as I would like to be treated, following the ADA xray recommendations of every 2 years for children unless they have a visible cavity or other risk factor. please give us some credit. Not all dentists are bad or just trying to make money. There are a lot of other professions where you don't have to attend school as long and you can make a heck of a lot more money.

    Just please discuss this article with your dentist. A little bit of skepticism is healthy, but just get your facts straight before making any decisions. Ps don't get your facts from the news, look it up yourself. (a poorly conducted study with conflicting results makes for a not very exciting news story)

    April 13, 2012 at 01:23 | Report abuse | Reply
    • Dr. Z

      Well put, as a fellow dentist, this study made my stomach churn. This study will be revoked as false in a few years, just like the autism/vaccinations study was. This is poor research design leading to widespread panic for no reason and at no help to the public. While everyone should be skeptical, digital xrays are the new technology and emit about 50% less radiation in our office and radiographs are only prescribed when a clinical situation has presented itself (decay, possible fracture, infection, etc.). The patient that refuses all radiographs because of this will unfortunately be subjected to either under-treatment because pathology will not be diagnosed as accurately or expeditiously, or overtreated because a dentist is afraid to let anything go too long.

      April 13, 2012 at 08:25 | Report abuse |
    • mikejdc

      Dr H.
      The point of this article is that it should make EVERY patient aware of potential implications that procedures, such as dental x-rays, can have on their long term health. The bottom line is that dental x-rays, the last I checked, utilizes Ionizing radiation, which potentially can alter the genetic makeup of cells in the human body. That evidence is irrefutable. I am a doctor and have infants. Rest assured I am going to make intelligent decisions when it comes to their dental health and whether xrays are medically necessary.

      April 15, 2012 at 16:35 | Report abuse |
    • Dr H

      Mikejdc, great to see that you will be making intelligent decisions regarding your children's health. I certainly have not suggested that dental xrays be used indiscriminately in an office, and I do believe it is important for parents to be well informed about the risks and benefits of any procedure, including xrays. As I said previously, my problem with this study is that it is poorly conducted and does not clearly report that the FMX had no significant increased risk. Parents need to be well aware of all of the sources of ionizing radiation (and amounts) that their children are exposed to daily. Part of this includes a conversation with the child's dentist, as I suggested. As with any medical procedure, there are risks and benefits to any procedure. Wishing you and your family a lifetime of dental health

      April 18, 2012 at 01:29 | Report abuse |
  5. eroteme

    If this noble 'study' has merit one might wonder why such 'study' comes up now instead of years, decades before.

    April 13, 2012 at 09:59 | Report abuse | Reply
  6. ipayattention

    what about mercury amalgm (or however you spell that) pretty sure we have known for many years that it screws up your stomach....but it is still used today.....funny thing is it's usually used on lower income individuals.......i would love some sort of science like rebuke from some random know it all troll out there....but i think in the end you will just find im 100% right....get back to me =)

    April 13, 2012 at 11:25 | Report abuse | Reply
  7. Lolik

    My father-in-law got a benign meningioma and it has been eight years and he has been through three brain surgeries. My mother-in-law is just saint who patiently cares for her 82-year old husband. I do not want to blame anybody, but I was told that dentists do not perform as many x-rays on them, their families and staff.
    I just know x-ray has never been very safe and when it comes as close as your head, watch out. It is better to loose all teeth and have dentures than have a brain tumor, not being able to walk and wear diapers.

    April 13, 2012 at 14:20 | Report abuse | Reply
    • Aminu

      Wow, this was a really great post. In thorey Id like to write like this also taking time and real effort to make a good article, but what can I say, I procrastinate alot and never seem to get something done. I added a Trackback to it on my weblog. I wish there was a post about prepaid phone plans.

      July 1, 2012 at 00:05 | Report abuse |
  8. Bert

    ever nOTicE how EveRyone Leaves The ROOm befOrE thE x-rAY machinE shOOts yoU WitH radiation?

    April 13, 2012 at 22:42 | Report abuse | Reply
    • tlo07

      Of course. Instead of being exposed to an x-ray once a year (like the patient) they would be exposed to hundreds.

      April 15, 2012 at 12:04 | Report abuse |
  9. CM10

    dental insurance require x-rays before they will pay for crowns, bridges, root canals, pulpotomy's, onlays, extractions, scaling and root planings, implants, composite fillings that are more then 2 surfaces, and when they want to verify that something is or isn't in the mouth. dentists will make a lot more money if you do not have x-rays. a root canal and crown will cost you around $2000. if your lucky. where a small filling is between $130 and $170. dentists have to pay for the x-ray film. they are not making money on the x-rays . dentists are trying to save their pts from having bacteria in their bodies which can complicate any existing health condition such as joint replacements. Please read about periodontal disease and it's effect on your heart. I don't know a dentist that has x-ray vision. They need to be able to take x-rays to see in between teeth, the roots, and the bone surrounding the teeth. My dentist takes the same amount of x-rays on his family(grandchildren included) as he does on his patients whom he thinks of as his friends.

    April 13, 2012 at 23:40 | Report abuse | Reply
  10. Dr.Sailaja Tamtam

    This study has no head and no tail. Just relying upon individuals memory??? How silly?? Some one is going after the well respected Dental profession. Most Dentists are good. Prudent dentists always strive to do what is best for the patient. As some dentist already mentioned yes!! it costs more $$$$ for a RCT, BU and a crown. If we are not preventing disease by Diagnosing correctly at a early phase of disease and wait till pts c/o of pain, its already too late!!! Progression of cavities varies from pt to pt depending on their diet, brushing habits and their regular dental care...

    April 14, 2012 at 10:34 | Report abuse | Reply
    • Loviesplatts

      This is so true. People need to read and read again. Someone read cancer and ran with it. The study had flaws and should be re-visited with better research practices in place. As far as someone needing an exray because they waited too long to be checked, that is the person's irresponibilty coming out not the dentist being overzealous. I have worked for civilian and military dentists and can say they do not take x-rays just like talking about it. People please look at the study carefully, ask questions of your dentist and do not be intimidated by them. If they are good dentists, and 98% of them are; they will welcome your questions with honest answers. Any radiation in excess is unhealthy. So you have to be aware, informed and intelligent enough that if you are going scoff at this type of new, you then need to exercise reasonable behavior.

      May 9, 2012 at 22:35 | Report abuse |
  11. mary

    They tell us now that dental x rays cause brain tumors.. Cell phones cause brain tumors..Mammograms cause tumors and...
    cat scans cause cancer.. and what other medical procedures? Many.

    April 14, 2012 at 16:43 | Report abuse | Reply
  12. mary

    And yet nuclear melt downs do NO harm..?

    April 14, 2012 at 16:45 | Report abuse | Reply
  13. mattandlj

    The dose from those x-rays is MINISCULE. As pointed out in the article, it's about the same dose that you receive in four days from living on Earth (due to normal background radiation that we all receive), and is actually significantly less than you receive on a single flight from LA to NYC. Your body has intrinsic DNA repair mechanisms which can - and do - handle this amount of radiation throughout your life. Junk science article, which I am astonished was published in Cancer, but am not astonished that CNN made into a big headline.

    April 14, 2012 at 17:05 | Report abuse | Reply
  14. bluezone40

    I've had several crowns and root canals and glad that I did (nothing hurts worse than a bad tooth), probably four since 2007. They always take dental x-rays. It's procedure. Guess you take your chances, as with everything else. What about cellphones? Power lines? Working at our computers/laptops every day? To quote from the movie Fight Club: "First you have to give up, first you have to *know*... not fear... *know*... that someday you're gonna die."

    April 14, 2012 at 22:20 | Report abuse | Reply
  15. JWT

    I've had several crowns and root canals and glad that I did (nothing hurts worse than a bad tooth), probably four since 2007. They always take dental x-rays. It's procedure. Guess you take your chances, as with everything else. What about cellphones? Power lines? Working at our computers/laptops every day? To quote from the movie Fight Club: "First you have to give up, first you have to *know*... not fear... *know*... that someday you're gonna die."

    April 14, 2012 at 22:21 | Report abuse | Reply
  16. Mike F

    You don't need a fancy study to know that sending radiation through someone's head increases their cancer risk. I keep asking the dentist to not take so many xrays....for instance one implant and they insist on 4 to 5 complete mouth scans (like the one shown in the picture) before and after the implant is put in.....really?

    April 15, 2012 at 09:34 | Report abuse | Reply
  17. Ryan

    As a professional medical researcher, seeing this published makes me cringe. The study is poorly done and not true

    April 15, 2012 at 11:25 | Report abuse | Reply
  18. tlo07

    Isn't this the same type of tumor recently blamed on cell phone usage?

    April 15, 2012 at 12:05 | Report abuse | Reply
  19. Joe

    I believe in survival of the fittest. Back in the caveman days it was brawn, but now I would say intelligence is an important part to survival. People who can't think with their brains and take in facts, use logical concepts, well they are more likely to make stupid choices which will be detrimental to them. Part of these choices include health related decisions. If a dental x-ray (bitewing) is worth 6 hours of background radiation, then 2 bitewings equals 12 hours background radiation. If you use digital x-rays that's even less. Now if I were to take 1 set of bitewing per year for 50 years, I would have been exposed to 25 days of extra radiation. Let's pretend you started getting 2 bitewings since you were born to make calculations easy. Hence, you have lived 18262.5 days (365.25 x 50), those 25 extra days of radiation equates to 0.00137 extra time lived. Now I understand you may have had some more, or less x-rays in your lifetime. But yes, that 0.00137 of extra time lived on Earth has caused your meningioma ... herp derp.

    Why would a dentist run out .... hmmm. My dentist sees about 14-20 patients a day. Let's pretend he takes 1 xray per patient, 300 days a year because he takes holidays and has weekends off. So lets say he sees 16 a day, that equates to 4800 x-rays a year. Multiply that by 40 years of work equals 192 000 x-rays. That equates to 48000 extra days of radiation. Well 25 doesn't seem so much compared to 48000 days of background radiation. Sigh the stupidity of people.

    April 16, 2012 at 23:21 | Report abuse | Reply
  20. Joe

    Oh and I forgot, if you are worried about dental radiation, might as well not catch a flight anywhere, because you are going to get a lot more radiation in a plane than a dental x-ray.

    April 16, 2012 at 23:58 | Report abuse | Reply
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  33. Alissa Banks

    I work for dentists peterborough and that is very incorrect. That's why we have those heavy blankets to put over your body. It's sufficient protection.

    December 13, 2012 at 16:48 | Report abuse | Reply
  34. Paul

    The other side of this article is the need for healthcare workers to be monitored. Radiation exposure is also detrimental to them. A good govt. website to view your radiation exposure for every day exposure is http://www.epa.gov/rpdweb00/understand/calculate.html


    December 15, 2012 at 10:03 | Report abuse | Reply
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    Implant Dentist TampaThe meningioma patients were more than twice as likely as the adults without brain tumors to have had dental X-rays at some point during their lives, Claus tells WebMD.

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  37. Ashley

    First off even if this is true, everything contains a risk. A dental X-ray is important to see if you have any tooth infection. If you do not know a tooth infection can kill you, if it does spread to other parts of your body. So yes, they take these X-rays to make sure there is no infection and of course to see how your teeth are lined up and what work needs to be done, without them you could not get accurate work done on your teeth. Second of all the dentists go to the other room and take the X-rays because they are exposed to radiation all day and need to protect themselves, unlike the patient who maybe comes in once a every couple of years to get dental work done.

    Also there is no proof of this, do not stop protecting your health just because someone mentions X-rays being linked to brain tumors. I would be more worried about the pills you take daily, for depression, pain pills, and other medicines. Look at the side effects of that crap, thoughts of suicide, uncontrollable poop, stomach issues, blood clots, and some even death. Stop believing everything that you read. I have had plenty of dental X-rays, as well as my kids and my family, and none of us have had tumors.

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