ADA Updates Dental Imaging Guidance for the Modern Practice
The American Dental Association has released its first major update to dental radiography recommendations in more than a decade, offering clearer guidance on when and when not to take dental X-rays. The new recommendations emphasize patient-specific decision-making and address both traditional two-dimensional imaging and newer cone-beam computed tomography.
If your practice has upgraded its imaging technology over the past decade, the American Dental Association’s (ADA) newly released radiography recommendations are right on time. Published in the January issue of the Journal of the American Dental Association, the updated guidance modernizes how oral health professionals think about diagnostic imaging, placing clinical judgment firmly in the driver’s seat.
At the heart of the update is a simple message: dental X-rays should be prescribed only when they are clinically justified. Rather than relying on routine schedules or convenience, imaging decisions should be based on a careful review of the patient’s medical and dental history, disease risk, prior images, and current clinical findings. The goal is to maximize diagnostic value while minimizing cumulative radiation exposure over a patient’s lifetime.
For the first time, the ADA’s recommendations address both two-dimensional radiographs and cone-beam computed tomography (CBCT) within the same framework. This is a notable shift, reflecting how common advanced imaging has become in everyday practice. While CBCT can be invaluable for implant planning, endodontics, evaluation of cracked teeth, temporomandibular disorders, and complex cases, the guidance reinforces that its use should be selective and reserved for situations where lower-dose imaging cannot answer the clinical question.
The recommendations also refine how clinicians think about recare intervals. Instead of one-size-fits-all timing, imaging frequency should reflect individual risk factors such as age, dental development, caries risk, periodontal status, and signs or symptoms of disease. Reviewing previously obtained images, whether from your own records or another provider, is emphasized as a best practice to avoid unnecessary duplication.
This update builds on the ADA’s 2024 publication focused on radiation safety, which concluded that routine use of thyroid collars and lead aprons is no longer necessary due to advancements in imaging technology and reduced radiation doses. Patients are increasingly curious and sometimes anxious about X-rays, and these guidelines provide a strong evidence-based foundation for explaining why an image is needed, or why it is not. Click here to read more.
