1) Scope and purpose

• Updated patient-selection guidance from the American Dental Association (ADA), endorsed by the American Academy of Oral and Maxillofacial Radiology (AAOMR).
• First major update in >10 years; first to integrate recommendations for both 2D dental radiography and CBCT.
• Central aim: ensure imaging is ordered only when clinically indicated, balancing diagnostic benefit against radiation exposure.

2) Core principles (appropriateness)

• Clinical examination first: imaging decisions should follow history + clinical findings and review of any prior images.
• Imaging is an adjunct to diagnosis/treatment planning, not a screening tool.
• Avoid duplicate imaging and imaging obtained for convenience (e.g., routine schedules without indication).
• Tailor imaging modality and frequency to:
• Patient age and developmental stage
• Disease status (caries/periodontal activity)
• Individual risk profile
• Current clinical question

3) 2D intraoral radiography

• Primary modality for:
• Caries detection (view selection guided by lesion location/anatomy and clinical judgment).
• Initial endodontic assessment (periapical and/or bitewing depending on indication).
• Periodontal baseline: clinical exam + full-mouth 2D series as a baseline reference.
• Follow-up imaging should be driven by disease progression and treatment response, not fixed intervals.

4) Panoramic radiography

• Recommended as initial imaging when clinically indicated for:
• Orthodontic assessment (eruption monitoring prior to treatment; root alignment during treatment).
• Dental development evaluation.
• Third molars and supernumerary/supplemental teeth assessment.
• For suspected temporomandibular disorders (TMD): may be used to rule out gross osseous abnormalities, but low sensitivity limits definitive diagnosis.
• Routine panoramic screening without indication is discouraged.

5) CBCT (3D imaging)

• Reserve CBCT for clearly defined scenarios where additional anatomic detail is needed and cannot be obtained by lower-dose imaging.
• Typical indications include:
• Complex implant planning and presurgical assessment
• Inconclusive findings after 2D imaging
• Endodontic retreatment and selected complex endodontic scenarios
• Selected trauma cases
• Periodontics:
• No evidence supporting routine CBCT use for periodontal management, except complex case planning.
• Optimization:
• Apply dose-reduction strategies.
• Use the smallest field of view (FOV) consistent with the diagnostic task.

6) Pediatric / young adult considerations

• Emphasize judicious prescribing and effective dose reduction.
• Ensure each exam is justified based on clinical findings and risk.

7) Radiation stewardship and related guidance

• Reinforces ALARA (As Low As Reasonably Achievable) across modalities.
• Notes prior (2024) ADA recommendations on radiation safety/regulatory issues, including discontinuation of routine thyroid and abdominal shielding.

8) Practical implications for dental radiologists

• Support referring clinicians with:
• Appropriateness and indication-based imaging selection
• CBCT justification, protocol optimization, and smallest-appropriate FOV
• Avoidance of duplicate imaging
• Clear reporting tied to the clinical question and risk profile

Citation

• “American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography,” Journal of the American Dental Association, January 2026.