Dental hygienists on the General and Courtesy Registers are authorized to order and/or apply any form of ionizing radiation in medical radiography. Authorization to perform this restricted activity is for the purpose of ordering dental X-ray imaging procedures and/or applying ionizing radiation for dental X-ray imaging procedures as a part of the practice of dental hygiene.
The dental hygienist orders and/or applies ionizing radiation safely and appropriately for the purpose of dental X-ray imaging procedures.
The dental hygienist who orders ionizing radiation for a dental X-ray imaging procedure must…
- Protect the patient from excessive radiation exposure in accordance with applicable legislation, policies, and guidelines, including Safety Code 30.
- Base the order on the clinical history and clinical assessment of the patient, professional judgment, and consideration of current, evidence-informed guidelines for prescribing radiographs.
- Justify that the results of the ordered procedure could inform their dental hygiene treatment decision to a degree that the benefits outweigh any risks.
- Confirm that there are no previous images available which would avoid the need for additional dental X-ray imaging procedures.
- Document the clinical objective for the order, including the clinical rationale and specific information required from the dental X-ray imaging procedure.
- Keep the number of ordered dental X-ray imaging procedures to a minimum, consistent with the clinical objective for the order.
- Only prescribe a higher dose X-ray imaging procedure if the clinical objective cannot be satisfactorily met by other lower dose dental X-ray modalities.
- Support the patient’s informed choices and obtain informed consent in accordance with the College’s Informed Consent Standard of Practice. This also includes discussing the following with the patient:
- The clinical rationale for recommending the procedure; and
- How the results will be used by the dental hygienist.
- Ensure that the ordered image(s) are fully interpreted, and all abnormal, atypical or unhealthy radiographic findings are documented in the patient record by either:
- Interpreting the image themselves; or
- Consulting with or referring to another health professional.
- Explain the relevant radiographic findings to the patient, provide the necessary follow-up, and refer the patient to an appropriate health professional when required.
The dental hygienist who applies ionizing radiation for a dental X-ray imaging procedure must…
- Only apply ionizing radiation when there is a patient-specific order from an authorized health professional, including when the dental hygienist has ordered it themselves in accordance with this Standard of Practice.
- Consult with the ordering health professional and take reasonable steps if an order is unclear, incomplete, outdated, illegible, inappropriate, or unsafe.
- Protect the patient and others from radiation in accordance with applicable legislation, policies, and guidelines, including Safety Code 30.
- Maintain records of retakes to facilitate a radiation quality assurance program.
The dental hygienist who owns ionizing radiation equipment must…
- Ensure radiation equipment is inspected and registered according to applicable legislation and provide evidence of current registration to the College.
- Ensure that a radiation protection program is developed, implemented, and maintained for the facility.
- Fulfill the responsibilities of a dental X-ray equipment owner as described in Safety Code 30.
The patient can expect that the dental hygienist discusses the risks and benefits of dental X-ray imaging procedures and safely takes X-ray images only when necessary for detecting or diagnosing oral health conditions.
APPLY: To expose a patient to ionizing radiation for the purpose of a dental X-ray imaging procedure.
DENTAL X-RAY IMAGING PROCEDURE: A technique that uses dental X-ray equipment in dental radiography, including the use of intra-oral (conventional, transportable, and hand-held) or extra-oral (panoramic, cephalometric and cone-beam computed tomography) modalities. It does not include the ordering and/or applying of ionizing radiation for any other medical diagnostic purpose or for any form of dental or medical radiation therapy.
EVIDENCE-INFORMED: The integration of best available evidence with clinical expertise and patient values1. This approach involves identifying, searching for, and interpreting the result of the best available evidence to inform decision-making processes.2
INFORMED CONSENT: Receiving the patient’s written or verbal permission to proceed with a proposed service following a process of decision-making leading to an informed choice. Informed consent involves ongoing communication between the parties involved. In the case of a minor or others who do not have the capacity to provide informed consent, the agreement must come from a legal guardian or substitute decision-maker legally authorized to act on behalf of a patient.
LEGISLATION: Federal or provincial acts, regulations, or codes.
ORDER: To prescribe a dental X-ray imaging procedure for a patient.
RECORD: As defined in the Health Information Act, means a record of health information in any form and includes notes, images, audiovisual recordings, x-rays, books, documents, maps, drawings, photographs, letters, vouchers and papers, and any other information that is written, photographed, recorded, or stored in any manner, but does not include software or any mechanism that produces records.
- Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2019). Evidence-Based Medicine: How to Practice and Teach EBM (5th ed). Elsevier.
- Federation of Dental Hygiene Regulators of Canada. (2021) Entry-to-Practice Canadian Competencies for Dental Hygienists. Accessed from: www.fdhrc.ca/wp/wp-content/uploads/2021/12/EPCCoDH_FDHRC_November_2021.pdf