C O N T I N U I N G E D U C AT I O N
Australian Dental Journal 2000;45:(3):208-213
Are dental radiographs safe?
Paul Abbott*
Abstract
Dental patients are often aware that radiation has
the potential to harm them but they do not usually
understand how or why and what potential harmful
effects may arise from dental radiographs. The
potential for undesirable effects must be balanced
against the benefits obtained from radiographs.
Dentists should address the concerns of patients
who question the need for radiographs and allow
them to make an informed decision. Data are
available that relate radiation exposure levels from
medical and dental radiographs to normal back-
ground exposure levels and allow comparisons
with everyday risks in life. Recognized radiation
authorities publish guidelines to help dentists with
their use of radiographs, although, due to the time
lag associated with testing and the publication of
results, some of the published data may not
always be entirely relevant to currently used X-ray
machines and techniques. Dentists also have
professional obligations not only to limit the use of
radiographs to potentially beneficial situations but
also to take good quality diagnostic radiographs,
to limit the doses used, to use good radiation safe-
ty measures and to use modern equipment to
achieve the best possible films. Radiographs must
then be properly developed and viewed under
appropriate conditions to gain the maximum pos-
sible diagnostic information from each exposure.
Key words: Radiographs, radiation, safety.
(Received for publication June 1999. Revised August
1999. Accepted August 1999.)
History
Wilhelm Roentgen accidentally discovered X-rays
in 1895 when he produced an unintentional radio-
graph of his own hand. He called the radiation X
because of its unknown qualities.1 Just two weeks
after Roentgens announcement about the new X-
rays, Dr Otto Walkhoff produced the first dental
radiograph this was an extra-oral film of a patients
jaws and he used an exposure time of 25 minutes. A
few months later, in early 1896, Dr C Edmund
Kells, a New Orleans dentist, took the first intra-oral
radiograph.1
*Endodontist, Senior Fellow, School of Dental Science, The
University of Melbourne, Victoria.
208
Early reports of radiation damage
Dr Kells was the first person to note problems
associated with the use of X-radiation. He reported
that long exposures caused a mild skin irritation
which was similar to sunburn, although it vanished
after a short time. The early X-ray machines needed
to be set and adjusted for each use. To do this, the
operator would place his hand between the actively
radiating tube and the film plate to check the
apparatus was working and was focused on the film.
After 12 years of taking radiographs in this way,
Kells noticed cancerous tumours on his fingers. He
subsequently had 35 operations to his fingers,
including several amputations, as a result of these
tumours. He committed suicide in 1928, aged 72.1
In the intervening years, other effects of radiation
have become evident, with a high occurrence of
bone sarcomas in workers using radium luminous
paints on watches, lung cancers in uranium miners,
skin erythema and leukaemia in radiologists, and
leukaemia and other malignancies among the
survivors of Hiroshima and Nagasaki.1,2
How does X-radiation damage tissues?
X-radiation is a form of energy. The X-rays can
pass through matter and disperse this energy. The
effect of energy dispersion will depend on the atomic
structure of the object and the energy of the beam.
Soft tissues are particularly susceptible to radiation
damage since they are essentially weak aqueous
solutions. Radiation damage to tissue can be classed
as either direct or indirect damage.1-2
Direct damage occurs when there is a direct hit of
a molecule by a photon or electron. Direct hits are
likely to affect the DNA and RNA molecular bonds
since their natural bond forces are only a few
electron volts compared to the many thousands of
electron volts produced by X-ray photons. Molecules
affected in this way are unable to pass on important
genetic information which results in mutilation, cell
death, carcinoma or genetic abnormalities.2 Heat is
also generated which may cause cellular changes
which are usually followed by normal physiological
healing processes.
Australian Dental Journal 2000;45:3.
Table 1. Relative tissue radiosensitivity* Table 2. Annual collective doses in the United
Tissue Relative radiosensitivity Kingdom in 1983*
Gonads 0.25 Source Effective %
Breast 0.15 Natural 77.80
Bone marrow 0.12 Medical 20.90
Lung 0.12 Fallout 0.41
Thyroid 0.03 Occupational 0.45
Bone surfaces 0.03 Nuclear waste 0.11
Remainder 0.30 Miscellaneous 0.34
Total 1.00 Total 100.00
*Adapted from Smith2 and the ICRP.8 *Adapted from Smith.2
Proportion of risk when the whole body is irradiated uniformly.

Indirect damage occurs when electrons hit other
atoms in their pathway and cause further ionization
and excitation this creates highly reactive ionized
molecules. Oxidation/reduction reactions occur
which disrupt enzymes and nucleic acids with
consequent damage to cell function and
reproduction.2
The biological effects of radiation can be classified
as somatic or genetic.1-2 Somatic effects concern the
individual person who has been irradiated and they
can be either acute or long-term effects. On the
other hand, genetic effects might undesirably
influence the progeny of the person who has been
irradiated. The actual effects that occur will depend
on the tissue radiosensitivity which is a function of
the tissues mitotic activity and varies considerably
throughout the body (Table 1). Typical acute effects
of radiation are skin erythema, pigmentation and
ulceration. Long-term effects include radiation-
induced leukaemia, cancer and genetic damage.1-2
Some authorities claim that any dose of radiation
has the potential to induce malignant changes even
small doses can cause damage to tissues and there is
no threshold dose below which radiation is
predictably safe.2 Once a malignancy has been
induced, the disease will follow its normal course
until it is clinically manifested, which may be many
years later. For example, radiation-induced
leukaemia takes an average of 12 years to manifest
and solid tumours may take more than 20 years.2
Hence, it is difficult if not impossible to show a
direct cause and effect of a particular exposure to
radiation to a particular cancer due to this latent
period of onset of symptoms and the high possibili-
ty that numerous radiographs have been taken for
medical and dental purposes throughout the
patients life. There are also many other potential
causes of malignancies to which people are exposed
throughout normal life, such as chemicals, foods and
food additives. Hence, not all malignancies are
caused by exposure to radiation.
Fortunately, the potential effects of radiation from
dental X-ray machines are minimal. Whole body
effects are unlikely as heat would burn out the X-ray
machine before a sufficiently large enough dose
Australian Dental Journal 2000;45:3.
could be generated. Partial body effects are possible
but also very unlikely for the same reason.2
Sources of radiation
There are many possible sources of radiation to
which people are exposed every day. Man-made
radiation accounts for about 25 per cent of the
Annual Collective Dose (ACD) of radiation to
which people are exposed, while natural background
radiation provides the other 75 per cent of the
annual dose.2 Typically, about 33 per cent of the
natural background radiation comes from cosmic
radiation (for example, the sun, stars, etc) and the
other 67 per cent from terrestrial radiation (that is,
natural radioactive substances on earth). The
amount of natural background radiation is
approximately 3Sv per year although the actual
amount varies in different locations throughout the
world; for example, countries such as Brazil, India,
China, France and Russia have 10-15 times more
natural background radiation than Australia.
Average figures for the ACD in the UK are shown in
Table 2. The dose for the UK is equivalent to
approximately 200Sv per year and the theoretically
predicted number of malignancies arising from this
level of exposure is less than three per year.2
Comparative doses of radiation
In order to allow meaningful comparisons
between various sources of radiation, the
Background Equivalent Radiation Time (BERT)
unit has been established. BERT is the number of
hours, days, weeks, months or years of exposure to
Table 3. Some examples of Background
Equivalent Radiation Times (BERT)*
Effective
Event BERT
dose (Sv)
One transatlantic flight 5 days 37.5
One flight Europe to Australia 15 days 112.5
Chest radiograph 4 days 30.0
Dental panoramic film 28 hours 7.0
Intra-oral PA with D speed film and
- round collimator 16 hours 4.0
- rectangular collimator 8 hours 2.0
*Adapted from Macdonald3 and the NRPB.10
209
Table 4. Comparative radiation doses of some Table 6. Relative exposures and
dental examinations compared with a chest radiation doses
radiograph and their Background Equivalent Highest Medical
Radiation Times (BERT)*
Radiotherapy treatment for carcinomas
Effective Equivalent CT scans: chest > abdomen > pelvis > spine > brain
Investigations BERT
dose (Sv) chest films Radiography: IV urogram > barium studies > spine >
abdomen > pelvis > skull > chest > knee
1 PA or BW 4 0.13 16 hours
Dental
Endo (4-5 PAs) 16-20 0.6-0.8 3.3 days
Panoramic film
FMS (10-15 films) 40-60 1.3-2.0 6.7-8 days
Lowest Intra-oral periapical and bitewing films
Panoramic film 7 0.2 28 hrs
Chest 30 1.0 4 days
*Adapted from the NRPB.10
PA=periapical film; BW=bitewing film; endo=series of films for
endodontic therapy on one tooth; FMS=full mouth survey. The risk of induction of fatal cancer or serious
Intra-oral films taken at 70kVp with D speed film and a round hereditary ill-health from radiation has been
collimator.
calculated to be 1 in 80 per Sv.2 This equates to an
estimated risk from dental panoramic tomography of
about one in a million (10-6) per film while the
natural background radiation that would equate to
estimated risk from intra-oral radiography is about 1
an adult receiving the same effective dose from
in 10 million (10-7) per exposure for intra-oral films
generated ionising radiation sources such as a dental
such as periapical and bitewing radiographs.2
X-ray machine.3 Some examples of radiation doses
However, the risk-estimates depend on the shape
expressed as BERT are listed in Table 3.
and length of the collimator, or position-indicating
X-ray examination of the chest has been a device, as reported by Cederberg et al.5 They showed
common procedure in medicine and one the general that long and short rectangular cones (23.3 and
public is usually familiar with. Hence, the dose of 35.3cm, respectively) have the lowest probability for
radiation from a single chest X-ray examination has stochastic effects (1 in 4.610-6), followed by long
become a standard with which radiation doses from round cones (1 in 1610-6), short round cones (1 in
other radiological examinations are compared.4 2310-6) and pointed cones (1 in 2610-6). All of
Comparative radiation doses from a range of dental these cones were open-ended except the short
and medical procedures are shown in Tables 4-6. pointed cone which was closed.5
Danforth and Torabinejad6 estimated the risks of
Risks of radiation
inducing various forms of carcinomas from
There are various methods for calculating and endodontic radiography and compared them with
expressing the risks of radiation. However, due to the other everyday risks (Table 7). These figures can be
latent period between the induction of a malignant compared with other one in a million risks7 (Table
lesion and its clinical manifestation, it is not possible 8) and they can be used to reassure patients that the
to determine whether any one particular exposure risk, although present, is extremely low and it is
has initiated some damage.2 Therefore, most of the being consistently reduced by new technology. The
published figures are estimates that should be estimates used by Danforth and Torabinejad are
considered with caution. Also, with the rapid based on an endodontic survey which they defined
advances in technology and image receptors, dose as being eight periapical films.6 However, many
reduction is a continuous process; thus published practitioners would typically take less than this
figures are useful guides but they are often outdated number of radiographs. An analysis of the authors
before they can be published. practice records over 16 years indicates an average of
between four and five films per tooth are taken
during the course of endodontic treatment.
Table 5. Comparative radiation doses
Danforth and Torabinejads report did not specify
of various medical examinations and
what type of cone was used but they did compare
their Background Equivalent Radiation
films taken with 70kVp and 90kVp machines. The
Times (BERT)*
results indicated that the use of 70kVp machines
Approximate equivalent reduced the risks slightly.6
Investigation BERT
number of chest films
A further example from Danforth and
Chest 1 4 days
Skull 5 20 days Torabinejads study6 concerned radiation exposure
Dorsal spine 50 6 months to the eyes. The mean dose to the eye from one
Lumbar spine 120 14 months
CT exam brain 100 1 year
endodontic survey was calculated to be 182.75Sv.
CT exam chest 400 4 years The threshold dose to induce cataracts is 2 million
Barium study large bowel 450 4.5 years Sv, so the number of endodontic surveys of eight
*Adapted from Perkins.4 films per survey to equal this threshold is 10,900,
210 Australian Dental Journal 2000;45:3.
Table 7. Estimated radiation risks associated with taking eight periapical films during endodontic
therapy with a 70kVp X-ray machine and D speed films*
Tissue site X-ray dose (Sv) Risk of neoplasia No of cigarettes Km driven
Bone marrow 56.3 1 in 909 million 0.8 3
Thyroid gland 122.6 1 in 833 000 8.7 34
Salivary gland 938.0 1 in 1.43 million 5.1 20
*Adapted from Danforth and Torabinejad.6
The estimated risk of inducing neoplasia from the radiation dose received from the eight exposures.
The number of cigarettes that need to be smoked to have the same risk of dying from smoking-induced cancer.
The number of kilometres that need to be driven to have the same risk of dying in a car accident.

which is 87,200 periapical films an unlikely
number of films to be taken on one patient!
While the above figures indicate the risks are very
low for each film exposed, it is important to consider
that the effects of radiation may also be cumulative.
Therefore, practitioners should carefully consider
the need and the potential benefits as well as the
potential harm for every film proposed. The number
of previous radiographs (both medical and dental)
should not be ignored and patients concerns should
be carefully considered and discussed with them.
Radiation protection
Dentists must be aware of, and use, safe practices
for radiation procedures at all times. The
International Commission on Radiological
Protection (ICRP) has published guidelines8 for
radiation protection since 1928. These guidelines
have been updated from time to time and they
concern protection for patients as well as protection
for operators of radiation generating equipment.
In Australia, in 1987, the National Health and
Medical Research Council (NHMRC) published a
booklet entitled Code of Practice for Radiation
Protection in Dentistry.9 Although now somewhat out
of date, this booklet provides guidelines for all
aspects of dental radiography, including exposure
levels, radiographic techniques, processing techniques
and interpretation of films.
Without due care, due to their increased exposure
to radiation at work, both dentists and their staff are
at risk of developing radiation-induced diseases.This
is in addition to any radiation they receive from
Table 8. One in a million risks in
everyday activities*
Situation Quantity
Cigarette (cancer) 1 pregnant women for a number of reasons (see
Living as a man (dying) 20 minutes
Living in New York (pollution) 2 days
Canoe accident 6 minutes
Bike accident 16km
Car accident 500km
Commercial plane accident 1600km
Plane travel (cosmic radiation) 9600km
*Adapted from Pochin.7
Australian Dental Journal 2000;45:3.
natural background and man-made sources during
their leisure time. Any exposure at work has no
therapeutic benefit and needs to be kept to an
absolute minimum at all times.2
Reducing the risks of X-radiation
All dentists have a professional responsibility to
their patients, staff and themselves to minimize any
risks which might be associated with radiation.
In order to reduce the risk of radiation damage to
patients, practitioners should follow the ALARA (as
low as reasonably achievable) principles.1-2,9 This
applies to all aspects of radiography including when
to take films, how many films should be taken, what
dose to use, which techniques, etc. The risk:benefit
ratio should be considered and justified for each
and every film taken.1
A lead apron with at least 0.25mm thickness of
lead has been recommended2,9 although recently
there has been some debate about the merits of such
devices.3,10 Lead aprons help to reduce the amount of
primary radiation reaching areas of the body that are
in the direct pathway of the primary beam.10
However, it is now considered that they may instead
potentiate the effect of scatter radiation that gets
under the apron since the scatter beams become
trapped between the apron and the body and are
then reflected back toward the tissues they are
supposed to protect.3,10 Since the risk of malignancy
from the primary beam during dental intra-oral
radiography is one in 10 million and the extra risk
from scatter radiation (without an apron) is much
less, perhaps in the order of one in 100 million,2 and
since only a small percentage of the primary beam is
scattered with modern machines,3,10 the value of lead
aprons is therefore questionable. However, lead
aprons do provide some psychological security for
patients who believe they are helping to protect their
distant organs and they are recommended for
below).9 Interestingly, a survey of Australian dentists
in 1988 revealed that lead aprons were always used
by only 66 per cent of the respondents, while 22 per
cent said they occasionally used them and 22 per
cent said they never used a protective apron for
their patients.11
211
 Further protection can be achieved with good
radiographic and processing techniques and with
quality control to ensure films are taken and
processed to provide high quality and diagnostically
useful information. However, unfortunately, the
general standard in dental practices may not be
ideal, as demonstrated by the results of the survey by
Monsour et al.12 This study revealed that many
radiographs need to be re-taken for reasons related
to poor technique and radiation practices; 34.2 per
cent were re-taken because of processing problems,
28.3 per cent due to incorrect techniques, 3.4 per
cent due to exposure problems and 1.2 per cent of
films had been lost from the patients record file.
Some films were re-taken as an aid to diagnosis (7.2
per cent) and some showed insufficient information
(2.7 per cent) for diagnosis. A recent survey of
radiographs sent to the author by dentists who had
referred patients for endodontic treatment supports
these findings, as 65 per cent of the films supplied
were considered to be inadequate for diagnostic
purposes and 89 per cent had not been processed
adequately.
The use of the parallel technique with film holders
will help to improve the diagnostic quality13 and
the reproducibility of radiographs.14 This will
consequently reduce the number of films required
and the amount of radiation exposure to patients.1-2
However, despite the published recommendations of
experts in dental radiography contained in textbooks
and journals,13-14 the use of film holders is not
common; in Australia, only 25 per cent of dentists
routinely used a device and 40 per cent occasionally
used one in the 1988 survey.11 Fortunately, the
practice of the dentist holding a film in the patients
mouth was not common; 60 per cent of Australian
dentists never do this but 25 per cent will do so less
than once every month and 1.5 per cent might do so
more than 10 times a month.11
Good surgery design, with large rooms and
appropriate wall thickness, and materials will help
protect dental staff. Staff should be at least 2m away
from the X-ray machine and the room should be
designed so the X-ray beam is never pointed toward
the exit door where staff are sheltering.9 The work-
load should be monitored, although it is unlikely
that dentists would reach the threshold level at
which this becomes dangerous. Monsour et al11
reported that the average number of radiographs
taken each week by Australian dentists is 22.114.5
intra-oral films and 6.27.8 extra-oral films, whereas
the threshold level at which X-radiation may become
harmful to an operator has been calculated as 360
dental exposures per week for 0.5 second each.2
Well-maintained, modern equipment is essential
for diagnostically acceptable radiographs and for
radiation safety. Machines that are more than 10
212
years old may need maintenance, upgrading or even
replacement. All aspects of every machine including
the filtration, beam size, timer, etc should be
checked regularly to ensure proper functioning.15
High-speed film should be preferred to lower speed
films12 although it is recognized that the diagnostic
quality of the image might be compromised.
Accurate processing techniques are also essential so
that diagnostic-quality films are produced which can
then be stored as a permanent part of the patients
record.9
Another issue of patient and staff safety is cross-
contamination. All films should be placed inside a
plastic protective barrier while in a patients mouth.
The barrier packet can then be opened and the film
transferred to a dental assistant for processing with-
out the assistant touching the contaminated packet.
Intra-oral radiographic films can now be purchased
with such barrier packets already applied or the
packets can be purchased separately and applied
individually to each film before use.
X-radiation during pregnancy
The most sensitive time for radiation effects to a
foetus is between the 32nd and 37th day
(approximately 4-5 weeks) of gestation, since
this is the time for organogenesis.2 The general
consensus of opinion is that more than 10Sv of
radiation is required for a significant risk to occur.
Furthermore, the developing foetus must be in the
direct pathway of this radiation.2 Both of these
requirements are unlikely to occur during dental
radiography and hence dental radiographs should
not be contra-indicated if there is a potential benefit
to be gained.2,9 However, practitioners should
consider that if a congenital defect does occur, then
people naturally try to blame someone or something
and they may relate it to dental radiographs. It is also
worth considering that very few women are aware
they are pregnant within the first eight weeks of
pregnancy. Therefore, it is important to take all
possible precautions to minimize the risks, including
the use of a lead apron2,9 (for radiation protection,
for medico-legal protection and for psychological
reasons).
Section 6.2.4 of the NHMRCs Code of Practice for
Radiation Protection in Dentistry9 states . . . dental
radiography can be undertaken with negligible dose
to the foetus at any time during pregnancy if proper
collimation is used and the equipment is properly
shielded. There is no need on radiation grounds to
defer dental radiography during pregnancy.
Despite these very clear recommendations,
Australian dentists still appear to be reluctant to take
radiographs during pregnancy. Monsour et al found
dentists attitudes vary in each state of Australia11
which may be a reflection of recommendations made
Australian Dental Journal 2000;45:3.
during dental school training. Overall, only 2 per
cent of the dentists surveyed would routinely take
radiographs during pregnancy. In an emergency
situation, 52-64 per cent would take a radiograph
but 36-46 per cent stated they would never take a
radiograph of a pregnant woman.11
The future
It is difficult to predict radiation practices but it is
likely to involve the use of faster films to reduce
exposure times and further development of
electronically controlled timers to produce an
optimum dose. Computers and digital imaging
technology are also being rapidly developed. Early
forms of these devices for intra-oral radiography had
limitations with respect to the sensor size and image
clarity but many of these problems are gradually
being overcome.
The major advantage of digital imaging technology
is the claimed reduction in exposure to radiation
which may be as much as 80 per cent. However, the
level of reduction in exposure is often overridden by
the need to take more than one image to gain the
same amount of diagnostic information as
conventional films. The ability to enhance images
(by altering the contrast, colour, etc) may also
increase the diagnostic usefulness of the image
generated. However, the cost and equipment needs
are high and further development is still required.
Manufacturers also need to develop software safe-
guards to ensure that images cannot be altered in
such a way that the original information is lost or
changed permanently16 since the ability to alter
images could lead to abuse of this technology which
has many possible legal and ethical consequences.
Then, even with new technology, there is still an
absolutely essential need for good, predictable, accurate
and safe techniques. This will ensure patients and
staff are not unnecessarily harmed and useful
diagnostic information is obtained, since new
technology will not compensate for poor techniques.
Summary
Exposure to any form of radiation can be
dangerous to health and this includes exposure to
X-radiation. It is important to remember that any
dose of radiation has the potential to induce
malignant changes. Even small doses might cause
damage to tissues and the current thought is there is
no threshold dose below which radiation is totally
and predictably safe. Some of the effects from
radiation are cumulative throughout life and there-
fore every possible effort should be made to reduce
these risks. Fortunately the relative risks associated
with dental radiography are quite low the risk of
induction of fatal cancer or serious hereditary ill-
health has been theoretically calculated as
Australian Dental Journal 2000;45:3.
approximately one in 10 million for each intra-oral
periapical or bitewing film. Extra-oral panoramic
films have a suggested risk of one in a million.
However, dentists should not be complacent about
these risks and they have a professional responsibility
to use radiography appropriately in their practices
and to maintain good, safe radiation procedures at
all times.
Acknowledgement
The assistance of Dr Ross Macdonald of Adelaide
in providing some of the information is gratefully
acknowledged.
References
1. Goaz PW, White SC. Oral radiology Principles and
interpretation. St Louis: CV Mosby, 1982:3-78.
2. Smith NJD. Dental radiography. 2nd edn. Oxford: Blackwell
Scientific Publications, 1988:1-53.
3. Macdonald R. Have you met BERT? ADA(SA) Newsletter
1997;10(9):8-9.
4. Perkins AC. Nuclear medicine: Science and safety. Montrouge:
John Libbey, 1995.
5. Cederberg RA, Frederiksen NL, Benson BW, Sokolowski TW.
Effect of the geometry of the intraoral position-indicating device
on effective dose. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1997;84:101-109.
6. Danforth RA, Torabinejad M. Estimated radiation risks
associated with endodontic radiography. Endod Dent Traumatol
1990;6:21-25.
7. Pochin EE. Nuclear radiation: Risks and benefits. Oxford:
Oxford University Press, 1985.
8. International Commission on Radiological Protection.
Recommendations of the ICRP. Publication 26. Oxford:
Pergamon Press, 1977.
9. National Health and Medical Research Council. Code of
practice for radiation protection in dentistry. Canberra:
Australian Government Publishing Service, 1987.
10. National Radiological Protection Board. Guidelines on radiology
standards for primary dental care. London: National
Radiological Protection Board, 1994;5:No. 3.
11. Monsour PA, Kruger BJ, Barnes A, Sainsbury A. Measures taken
to reduce X-ray exposure of the patient, operator, and staff. Aust
Dent J 1988;33:181-192.
12. Monsour PA, Kruger BJ, Barnes A, Gordon Macleod A. A survey
of dental radiography. Aust Dent J 1988;33:9-13.
13. Bhakdinaronk A, Manson-Hing LR. Effect of radiographic
technique upon prediction of tooth length in intraoral
radiography. Oral Surg Oral Med Oral Pathol 1981;51:100-107.
14. Andreasen JO, Paulsen HU,Yu Z, Ahlquist R. A long-term study
of 370 autotransplanted premolars: Part 1. Surgical procedures
and standardized techniques for monitoring healing. Eur J
Orthod 1990;12:3-13.
15. Monsour PA, Kruger BJ, Barnes A. X-ray equipment used by
general dental practitioners in Australia. Aust Dent J
1988;33:81-86.
16. Bruder GA, Casale J, Goren A, Friedman S. Alteration of com-
puter dental radiography images. J Endod 1999;25:275-276.
Address for correspondence/reprints:
Dr Paul Abbott,
5 Westley Avenue,
Ivanhoe, Victoria 3079.
213