CASE SCIENTIFIC SESSION

RADIOLOGI

EFEK KESEHATAN DARI PAPARAN

RONTGEN GIGI

Diajukan untuk memenuhi syarat dalam melengkapi

Kepaniteraan Klinik di Bagian Radiologi

Oleh :

PUTRI AMALIA
19100707360804109

Pembimbing : drg. Suci Auliya

RUMAH SAKIT GIGI DAN MULUT

UNIVERSITAS BAITURRAHMAH
PADANG
2020
 Open Access
Environmental Health and Toxicology Volume: 33(4), Article ID: e2018017, 6 pages
https://doi.org/10.5620/eht.e2018017
• Review
eISSN: 2233-6567

Health effects from exposure to dental diagnostic X-ray

Su-Yeon Hwang1, Eun-Sil Choi1, Young-Sun Kim1, Bo-Eun Gim2, Mina Ha3, Hae-Young Kim1,4
1
Department of Public Health Sciences, Graduate School, Korea University, Seoul; 2Expert Group on Health Promotion for Seoul Metropolitan Government,
Seoul; 3Department of Preventive Medicine, Dankook University College of Medicine, Cheonan; 4Department of Health Policy and Management, College
of Health Science, Korea University, Seoul, Korea

The purpose of this review is to summarize the results of studies on of the association between exposure to dental X-rays and health
risk. To perform the systematic review, We searched the PUBMED, EMBASE, and MEDLINE databases for papers published before
December 15, 2016. A total of 2 158 studies, excluding duplicate studies, were found. Two reviewers independently evaluated the
eligibility of each study. The final 21 studies were selected after application of exclusion criteria. In terms of health outcomes, there
were 10 studies about brain tumors, 5 about thyroid cancer, 3 about tumors of head and neck areas, and 3 related to systemic
health. In brain tumor studies, the association between dental X-ray exposure and meningioma was statistically significant in 5 of
the 7 studies. In 4 of the 5 thyroid-related studies, there was a significant correlation with dental diagnostic X-rays. In studies on
head and neck areas, tumors included laryngeal, parotid gland, and salivary gland cancers. There was also a statistically significant
correlation between full-mouth X-rays and salivary gland cancer, but not parotid gland cancer. Health outcomes such as leukemia,
low birth weight, cataracts, and thumb carcinomas were also reported. In a few studies examining health effects related to dental
X-ray exposure, possibly increased risks of meningioma and thyroid cancer were suggested. More studies with a large population and
prospective design are needed to elaborate these associations further.

Keywords: Dental radiography, Health, Radiation exposure

INTRODUCTION
Dental diagnostic X-rays are an essential part of dental prac-
tice. Although radiation doses have been reduced due to the
development of digital techniques, dental diagnostic X-ray
imaging remains one of the most common types of radiologi-
cal procedures that are frequently performed in dental clinics
for oral examinations [1,2]. Dental diagnostic X-rays for certain
types of examinations, including bitewings, full-mouth series,
and panoramic views, are in common use. Considering the
lifetime frequency of exposure to dental diagnostic X-rays,
even a slight increase in health risk would be of considerable
public health importance [3].
Dental X-rays expose patients to relatively low radiation doses.
However, the survivors of the Hiroshima atomic bombings pro-
vide evidence of increased cancer risk from low doses of radia-
Received: March 5, 2018 Accepted: July 4, 2018
Corresponding author: Hae-Young Kim
Department of Health Policy and Management, College of Health Sciences,
Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea
E-mail: kimhaey@korea.ac.kr
This article is available from: http://e-eht.org/
tion [4]. Repeated exposure could also increase cancer risk [5].
Exposure to dental X-rays is associated with potential risk of
cancer, which was revealed in previous studies [6,7].
In the head and neck region, cancer risks caused by exposure
to dental X-rays have been discussed. Although many epidemi-
ological studies have reported on the association between ex-
posure to dental X-rays and meningioma risk, it is still contro-
versial, as some studies have shown a lack of association [8-10].
A meta-analysis study proposed that there is no clear evidence
of a significant association between exposure to dental diag-
nostic X-rays and the risk of developing meningioma [11]. Sev-
eral studies have found an association between dental X-ray ex-
posure and increased risks of brain cancer [12,13], tumors of
the parotid gland [14] and breast cancer [15] and thyroid cancer
[16,17]. In particular, thyroid cancer is one of the most common
cancers in the worldwide, and the side effects from dental radi-
ation exposure are likely to contribute to its incidence due to
the location of the thyroid gland. Repeated exposure to dental
X-rays may result in various health problems including head
and neck tumors and various systemic problems. Thus, we con-
ducted a systematic review of papers that reported an associa-
tion between dental X-ray exposure and overall health risks be-

Copyright © 2018 The Korean Society of Environmental Health and Toxicology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
Page 1 of 6
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Environmental Health and Toxicology 2018;33(4):

cause no previous reports have summarized these associations.

MATERIALS AND METHODS

The patient, intervention, comparator, outcomes (PICO) method was followed as a viable tool for the systematic review process
[18]. The PICO method for this systematic review was as follows. The “P” referred to all patients, the “I” referred to dental X-ray
exposure, the “C” referred to dental X-ray non-ex- posure, and the “O” referred to brain cancer, meningioma, thyroid cancer,
leukemia, and other cancers.

Search strategy and data sources

We searched the PUBMED, EMBASE, and MEDLINE data- bases and performed a manual search for papers. The data- bases were
searched for all related paper published before December 2016. The paper published in all languages were selected. The following
search terms were employed.
(i) PUBMED: (“radiography, dental” [MeSH Terms] OR (“ra- diography” [All Fields] AND “dental” [All Fields]) OR “dental
radiography” [All Fields] OR “dental x ray” [All Fields]) AND exposure [All Fields] AND (“brain neoplasms” [MeSH Terms] OR
(“brain” [All Fields] AND “neoplasms” [All Fields]) OR “brain neoplasms” [All Fields] OR (“brain” [All Fields] AND “cancer” [All
Fields]) OR “brain cancer” [All Fields]); (ii) EM- BASE: ‘dental’/exp OR dental AND (‘x ray’/exp OR ‘x ray’) AND (‘exposure’/exp
OR exposure); (iii) Manual search was carried out using the reference lists of papers included in the systematic review, on review
papers about overall health.

Study inclusion and exclusion

Two reviewers (S.Y.H, E.S.C.) independently assessed the eli- gibility of each study through the databases based on the pre-
determined selection criteria. Any disagreements were resolved through discussion. The inclusion criteria were as follows: (i) human
study; (ii) health problems including cancers related to dental radiation exposure; (iii) the full text of the study was available. The
exclusion criteria were as follows: (i) Radiation dose assessment study; (ii) Radiation safety management study;
(iii) Review articles; (iv) Letter and recommendation.

Data extraction
Two authors (M.A.H. and H.Y.K) independently collected the following information: first author’s name, year of publication, study
design, dental diagnostic X-ray type, health outcome, significance, risk estimates, and their confidence intervals (CIs). We tried to
summarize the significance of test results ac- cording to the types of health outcomes and types of the den-

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 Su-YeonHwang, et al. | Healtheffect from dentalX-rays
tal x-ray. However, test results in some studies were expressed for more detailed categories such as age groups or frequencies of
exposure and occurred either consistent which means that all test were significant or nonsignificant, or inconsistent which means
that both coexisted. To solve the problem, the integrat- ed significance was marked as having partial significance (PS) when only
some of the characteristics were statistically signifi- cant, as having significance (S) when all the characteristics were
significant, and as not having significance (NS) when all were nonsignificant.

Quality assessment
We assessed the methodological quality of each study using the Newcastle-Ottawa scale (NOS) [19] which uses a star rat- ing
system. A full score is 9 stars, and a score range 5 to 9 stars is considered to be a high methodological quality while a score
range 0 to 4 is considered to be poor quality. Nineteen case-control studies and one cohort study were assessed on the quality
excluding one case-report study.

RESULTS

A total of 2 158 studies, except for duplicate studies, were ini- tially collected. The abstracts and titles of the 2 158 papers were
assessed. The full-text of the final 21 studies that were selected through classifications of exclusion criteria were read (Figure 1).
We assessed information provided by the reporting of case– controls (n = 19), cohort studies (n = 1), and case studies (n = 1). These
studies were published between 1997 and 2015. These studies were conducted in the following countries: the United States (n=
12), Sweden (n= 4), Taiwan (n= 1), Australia (n= 1), Kuwait (n = 1), Japan (n = 1), and Syria (n = 1).

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Environmental Health and Toxicology 2018;33(4):

Thyroid cancer Systemic health outcomes

There were five research findings related to thyroid Leukemia and low birth weight have been reported as system-
cancer (Table 1). As far as research design was ic health outcomes related to dental X-ray exposure (Table 1).
concerned, four were case–control studies, while one One study categorized dental diagnostic X-ray types and ex-
was a cohort study. The five studies did not specify amined correlations with low birth weight (LBW) and showed
dental diagnostic X-ray types. In four of the five studies, that only panoramic examination types had a statistically sig-
there were significant correlations between dental nificant correlation with LBW. The risk of leukemia signifi-
diagnostic X-rays and thyroid cancer. One of these cantly increased in accordance with dental diagnostic X-ray
studies categorized the subjects by occupation and exposure. A case report showed that thumb carcinoma oc-
confirmed the correlation between dental practice and curred in radiographic technician who had performed dental
thyroid cancer. diagnostic X-ray examinations for 15 years.
Tumors in head and necks areas
Table 1 lists research findings on the tumors in head
and necks areas. Tumors included laryngeal, parotid
gland, and salivary gland cancers. As exposure to dental
diagnostic X-rays in- creased, the risk of laryngeal cancer
also increased. There was also a statistically significant
correlation between full-mouth X- rays and salivary gland
cancer, but not parotid gland cancer.

Table 1. Summary of studies on association between dental X-ray exposure experience and thyroid cancer, tumors in head and neck areas, and other
health outcomes
Study
Author (year) Country No. of exposed Dental X-ray Health outcome Significancea
design case/control types
Thyroid cancer
Wingren G (1993) [27] Sweden Case-control 11/12 Any Papillary thyroid cancer S Positive association (OR = 2.8 ,95%CI = 1.1-7.5)
Hallquist A (1994) [28] Sweden Case-control 14/34 Any Papillary thyroid cancer NS -
Wingren G (1997) [17] Sweden Case-control 7/1 Any Papillary thyroid cancer S Occupation: dentists or dental assistants
(OR = 13.1 95%CI: 2.1-389)
Memon A (2010) [16] Kuwait Case-control 313/313 Any Thyroid cancer S Positive association (OR = 2.1, 95%CI: 1.4-3.1)
Neta (2013) [29] US Prospective 251/75 000c Any Thyroid cancer S Positive association (RR = 1.13 95%CI: 1.01-1.26)
cohort
Tumors in head and neck areas
Hinds MW (1979) [30] US Case-control 47/47 Any Laryngeal cancer PS Heavy smoker: Positive association
(RR = 7.5, P = 0.02) at frequent exposure ≥ 10
Preston-Martin S US Case-control 408/408 Any Malignant parotid gland tumor NS -
(1988) [31] Any Benign parotid gland tumor NS -
Horn-Rose PL (1997) [32] US Case-control 106/122 Full mouth Salivary gland cancer S Positive association (OR = 1.6, 95%CI:1.0-2.7)
Systemic health outcome
Motoi N (1989) [33] Japan Case-control 63/126 Any Leukemia S Positive association (RR = 1.4)
Hujoel P (2004) [34] US Case-control 1 117/4 468 Full mouth Low-birth-weight NS -
Panoramic S Positive association with LBWb and NBWb(p = 0.009)
Bitewings NS -
Esam S (2015) [35] Syria Case report - - Thumbs carcinoma - Dental Radiographer: A dental radiographer developed
thumbs carcinoma after 15 years of practicing.
a
PS: partial significance S: significance NS: no significance.
b
LBW: low birth weight, birth weight < 2 500 g; NBW: normal birth weight, birth weight ≥ 2 500 g.
c
No. of exposed case/population.

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DISCUSSION
Patients are certainly exposed to dental diagnostic X-rays,
and dental practitioners also potentially receive exposure. Al-
though the level of exposure is lower than that of medical radi-
ation, there is an innate risk from radiation exposure that can-
not be ignored. However, there are a few studies on low-dose
dental diagnostic X-ray exposure and health effects, except
with respect to some parts of the body. In addition, papers re-
port inconsistent statistical significances on dental diagnostic
X-ray exposure and health effects, depending on the subjects
and research design; therefore, related studies should be sys-
tematically organized. Hence, through a systematic literature
review, this study included various studies with different re-
search designs and examined the health risks associated with
dental diagnostic X-ray exposure. For the literature review, this
study examined twenty-one papers on dental diagnostic X-ray
exposure and healtheffects.
Among twenty-one papers that reported a correlation be-
tween dental diagnostic X-rays and overall health, eighteen
papers assessed a correlation with head and neck areas. The
selected papers included ten on brain cancer, five on thyroid
cancer, and three on head and neck areas other than the brain
and thyroid. Since the oral cavity is anatomically located near
the head and neck [36], dental X-ray examinations seem to af-
fect the brain and neck areas. The correlation of X-rays with
brain and thyroid cancers has been reported for many de-
cades and seems to explain this finding.
Papers that reported a correlation between dental diagnostic
X-ray exposure and overall health of dental practitioners were
identified. The present study identified two papers on occupa-
tional groups [17,35]. According to a study on dental practitio-
ners and thyroid cancer the risk of thyroid cancer was 13.1
times (95% CI 2.1–389) higher among female dentists and den-
tal hygienists [17]. It is believed that women are more likely to
have to thyroid cancer than men due to their hormones [37]. In
a case report, a dental radiologist was exposed to dental diag-
nostic X-rays for 15 years and ended up developing finger can-
cer, which demonstrates that long-term exposure to low doses
of dental diagnostic X-rays can pose a risk to health [35]. Anoth-
er paper also reported that the cumulative dose for dentists who
had worked for a long time was high [38]. Hence, dental practi-
tioners should be aware of exposure to low doses of dental diag-
nostic X-rays, and risk of accumulative exposure to low-dose
radiation from dental X-rays cannot be ruled out.
Dental diagnostic X-ray types were specifically categorized.
Especially, panorama examination types are more commonly
used than simple dental X-ray types, because panoramic diag-
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Su-YeonHwang, et al. | Healtheffect from dentalX-rays
nostic information coverage exceeds that of dental diagnostic
X-rays [39]. Panoramic examinations also require fewer steps
than conventional full-mouth examination types [40]. The full-
mouth type had a statistical correlation with meningioma and
salivary gland cancers. Meningioma cancer showed four times
higher risk at younger ages (< 20 years). Unlike adults, children
are much more sensitive to radiation exposure due to active cell
division [41]. In addition, the panorama examination type
showed a correlation with meningioma cancer at higher expo-
sure frequencies. Accordingly, a study on the amount of radia-
tion exposure from each dental diagnostic X-ray type is needed.
Nonetheless, the selected papers on thyroid cancer, which has a
high level of radiation sensitivity [42], did not categorize dental
diagnostic X-ray types, so this could not be examined.
There were some limitations of this study. This study did not
specifically categorize exposure measurements, including ex-
posure dose (mGy) and frequency, because each study has di-
verse radiation exposure categories. This study performed the
only systematic review, not was extended to a meta-analysis,
because the types of health outcomes were too diverse. How-
ever, we could identify trends in the dental diagnostic X-ray
studies via this systematic literature review. This study has
some important contributions. First, unlike existing literature
reviews, this study covered diverse health outcomes as well as
meningioma. Second, this study showed evidence that the in-
creased risk of head and neck cancer due to exposure to low
doses of dental diagnostic X-rays cannot be ignored.
It should also be noted that no studies have examined the
specific types of dental X-rays and prevalence of thyroid can-
cer, which should be explored in further studies. Further stud-
ies are also needed to investigate the health effects of dental
diagnostic X-rays in dental practitioners, who may be fre-
quently exposed to high levels of radiation exposure.
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 EFEK KESEHATAN DARI PAPARAN RONTGEN GIGI
1 1 1 2 3 1,4
Su-Yeon Hwang , Eun-Sil Choi , Young-Sun Kim , Bo-Eun Gim , Mina Ha , Hae-Young Kim
1
Departemen Ilmu Kesehatan Masyarakat, Sekolah Pascasarjana, Universitas Korea, Seoul; 2 Kelompok Ahli Promosi Kesehatan untuk
Pemerintah Metropolitan Seoul, Seoul; 3 Departemen Kedokteran Pencegahan, Fakultas Kedokteran Universitas Dankook,
Cheonan; 4 Departemen Kebijakan dan Manajemen Kesehatan, Sekolah Tinggi Ilmu Kesehatan, Universitas Korea, Seoul, Korea

Tujuan dari tinjauan ini adalah untuk meringkas hasil studi tentang hubungan antara paparan sinar-X
dari rontgen gigi dan risiko kesehatan. Untuk melakukan tinjauan sistematis, Kami mencari database
PUBMED, EMBASE, dan MEDLINE untuk hasil yang diterbitkan sebelum 15 Desember 2016.
Sebanyak 2. 158 studi, tidak termasuk studi duplikat yang ditemukan. Dua peneliti secara independen
mengevaluasi kelayakan setiap studi. 21 studi terakhir dipilih setelah penerapan kriteria
eksklusi. Dalam hal hasil kesehatan, ada 10 penelitian tentang tumor otak, 5 tentang kanker tiroid, 3
tentang tumor pada daerah kepala dan leher, dan 3 terkait dengan kesehatan sistemik. Dalam studi
tumor otak, hubungan antara paparan sinar-X dari rontgen gigi dan meningioma secara statistik
signifikan dalam 5 dari 7 studi. Dalam 4 dari 5 penelitian terkait tiroid, ada korelasi yang signifikan
dengan sinar-X dari rontgen gigi. Dalam studi pada daerah kepala dan leher, tumor termasuk kanker
laring, kelenjar parotis, dan kanker kelenjar ludah. Ada juga korelasi yang signifikan secara statistik
antara sinar-X dari rongga mulut dan kanker kelenjar ludah, tetapi tidak kanker kelenjar parotis. Hasil
kesehatan seperti leukemia, berat badan lahir rendah, katarak, dan thumbs carcinoma juga
dilaporkan. Dalam beberapa penelitian yang meneliti efek kesehatan yang berhubungan dengan
paparan sinar-X dari rontgen gigi, kemungkinan peningkatan risiko meningioma dan kanker tiroid
telah disarankan. Dibutuhkan lebih banyak studi dengan populasi besar dan desain prospektif untuk
menguraikan asosiasi ini lebih lanjut.

Kata kunci: Radiografi Gigi, Kesehatan, Paparan Radiasi

PENDAHULUAN

X-ray diagnostik gigi adalah bagian penting dari praktik gigi. Meskipun dosis radiasi telah

berkurang karena perkembangan teknik digital, diagnostik X-ray gigi tetap menjadi salah satu jenis

prosedur radiologi yang paling umum yang sering dilakukan di klinik gigi untuk pemeriksaan oral

[1,2]. X-ray diagnostik gigi untuk jenis pemeriksaan tertentu, termasuk bitewings, periapikal, dan

panoramik, umum digunakan. Mengingat frekuensi paparan sinar X diagnostik gigi seumur hidup,

bahkan sedikit peningkatan risiko kesehatan akan menjadi sangat penting bagi kesehatan masyarakat

[3]. Sinar-X dari rontgen gigi memaparkan dosis radiasi yang relatif rendah pada pasien. Namun,

para penyintas bom atom Hiroshima memberikan bukti peningkatan risiko kanker dari dosis rendah

radiasi. [4]. Paparan berulang juga dapat meningkatkan risiko kanker [5]. Paparan sinar-X dari

rontgen gigi dikaitkan dengan potensi risiko kanker, yang terungkap dalam penelitian sebelumnya

[6,7].

Di daerah kepala dan leher, risiko kanker yang disebabkan oleh paparan sinar-X dari rontgen

gigi telah dibahas. Meskipun banyak penelitian epidemiologis telah melaporkan hubungan antara

eksposur dengan sinar-X dari rontgen gigi dan risiko meningioma ini masih kontroversial, karena

beberapa penelitian menunjukkan kurangnya hubungan [8-10]. Sebuah studi meta-analisis

mengusulkan bahwa tidak ada bukti yang jelas tentang hubungan yang signifikan antara paparan

sinar X diagnostik gigi dan risiko pengembangan meningioma [11]. Beberapa penelitian telah

menemukan hubungan antara pemeriksaan sinar-X dari rontgen gigi dan peningkatan risiko kanker

otak [12,13], tumor kelenjar parotis [14] dan kanker payudara [15] dan kanker tiroid [16,17] . Secara

khusus, kanker tiroid adalah salah satu kanker paling umum di seluruh dunia, dan efek samping dari

paparan radiasi gigi cenderung berkontribusi terhadap kejadiannya karena lokasinya di kelenjar

tiroid.
 Paparan berulang dengan sinar-X dari rontgen gigi dapat menyebabkan berbagai masalah

kesehatan termasuk tumor kepala dan leher dan berbagai masalah sistemik. Dengan demikian, kami

melakukan tinjauan sistematis dari hasil yang melaporkan hubungan antara paparan sinar-X dari

rontgen gigi dan risiko kesehatan secara keseluruhan.

METODE DAN BAHAN

Metode pasien, intervensi, p embanding, hasil (PICO) diikuti sebagai alat yang layak untuk

proses peninjauan sistematis [18]. Metode PICO untuk tinjauan sistematis ini adalah sebagai

berikut. "P" merujuk pada semua pasien, "I" merujuk pada paparan sinar-X dari rontgen gigi, "C"

merujuk pada sinar-X dari rontgen gigi non-eksposur, dan "O" merujuk pada kanker otak, meningioma,

tiroid kanker, leukemia, dan kanker lainnya

Strategi Pencarian dan Sumber Data

Kami mencari basis data PUBMED, EMBASE, dan MEDLINE dan melakukan pencarian

manual untuk hasil. Basis data dicari untuk semua hasil terkait yang diterbitkan sebelum Desember

2016. Hasil yang diterbitkan dalam semua bahasa dipilih. Istilah pencarian berikut digunakan.

(i) pubmed: ("radiografi, gigi" [ketentuan mesh] atau ("ra-diografi" [semua bidang] dan "gigi" [semua

bidang]) atau "radiografi gigi" [semua bidang] atau "sinar x gigi" [semua bidang]) dan pemaparan

[semua bidang] dan ("neoplasma otak" [ketentuan mesh] atau ("otak" [semua bidang] dan "neoplasma"

[semua bidang]) atau "neoplasma otak" [semua bidang] atau ( "otak" [semua bidang] dan "kanker"

[semua bidang]) atau "kanker otak" [semua bidang]); (ii) em-base: 'dental' / exp atau dental and ('x ray'

/ exp atau 'x ray') and ('exposure' / exp atau exposure); (iii) pencarian manual dilakukan dengan

menggunakan daftar referensi hasil yang termasuk dalam tinjauan sistematis, pada hasil ulasan tentang

kesehatan secara keseluruhan.

Kriteria Inklusi dan Eksklusi

Dua penulis (SYH, ESC) secara independen menilai kelayakan setiap studi melalui database

berdasarkan kriteria seleksi yang ditentukan sebelumnya. Setiap perbedaan pendapat diselesaikan

melalui diskusi. Kriteria inklusi adalah sebagai berikut: (i) studi manusia; (ii) masalah kesehatan

termasuk kanker yang berhubungan dengan paparan radiasi gigi; (iii) teks lengkap penelitian yang

tersedia. Kriteria eksklusi adalah sebagai berikut: (i) Studi penilaian dosis radiasi; (ii) Studi manajemen

keselamatan radiasi; (iii) Tinjau artikel; (iv) Surat dan rekomendasi.

Pengumpulan Data

Dua penulis (MAH dan HYK) secara independen mengumpulkan informasi berikut: nama

pertama penulis, tahun publikasi, desain penelitian, tipe X-ray diagnostik gigi, hasil kesehatan,

signifikansi, perkiraan risiko, dan interval kepercayaan mereka (CI). Kami mencoba untuk meringkas

pentingnya hasil tes sesuai dengan jenis hasil kesehatan dan jenis dental x-ray.

Namun, hasil tes dalam beberapa penelitian dinyatakan untuk kategori yang lebih rinci seperti

kelompok umur atau frekuensi paparan dan yang konsisten, berarti bahwa semua tes signifikan atau

tidak signifikan, atau tidak konsisten yang berarti keduanya hidup berdampingan. Untuk memecahkan

masalah, signifikansi integrasi ditandai memiliki signifikansi parsial (PS) ketika hanya beberapa

karakteristik yang signifikan secara statistik, sebagai memiliki signifikansi (S) ketika semua

karakteristik signifikan, dan tidak memiliki signifikansi (PS). (NS) ketika semuanya tidak signifikan.
Penilaian Kualitas

Kami menilai kualitas metodologis dari setiap studi menggunakan skala Newcastle-Ottawa

(NOS) [19] yang menggunakan sistem rating. Skor penuh adalah 9, dan kisaran skor 5 hingga 9

dianggap sebagai kualitas metodologis yang tinggi sedangkan rentang skor 0 hingga 4 dianggap

berkualitas buruk. Sembilan belas studi kasus-kontrol dan satu studi kelompok dinilai pada kualitas,

tidak termasuk satu studi kasus-laporan.

Hasil

Sebanyak 2.158 studi, kecuali untuk studi duplikat, awalnya dikumpulkan. Abstrak dan judul

dari 2 158 hasil dinilai. Teks lengkap dari 21 studi akhir yang dipilih melalui klasifikasi kriteria

eksklusi dibaca (Gambar 1). Kami menilai informasi yang diberikan oleh pelaporan kontrol kasus (n =

19), studi kohort (n = 1), dan studi kasus (n = 1). Studi-studi ini diterbitkan antara tahun 1997 dan 2015.

Studi-studi ini dilakukan di negara-negara berikut: Amerika Serikat (n = 12), Swedia (n = 4), Taiwan (n

= 1), Australia (n = 1), Kuwait ( n = 1), Jepang (n = 1), dan Suriah (n = 1).

Ada tujuh laporan tentang meningioma, tiga pada glioma, satu pada neuroma akustik, dan satu

pada schwannoma vestibular, sementara dua laporan menyebutkan kanker otak yang tidak

spesifik. Tujuh hasil melaporkan hubungan positif yang signifikan dan tiga menunjukkan hubungan

signifikan sebagian positif, sedangkan delapan memiliki hasil yang tidak signifikan. Satu hasil

melaporkan hubungan negatif antara paparan sinar-X rongga mulut dan glioma.

Hubungan dengan meningioma signifikan dalam 5 dari 7 studi, sementara itu tidak signifikan

dalam 2 studi yang tersisa. Hasil yang tidak konsisten dilaporkan pada hubungan dengan

glioma. Hubungan positif yang kuat ditemukan dalam kaitannya dengan schwannoma vestibular,

sementara tidak dengan neuroma akustik. Jenis pemeriksaan rongga mulut meningkatkan risiko tumor

otak secara signifikan dalam tiga dari empat studi.

Kanker Tiroid

Ada lima temuan penelitian yang terkait dengan kanker tiroid (tabel 1). Sejauh desain

penelitian yang bersangkutan, empat adalah studi kasus-kontrol, sedangkan satu adalah studi

kohort. Kelima penelitian tidak menentukan tipe X-ray diagnostik gigi. Dalam empat dari lima studi,

ada korelasi yang signifikan antara sinar-X diagnostik gigi dan kanker tiroid. Salah satu studi ini

mengkategorikan subjek berdasarkan pekerjaan dan mengkonfirmasi korelasi antara praktik gigi dan

kanker tiroid.

Tabel 1 daftar temuan penelitian tentang tumor di daerah kepala dan leher. Tumor termasuk kanker

laring, kelenjar parotis, dan kanker kelenjar getah bening. Ketika paparan sinar-X diagnostik gigi

meningkat, risiko kanker laring juga meningkat. Ada juga korelasi yang signifikan secara statistik

antara sinar-X rongga mulut dan kanker kelenjar ludah, tetapi tidak kanker kelenjar parotis.

Hasil Kesehatan sistemik

Leukemia dan berat badan lahir rendah telah dilaporkan sebagai hasil kesehatan sistemik

terkait dengan paparan sinar-X dari rontgen gigi (Tabel 1). Satu studi mengkategorikan tipe X-ray

diagnostik gigi dan korelasi examined dengan berat lahir rendah (BBLR) dan menunjukkan bahwa

hanya tipe pemeriksaan panoramik yang memiliki korelasi signifikan secara statistik dengan

BBLR. Risiko leukemia meningkat secara signifikan sesuai dengan paparan sinar X diagnostik.

Sebuah laporan kasus menunjukan bahwa terjadi thumbs carcinoma di teknisi raiografi yang telah

melakukan pemeriksaan X-ray diagnostik gigi selama 15 tahun.

Tabel 1. Ringkasan studi tentang hubungan antara pengalaman paparan sinar-X dari rontgen gigi dan kanker tiroid, tumor di daerah
kepala dan leher, dan hasil kesehatan lainnya
Subjek (tahun) Negara Desain No. expose Jenis Gangguan kesehatan Signifikasi a
studi kasus/kontrol Dental X-ray
Thyroid cancer
Wingren G (1993) [27] Sweden Case-control 11/12 Any Papillary thyroid cancer S Positive association (OR = 2.8 ,95%CI = 1.1-7.5)
Hallquist A (1994) [28] Sweden Case-control 14/34 Any Papillary thyroid cancer NS -
Wingren G (1997) [17] Sweden Case-control 7/1 Any Papillary thyroid cancer S Occupation: dentists or dental assistants
(OR = 13.1 95%CI: 2.1-389)
Memon A (2010) [16] Kuwait Case-control 313/313 Any Thyroid cancer S Positive association (OR = 2.1, 95%CI: 1.4-3.1)
Neta (2013) [29] US Prospective 251/75 000 c Any Thyroid cancer S Positive association (RR = 1.13 95%CI: 1.01-1.26)
cohort
Tumors in head and neck areas
Hinds MW (1979) [30] US Case-control 47/47 Any Laryngeal cancer PS Heavy smoker: Positive association
(RR = 7.5, P = 0.02) at frequent exposure ≥ 10
Preston-Martin S US Case-control 408/408 Any Malignant parotid gland tumor NS -
(1988) [31] Any Benign parotid gland tumor NS -
Horn-Rose PL (1997) [32] US Case-control 106/122 Full mouth Salivary gland cancer S Positive association (OR = 1.6, 95%CI:1.0-2.7)
Systemic health outcome
Motoi N (1989) [33] Japan Case-control 63/126 Any Leukemia S Positive association (RR = 1.4)
Hujoel P (2004) [34] US Case-control 1 117/4 468 Full mouth Low-birth-weight NS -
Panoramic S Positive association with LBWb and NBWb(p = 0.009)
Bitewings NS -
Esam S (2015) [35] Syria Case report - - Thumbs carcinoma - Radiographer: petugas dental radiografi yang terkena
thumbs karsinoma setelah 15 thn bekerja
a
PS: signifikan sebagian S: signifikan NS: tidak signifikan.
b
LBW: low birth weight, birth weight < 2 500 g; NBW: normal birth weight, birth weight ≥ 2 500 g.

PEMBAHASAN

Pasien pasti terpapar dengan rontgen diagnostik gigi, dan praktisi gigi juga berpotensi

menerima paparan. Meskipun tingkat paparan lebih rendah dari radiasi medis, ada risiko bawaan dari

paparan radiasi yang tidak dapat diabaikan. Namun, ada beberapa penelitian tentang paparan sinar X

diagnostik gigi dosis rendah dan efek kesehatan, kecuali sehubungan dengan beberapa bagian

tubuh. Selain itu, hasil melaporkan signifikansi statistik yang tidak konsisten pada paparan sinar-X

diagnostik gigi dan efek kesehatan, tergantung pada subjek dan desain penelitian; Oleh karena itu,

studi terkait harus diatur secara sistematis. Melalui tinjauan literatur yang sistematis, penelitian ini

mencakup berbagai penelitian dengan desain pencarian ulang yang berbeda dan memeriksa risiko

kesehatan yang terkait dengan paparan sinar X diagnostik. Untuk tinjauan literatur, penelitian ini

memeriksa dua puluh subjek yang terkena paparan sinar-X diagnostik gigi dan efek kesehatan.
 Di antara dua puluh hasil tersebut, satu hasil melaporkan korelasi antara rontgen diagnostik gigi

dan kesehatan secara keseluruhan, delapan belas hasil menilai korelasi dengan area kepala dan

leher. Hasil yang dipilih termasuk sepuluh pada kanker otak, lima pada kanker tiroid, dan tiga pada

daerah kepala dan leher selain otak dan tiroid. Karena rongga mulut secara anatomis terletak di dekat

kepala dan leher [36], pemeriksaan X-ray gigi tampaknya mempengaruhi area otak dan leher. Korelasi

sinar-X dengan kanker otak dan tiroid telah dilaporkan untuk banyak dekade dan tampaknya

menjelaskan temuan ini.

Hasil yang melaporkan korelasi antara paparan sinar-X diagnostik gigi dan kesehatan praktisi

gigi secara keseluruhan diidentifikasi. Penelitian ini mengidentifikasi dua hasil tentang kelompok kerja

[17,35]. Menurut sebuah penelitian pada praktisi gigi, risiko kanker tiroid adalah 13,1 kali (95% CI

2,1-389) lebih tinggi di antara dokter gigi wanita dan ahli kesehatan gigi [17]. Dipercayai bahwa

wanita lebih mungkin terkena kanker tiroid daripada pria karena hormon mereka [37].

Dalam sebuah laporan kasus, seorang ahli radiologi gigi yang terkena paparan rontgen

diagnostik gigi selama 15 tahun, akhirnya terkena thumbs carcinoma, yang menunjukkan bahwa

paparan jangka panjang dengan dosis rendah diagnostik sinar-X dari rontgen gigi dapat menimbulkan

risiko untuk kesehatan [35]. Hasil lain juga melaporkan bahwa dosis kumulatifn paparan untuk dokter

gigi yang telah bekerja untuk waktu yang lama adalah tinggi [38]. Oleh karena itu, praktisi gigi harus

waspada terhadap paparan dosis rendah rontgen diagnostik gigi, dan risiko paparan akumulatif

terhadap radiasi dosis rendah dari sinar-X dari rontgen gigi tidak dapat dikesampingkan.

Jenis rontgen diagnostik gigi secara khusus dikategorikan. Terutama, tipe pemeriksaan

panoramik lebih umum digunakan daripada tipe X-ray gigi sederhana, karena cakupan informasi

diagnostik melebihi rontgen diagnostik gigi [39]. Pemeriksaan panoramik juga membutuhkan langkah-

langkah yang lebih sedikit daripada jenis pemeriksaan rongga mulut konvensional [40].
 Jenis rongga mulut memiliki korelasi statistik dengan meningioma dan kanker kelenjar

ludah. Kanker meningioma menunjukkan risiko empat kali lebih tinggi pada usia muda (<20

tahun). Tidak seperti orang dewasa, anak-anak jauh lebih sensitif terhadap paparan radiasi karena

pembelahan sel aktif [41]. Selain itu, jenis pemeriksaan panoramik menunjukkan korelasi dengan

kanker meningioma pada frekuensi paparan yang lebih tinggi. Oleh karena itu, studi tentang jumlah

paparan radiasi dari setiap tipe X-ray diagnostik gigi diperlukan. Meskipun demikian, hasil pada

kanker tiroid, memiliki tingkat sensitivitas radiasi yang tinggi [42], tidak mengategorikan tipe X-ray

diagnostik gigi, jadi ini tidak dapat diperiksa.

Ada beberapa keterbatasan dalam penelitian ini. Studi ini tidak secara khusus mengkategorikan

pengukuran paparan, termasuk dosis exposure (mGy) dan frekuensi, karena setiap studi memiliki

kategori paparan radiasi. Studi ini melakukan satu-satunya tinjauan sistematis, tidak diperluas ke meta-

analisis, karena jenis hasil kesehatan terlalu beragam. Namun, kami dapat mengidentifikasi tren dalam

studi X-ray diagnostik gigi melalui tinjauan literatur sistematis ini. Penelitian ini memiliki beberapa

kontribusi penting.

Pertama, tidak seperti ulasan literatur yang ada, penelitian ini mencakup beragam hasil

kesehatan serta meningioma. Kedua, penelitian ini menunjukkan bukti bahwa peningkatan risiko

kanker kepala dan leher akibat paparan sinar-X diagnostik gigi dosis rendah tidak dapat diabaikan.

Juga harus dicatat bahwa tidak ada penelitian yang meneliti jenis rontgen gigi tertentu dan

prevalensi kanker tiroid, yang harus dieksplorasi dalam penelitian lebih lanjut. Penelitian lebih lanjut

juga diperlukan untuk menyelidiki efek kesehatan dari rontgen diagnostik gigi pada praktisi gigi, yang

mungkin sering terpapar dengan paparan radiasi tingkat tinggi.

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