ADA radiation safety recommendations (2024): lead aprons and thyroid collars come off, unless your state says otherwise

What it says#

On February 1, 2024, the Journal of the American Dental Association published recommendations from an expert panel convened by the ADA Council on Scientific Affairs, developed with support from FDA medical physicists. The panel searched systematic reviews, organizational guidelines and regulatory reviews published since 2010; 95 documents met its criteria.

The headline: the use of lead abdominal aprons or thyroid collars on patients during dental X-rays is no longer recommended. The panel's reasons are that the shields are not necessary to protect patients from the exposure of modern dental imaging, and that they can block the primary beam, which means retakes and more dose, not less.

Protection comes from the equipment and the ordering instead. The recommendations call for restricting the beam to the area being imaged with rectangular collimation, using digital receptors rather than film, positioning the patient properly, ordering radiographs to get the diagnostic information you need and no more, and using cone-beam CT only when a lower-exposure option will not answer the clinical question.

The ADA's press release states the recommendations apply to all patients regardless of age or health status, and names pregnancy specifically. The ADA's own X-rays topic page, updated as recently as March 2026, still carries the same line: thyroid collars are no longer recommended for any imaging procedure in dentistry.

Who it applies to#

Every dental practice that takes radiographs, and every patient in the chair. The recommendations reach intraoral, panoramic and cephalometric imaging and CBCT.

Two things sit outside it. First, the law. The ADA's release says practitioners must adhere to all applicable federal, state and local regulations on radiation safety, and its news article adds that some states may mandate continued use of certain equipment, so dentists should abide by the laws and regulations where they practice. Hawaii's Board of Dentistry put out a notice on March 25, 2024 reminding licensees that Hawaii Revised Statutes §448-1.5 still requires a lead apron covering the patient's torso, and that a violation is improper conduct under the dental practice act. Texas went the other way and opened a rulemaking conversation: its board held a stakeholder meeting on September 27, 2024 on removing the apron requirement from 22 Texas Administrative Code §§108.42 and 113.2.

Second, staff. The panel's operator recommendations are separate from patient shielding; the ADA topic page notes it recommends dosimeters and work-practice controls for pregnant staff who work with X-rays.

What changed#

The prior reference point was the joint ADA and FDA patient-selection recommendations, last revised in 2012, which described the use of protective aprons. The 2024 panel replaced apron-and-collar protection with beam restriction and receptor choice, and made the pregnancy question explicit: no exception.

The change is easier to explain to patients than it sounds. Rectangular collimation limits the beam to roughly the size of the receptor, so the abdomen and thyroid are largely outside the field before any apron would come into play; the apron was protecting against scatter that the equipment now keeps small. The figure above is that idea drawn as a schematic, not a dose measurement.

Where the source is#

The ADA press release of February 1, 2024 is the plain-English statement and is the link under the title. The recommendations themselves are Benavides et al., JADA 2024;155(4):280-293.e4, published online the same day; the DOI link opens the article page (the full text is behind JADA access). The two state documents above are the Hawaii board notice and the Texas board stakeholder notice, each a one-page PDF.