Pediatric Dentist Experiences with Caregiver Radiograph and Imaging Refusal

Abstract

Purpose: This study investigated pediatric dentists’ experiences with caregiver radiograph and imaging refusal and how dentists manage it in clinic. Methods: American Academy of Pediatric Dentistry (AAPD) members were recruited by email from October 2024 to November 2024 to complete an online Research Electronic Data Capture (REDCap) survey on experiences with caregivers who refuse radiographs (intraoral, extraoral, and bitewing) and cone beam computed tomography (CBCT) imaging; bitewing radiograph refusal management; lead shielding practices; and provider and practice characteristics. Bivariate analyses were completed using the Chi-square test to identify practice-level characteristics associated with refusal (α=0.05). Results: Of the 8,342 invited participants, 695 completed the survey (8.3%). Substantial percentages of responding pediatric dentists reported radiograph and CBCT refusal to be a big or medium-sized problem (intraoral=23.2%; extraoral=12.1%; bitewing=21.7%; CBCT=9.0%). Pediatric dentists in private practice were significantly more likely to report radiograph refusal as a big problem than those in community health center/public health clinic or hospital/university settings (P-values<.05); there were no differences in CBCT refusal by setting (P=.85). Pediatric dentists practicing in clinics with >50% Medicaid-enrolled children reported having significantly fewer caregivers who refused radiographs (P-values<.05); there was no difference in CBCT refusal by % Medicaid (P=.42). Dentists believed caregivers who refused immunizations and those who refused fluoride were most likely to refuse bitewing radiographs. Most dentists (81.0%) used lead shielding, for whom the most common reason was that it increased caregiver acceptance of radiographs (73.6%). Conclusions: Radiograph and CBCT imaging refusal are significant clinical challenges, which highlights the importance of developing chairside strategies that pediatric dentists can use to help caregivers make decisions about radiographs and imaging for their children.