Radiation safety expert Sue Scherer, RDH, joins Andrew Johnston to unpack the ongoing confusion around lead aprons, patient shielding, and the difference between ADA recommendations and state regulations. With new evidence showing that shielding doesn’t prevent internal scatter—and may even increase exposure due to retakes—many clinicians are reexamining their protocols.

Scherer explains what the ADA guidance actually means, how to verify your state’s laws, and how to communicate changes clearly to patients while keeping ALARA at the forefront.

Transcript

Host: Andrew Johnston
Co-host: Jackie Sanders
Guest: Sue Scherer, RDH

Andrew:
Welcome back, everyone, to another episode of A Tale of Two Hygienists, episode 484. I’m your host, Andrew Johnston, and thanks so much for being with us today. We’ve got a great show—one that comes on the heels of a lot of confusion I’ve seen in social media lately regarding lead aprons and the need for shielding during dental radiographs.

Today, we have Sue Scherer with us to help navigate this confusing space between regulations, recommendations, and what the ADA actually does—and does not—have authority over. It’s incredibly useful information, especially as clinicians try to determine what’s right in their own states.

You’re also going to hear a familiar but “newer” voice—Jackie Sanders, who will be joining us as often as her schedule allows. I’m hoping to monopolize her time for at least four to six episodes a month.

It’s a great episode, and many thanks to Sue for joining us. Her contact information and references are available in the show notes.

Andrew:
Listeners, welcome to another interview segment of A Tale of Two Hygienists. We’re joined today by Sue Scherer. Sue, thank you for being here with Jackie and me.

Sue:
Thank you for having me back. I appreciate you both.

Andrew:
The last time we talked, we dove into shielding and radiology, and I wanted to revisit that. I practiced in Washington and Oregon, and back in 2016 I remember Oregon announcing that shielding was no longer required for dental X-rays. It was controversial for about ten minutes—and then everyone moved on. But last year, the ADA released new recommendations, and suddenly social media is full of questions again.

Help us understand what’s going on.

Sue:
This topic has exploded on Facebook. I keep seeing the same questions: “Are we still shielding?” “Does anyone shield anymore?” “My office got rid of shielding—are we allowed to do that?”

The key thing to understand is that what the ADA released in February 2024 is a recommendation, not a regulation.

There is excellent research showing that lead shielding does not prevent internal scatter, which is the main source of patient exposure during dental radiographs. Shielding can also obstruct the beam—especially when the thyroid collar is attached and positioned too high—which forces retakes and increases dose. That’s the opposite of ALARA.

So the evidence suggests shielding isn’t helpful and may even create new exposures through retakes.

Sue:
Many hygienists will relate to this: you put the shield on, and the attached thyroid collar comes up so high that you can’t get a proper projection. I used to lay the collar flat on the patient’s shoulders because it interfered so often.

And when shielding blocks the beam, you get cone cuts and retakes. From an ALARA standpoint, that’s not ideal.

With digital radiography, patient exposure is already extremely low. Even film exposures have dropped dramatically since the days of D-speed film.

The bottom line: based on current evidence, shielding provides no meaningful protective benefit.

Sue:
But here’s the part that concerns me: the ADA recommendation does not override state law.

I practiced clinically for 20 years in New Jersey, and our regulations specifically require shielding during dental radiographs. It’s written into law. It’s not optional or up to clinician discretion. If it’s in your scope, you must follow it.

So when I see people online saying, “We haven’t shielded for years!” I want to tell them gently: slow down. Check your state regulations before making changes.

Some states have no law addressing it at all—so it becomes a practice-level decision. Others mandate shielding. Others prohibit it. It varies widely.

Jackie:
And people often treat the ADA like it’s the ultimate authority.

Sue:
Yes. Many clinicians incorrectly believe the ADA has regulatory power. It does not. The ADA provides guidance, not law. State boards—or sometimes departments of health—set the rules.

If hygienists are confused, imagine how confused our patients are. We’ve shielded them forever. If we change that, we need to be able to explain why—professionally and accurately.

Andrew:
So the first step is knowing your own state’s governing body.

Sue:
Exactly. And it’s incredibly easy to find. Google: “Who governs dental hygienists in [your state]?”

It pulls up the regulatory board in seconds. Whether it’s New Jersey Consumer Affairs, the Illinois Department of Professional Regulation, or the California Dental Board—you’ll find your answer immediately.

This is critical for practicing safely and legally.

Sue (continued):
Let me give an example. I recently searched California’s governing body to double-check my information before a course. Within seconds, Google pulled up the correct regulatory agency. You can do this for any state and share that information with colleagues who need clarity.

Jackie:
Social media can make all of this even messier. People give opinions confidently even when they’re not accurate.

Sue:
Exactly. And this leads to misinformation. That’s why understanding your scope and citing the actual regulations is so important when you talk to colleagues—or to patients.

Andrew:
Let’s shift to clinical scenarios. If a state removes a shielding requirement, that doesn’t mean clinicians are prohibited from using shields, right?

Sue:
Correct. Removing a mandate doesn’t mean “don’t shield.” It simply means the evidence doesn’t support requiring it.

So for example, if the thyroid collar consistently blocks the beam and causes retakes, that becomes counterproductive. But if a patient prefers the shield, and positioning doesn’t interfere, it’s fine to use it.

Jackie:
Were the recommendations different for CBCT?

Sue:
Yes. CBCT involves a higher exposure, so it should only be taken when traditional radiographs cannot provide the required clinical information. It should essentially be a last resort. That falls under ALARA as well.

Sue:
I have a personal example. My son needed two baby teeth extracted. The orthodontist had just taken a panoramic X-ray in October. A month later, the oral surgeon wanted another pano. When I asked why, there was no clear explanation. Eventually, they chose not to retake it.

This reinforced something important: we must know why we’re taking each image—and whether it’s truly necessary.

Sue:
Insurance should not dictate radiograph frequency. The ADA has clear recommendations based on caries risk and perio risk.
For a low-risk patient with no history of decay, bitewings may only be needed every 18–24 months. Full-mouth series are based on clinical need—not because insurance will pay.

Andrew:
What about handheld X-ray units? Do clinicians need shielding?

Sue:
A long-term study tracked clinicians taking 100 X-rays per week for 46 weeks. Operator exposure was negligible. Handheld devices have both internal and external shielding built in. The biggest factor is proper training and proper positioning.

If the operator chair or setup prevents proper positioning, shielding can be used for comfort—but from a dose perspective, handheld devices are designed to be safe.

Andrew:
If a state allows no shielding, how much do you explain to patients?

Sue:
I believe in transparency. I would say something like:
“The ADA now recommends against routine shielding because evidence shows it does not reduce your exposure.”

If the patient still wants it, I would use it. It’s not harmful—it just isn’t necessary.

Andrew:
If listeners want to reach out to you, how can they connect?

Sue:
They can email me at [email protected] or find me on Instagram at @suescherer. I’ll also be teaching a course on radiation safety at Under One Roof Extended, which will go deeper into ALARA and the new recommendations.

Andrew:
Sue, thank you so much for being here today.

Sue:
Thank you for having me.

Resources:

The effects of device position on the operator’s radiation dose when using a handheld portable X-ray device: https://pubmed.ncbi.nlm.nih.gov/26764582/

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