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Dental X-Ray Safety During Pregnancy: What the Evidence Says

Introduction

Many expectant mothers delay dental care because they are worried about X-rays. The concern is understandable, but surveys suggest it often rests on misconceptions. In a Saudi survey of 410 women, 91% showed poor knowledge of dental imaging, and only 4% reported that pregnant women can have dental imaging during any trimester [PMID 34284764]. In a Turkish survey of 130 pregnant women, 76.92% considered dental radiography unsafe [PMID 42121581], and in a Chinese survey of 383 pregnant women, safety concerns were the primary barrier to seeking care (74.93%) [PMID 41425487].

This article summarises what published studies say about dental X-ray safety during pregnancy: how much radiation reaches the foetus, what the studies of birth outcomes show, and what a patient in India can reasonably expect from her dentist.

How much radiation reaches the foetus?

A dental X-ray beam is aimed at the head and neck, far from the abdomen, so the dose to the uterus is very small. Two dosimetry studies have measured it directly.

  • Phantom measurements across modalities. Kelaranta and colleagues used an anthropomorphic female phantom to estimate upper limits of foetal dose for intraoral, panoramic (OPG), cephalometric and CBCT examinations. Upper estimates of foetal dose ranged from 0.009 to 6.9 μGy without lead shields and from 0.005 to 2.1 μGy with them. The unshielded foetal doses were below 1% of the annual dose limit of 1 mSv for a member of the public [PMID 26313308].
  • Uterine dose per radiograph. An earlier German study found a mean uterine organ dose of 0.4 μSv per radiograph for the most common examinations, which could be halved when the patient wore a protective apron. The authors concluded that, of all diagnostic radiography procedures, dental radiography involves the least radiation risk to the foetus [PMID 2639045].

A 2022 historical review in the Journal of the American Dental Association, covering literature from 1957 through 2021, concluded that, if properly performed, dental radiography produces so little ionising radiation that it is unlikely to reach the teratogenic threshold, and that necessary dental radiography is safe at any stage of pregnancy as long as proper safety equipment is used [PMID 35985884].

What about birth weight?

One study is often cited in discussions of this topic. In a population-based case-control study from Washington State, an estimated gestational dental radiation exposure higher than 0.4 mGy was associated with low birth weight (adjusted OR 2.27, 95% CI 1.11 to 4.66) and with term low birth weight (adjusted OR 3.61, 95% CI 1.46 to 8.92). This level of exposure occurred in only 21 (1.9%) mothers of low-birth-weight infants [PMID 15113817].

That association has not been consistently reproduced. In a survey of 1200 mothers in Shiraz, there were no statistically significant differences in mean newborn weight between mothers exposed to common radiation sources, including dental and non-dental radiographs, and unexposed mothers; the authors stated that their findings cast doubt on earlier reports [PMID 23633865].

In our reading, the Washington study shows an association, not proof of cause: a case-control design cannot exclude the possibility that women who needed more dental imaging differed in other ways relevant to birth weight. Because the result has been influential, however, it supports the general principle that X-rays in pregnancy should be clinically justified and kept to what is necessary.

Timing and the first trimester

The evidence on dose does not oblige a pregnant woman to postpone a needed X-ray. The Finnish authors stated that pregnancy is never a reason to avoid or postpone a clinically justified dental radiographic examination [PMID 26313308]. For routine or elective imaging, a case review advises a more conservative approach: limit ionising radiation in the first trimester to what is minimally needed, defer elective imaging until after the birth, and follow published radiographic selection criteria [PMID 37714629]. A review written for midwives notes that dental radiographs may be performed safely with appropriate shielding, and that non-emergency treatment is best provided between 14 and 20 weeks' gestation for comfort and optimal fetal safety [PMID 21429074].

Is a lead apron necessary?

The studies differ in emphasis. In the phantom study, lead shields reduced the already low foetal and breast doses, but the authors judged the need for foetal and breast shielding to be irrelevant because the risks were minimal without it [PMID 26313308]. Older dosimetry work [PMID 2639045] and the clinical reviews [PMID 35985884][PMID 21429074] treat shielding as part of routine safe practice. In our reading, a patient who feels more reassured with an apron can reasonably ask for one; its absence does not make a justified X-ray unsafe.

Practical guidance for expectant mothers

The following points are our interpretation of the evidence above. They do not replace the advice of your dentist or obstetrician.

  1. Tell your dentist you are pregnant, or might be, before any X-ray, so that the examination can be justified and planned [PMID 37714629].
  2. Do not delay treatment for pain or infection because of X-ray worries. The measured foetal doses are very small [PMID 26313308][PMID 2639045], and reviews consider necessary imaging safe at any stage of pregnancy [PMID 35985884].
  3. Expect only the X-rays you need. Elective or routine images may be deferred until after delivery [PMID 37714629].
  4. Plan routine dental care for the second trimester where possible, which one review describes as the most comfortable window for non-emergency treatment [PMID 21429074].
  5. Ask about shielding if it reassures you [PMID 26313308][PMID 21429074].

If you are unsure whether a dental problem needs to be seen in person, D4dent's patient services let you book a dentist online and arrange a teleconsultation, so that you can discuss your situation with a dentist before a clinic visit. Appointments booked online come with email or SMS reminders.

Frequently asked questions

Is it safe to have a dental X-ray while pregnant?

A 2022 review of studies published from 1957 to 2021 concluded that necessary dental radiography is safe at any stage of pregnancy, provided proper safety equipment is used. A phantom study found that estimated foetal doses from dental examinations were below 1% of the annual public dose limit of 1 mSv. Always tell your dentist that you are pregnant.

Do I need a lead apron for a dental X-ray during pregnancy?

Lead shields lowered the already small foetal doses in a phantom study, but the authors judged the added protection to be clinically irrelevant. Other reviews still describe shielding as part of routine safe practice, so your dentist may offer an apron and you can ask for one.

Should dental X-rays be postponed until after delivery?

Pregnancy is not a reason to avoid a clinically justified dental X-ray, according to the Finnish phantom study. For elective or routine imaging, a case review advises limiting radiation in the first trimester to what is minimally needed and deferring elective imaging until after the birth.

Limitations to keep in mind

The dose figures come from phantom and dosimetry studies rather than measurements in pregnant patients [PMID 26313308][PMID 2639045]. The birth-weight evidence consists of one case-control study [PMID 15113817] and one survey-based study [PMID 23633865], and the awareness data come from single-country questionnaires [PMID 34284764][PMID 42121581][PMID 41425487]. Figures are taken from published abstracts; readers should consult the full texts before citing specific values.

Conclusion

Dental X-rays deliver a very small dose to the foetus, well below 1% of the annual public dose limit in phantom measurements [PMID 26313308], and a review of more than six decades of literature concluded that necessary dental radiography is safe at any stage of pregnancy when proper safety equipment is used [PMID 35985884]. One case-control study has linked higher gestational dental radiation exposure with low birth weight [PMID 15113817], which reinforces the principle of taking only the X-rays that are clinically needed. In our reading, the greater risk for most expectant mothers is leaving dental pain or infection untreated because of fear of an X-ray.

More in this series

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References

  1. Flagler CK, Troici CM, Rathore SA. A historical review of the effects of dental radiography on pregnant patients. J Am Dent Assoc. 2022 Oct;153(10):989-995. PMID: 35985884
  2. Kelaranta A, Ekholm M, Toroi P, Kortesniemi M. Radiation exposure to foetus and breasts from dental X-ray examinations: effect of lead shields. Dentomaxillofac Radiol. 2016;45(1):20150095. PMID: 26313308
  3. Weber J, Ewen K, Schubel F. [Determining organ doses in the uterus during dental x-ray examinations]. Dtsch Zahnarztl Z. 1989 May;44(5):340-3. PMID: 2639045
  4. Hujoel PP, Bollen AM, Noonan CJ, del Aguila MA. Antepartum dental radiography and infant low birth weight. JAMA. 2004 Apr 28;291(16):1987-93. PMID: 15113817
  5. Mortazavi SM, Shirazi KR, Mortazavi G. The study of the effects of ionizing and non-ionizing radiations on birth weight of newborns to exposed mothers. J Nat Sci Biol Med. 2013 Jan;4(1):213-7. PMID: 23633865
  6. Duda PW, Singer SR, Alamodi E, Mupparapu M. A Pregnant Patient (First Trimester) Reporting for Pain in Relation to the Maxillary Left First Molar Was Prescribed a Full Mouth Series Radiographs in the Dental Office. Dent Clin North Am. 2023 Oct;67(4):703-705. PMID: 37714629
  7. Kloetzel MK, Huebner CE, Milgrom P. Referrals for dental care during pregnancy. J Midwifery Womens Health. 2011 Mar-Apr;56(2):110-7. PMID: 21429074
  8. Bahanan L, Tehsin A, Mousa R, Albadi M, Barayan M, Khan E, Khalifah H. Women's awareness regarding the use of dental imaging during pregnancy. BMC Oral Health. 2021 Jul 20;21(1):357. PMID: 34284764
  9. Atav A, Gunes A, Ovsay E, Topbaş C. Evaluation of Pregnant Women's Perspectives on Root Canal Treatment: A Cross-Sectional Study. Healthcare (Basel). 2026 Apr 24;14(9):1138. PMID: 42121581
  10. Wang X, Xu B, Fan J, Wang Y. Factors Influencing Knowledge, Attitudes, and Practices (KAP) Regarding Dental Diagnosis and Treatment During Pregnancy Among Pregnant Women in Harbin, China: A Cross-Sectional Study. Int J Womens Health. 2025 Dec 13;17:5399-5410. PMID: 41425487