Dental patients face radiation risk

Thousands of unsuspecting Jamaicans may have been or are currently being exposed to radiation after receiving treatment at dental offices.

Dr Cliff Riley, director general of the Hazardous Substances Regulatory Authority (HSRA), raised his concerns about the issue while speaking with The Gleaner yesterday.

According to him, out of all the medical professionals who utilise ionising radiation apparatus or devices emitting ionising radiation, dentists are the most non-compliant with the regulations, a trend noticed since 2019.

Riley continued that only 12 per cent of the island’s 284 dental practices were currently authorised to use ionising radiation.

“And a lot of those who are authorised are public facilities - the dental clinics in the Ministry of Health - so you can just estimate how many private entities are not authorised, and then you’ll see how alarming it is,” he said.

Riley further pointed out that although ionising radiation has many beneficial uses, it is also extremely dangerous. For this reason, it is important to enforce the Nuclear Safety and Radiation Protection Act, 2015 and the Nuclear Safety and Radiation Protection Regulations, 2019, which guarantee that people, property, and the environment are protected from the damaging effects of ionising radiation.

He explained that the HSRA is responsible for inspecting organisations that use ionising radiation equipment and ensuring that safety protocols are followed to safeguard patients, equipment operators, and the environment. This is done by a team of 14 independent, qualified experts who visit the facilities and conduct thorough evaluations.

“We do things like checking the equipment to ensure that the radiation coming out is in keeping with what it’s supposed to be generating. We look at radioactive [and] nuclear materials ... that all [these] sources are accounted for whether they are being used or they are not being used,” he said.

Considering that the dental fraternity has been known to be quite resistant to obtaining authorisation or often takes a very lengthy time to do so, Riley stated that the HSRA was unable to guarantee the safety of the public using facilities that do not hold an HSRA licence.

This, he added, was of major concern because dentists are the largest users of radiation sources.

“A lot of persons in the public are taking significant risk having all these X-rays done by dentists who are not authorised ... on the contrary, we have 83 per cent of the diagnostic facilities being authorised,” he added.

Therefore, he encouraged dentists to obtain authorisation.

He stated that the registration fee for certification of authorisation ranges from $25,000 to $50,000 and is valid for up to two years.

Exercise caution

Riley also cautioned the public to exercise caution while receiving care at dental offices, making sure that the institution has authorisation before allowing them to take any kind of X-ray.

“All the medical and dental facilities that are authorised have a certificate of authorisation, which we advise the entities [to] place at a space that members of the public can see ... so if you don’t see that certificate in office, they are not authorised,” he added.

According to the World Health Organization (WHO), ionising radiation is a type of energy released by atoms in the form of electromagnetic waves or particles.

Its application in medicine can be found in services such as radiography (X-rays), dental X-rays, computed tomography (CT) scans, nuclear medicine, a fluoroscopy, and a mammography.

There are more than 480 facilities that use ionising radiation in Jamaica.

Facilities that are found non-compliant with the law can be fined $3 million or face imprisonment of up to six months.

Riley continued that workers at non-compliant offices also run the risk of high levels of radiation exposure.

“We have gone to facilities, and when you look at the radiation levels, we have to ask the guys to just stop all operations, and they’ve been operating for a long time. Their staff and patients were being exposed to all kinds of radiation and they never had a clue,” he explained.

The annual maximum amount of radiation exposure permitted per individual is 20 millisieverts (mSv/year) after which radiation exposure is thought to be extremely detrimental to them.

“When we talk about property as well ... most dental facilities are in plazas, so we ensure that they have what we call the shielding between their wall, so radiation does not go over to their neighbours and cause any harm,” he said, noting that concrete walls cannot block radiation completely and that lead would also be required.

Enforcement activities

Riley noted that the HSRA has started a number of enforcement activities, with a significant number of facilities to be hauled before the courts in short order.

He stated that facilities usually received up to three messages (email and delivered letters) notifying them of their non-compliance and have up to three months to comply. He added that while the HSRA did not seek to shutter facilities, it is compelled to take legal action when they refuse to comply.

“We take this very seriously because we know the negative impact of ionising radiation. We saw what happened in Trinidad with the number of persons who had skin burns from high doses of radiation. We cannot afford for that to happen in Jamaica,” he added.

“We need to care for our patients enough to ensure that we implement best practices,” Riley said.

asha.wilks@gleanerjm.com