Guidance updated May 2025
We have updated this guidance to include information on cone-beam computed tomography equipment and hand-held X-ray machines.
This box only lists significant updates, for example where we are updating the factual content of our guidance. We do not include minor changes, such as editorial corrections.
In dentistry, X-rays are used to identify problems such as infections, decay and bone loss.
They help practitioners to see areas of the mouth and/or conditions that they might not be able to see just through a routine examination. X-rays can also help to identify any problems that may present in the future.
We will consider how your practice uses X-rays when we review if the practice is safe. This relates to:
Legislation and guidance on radiation protection
As well as the Health and Social Care Act regulations, dedicated legislation and professional guidelines govern the use of dental X-ray equipment.
- The Ionising Radiation (Medical Exposure) Regulations 2017 aim to make sure that medical ionising radiation is used safely to protect patients from the risk of harm when being exposed. They set out the responsibilities of duty holders (the employer, referrer, IR(ME)R practitioner and operator) for radiation protection and the basic safety standards that duty holders must meet.
- Where a member of the public or a worker receives an over-exposure to ionising radiation, this needs to be reported to the Health and Safety Executive under Regulation 26 of The Ionising Radiation Regulations 2017.
- Over-exposures resulting from equipment faults before the equipment is put into clinical use, for example for critical examination, should also be reported to Health and Safety Executive: Ionising radiation
- Guidance for dental practitioners on the safe use of X-ray equipment (UK Health Security Agency Dental X-ray Protection Services).
Cone-beam computed tomography (CBCT) equipment
CBCT machines produce a 3-dimensional scan of the jaws and teeth. They are commonly used for planning dental implant placement and oral surgery procedures. Although the amount of radiation used is higher than traditional 2-dimensional X-rays, the dose is lower than other forms of CT scans.
Practitioners should take into account the Guidance notes for dental practitioners on the safe use of X-ray equipment when acquiring, using and maintaining a CBCT machine. This includes staff training.
Hand-held X-ray equipment
Portable hand-held X-ray equipment can be used in different surgeries and on domiciliary visits. The dose to the patient and operator is comparable to wall-mounted X-ray equipment, as long as certain additional precautions are observed.
Practices should take into account the following guidance when purchasing, using and maintaining a hand-held X-ray machine:
- Guidance on the safe use of hand-held dental X-ray Equipment (Public Health England)
- Guidance notes for dental practitioners on the safe use of X-ray equipment (Public Health England and College of General Dentistry)
- Medical Device Alert: Non CE-marked portable dental X-ray units (MDA/2012/046)
Issues we will consider
- How do you put arrangements for radiation protection into practice?
- Have you consulted a radiation protection adviser (RPA) and medical physics expert (MPE)? The same person may fulfill both roles.
- Have you registered with Health and Safety Executive? Do you have a certificate?
- Have you documented the arrangements for radiation protection, for example, in a radiation file or folder?
- Do you quality-assure or test the performance of the radiography equipment?
- Is the X-ray equipment maintained or serviced by an appropriate person? This could be the organisation that installed the equipment.
- Does an appropriately trained member of staff do a visual inspection of X-ray sets to identify any safety faults?
- Which staff are involved in taking X-rays and are they trained to current professional guidelines?