Dental X-rays and meningioma – is there a risk?


There have been  a  number of stories in the press  regarding the recent paper  by Claus et al  on dental X-rays and meningiomas.   Meningiomas  are mostly benign tumours which arise from the dura mater and are usually slow-growing.   They are the most common benign brain tumour  although  relatively uncommon with an incidence of around 6 per 100,000 and a female:male ratio  is 2:1 . The aim of the  Claus study was to examine the association between dental x-rays and the risk of intracranial meningioma.

What did they do?

The authors identified all individuals aged 20-70) with histologically confirmed intracranial meningioma in several states ( cases)over a 5 year period  using Rapid Case Ascertainment (RCA) systems and state cancer registries.  Controls were matched to cases by 5-year age interval, sex, and state of residence excluding those with previous history of meningioma and/or a brain lesion of unknown outcome.

Following approvals participants were contacted for a telephone interview, questions included onset, frequency, and type of dental care received including the number of times they had received radiographs (bitewing, full-mouth, or panoramic [panorex]), during 4 time periods: when aged <10 years, 10-19 yrs,20 -49 years, ≥50 years. Information also was gathered on the occurrence and timing of therapeutic radiation treatments.

A conditional logistic regression was used to assess the odds of meningioma associated with risk factors. individuals who had received therapeutic radiation were removed from all analyses that assessed the risk associated with dental x-rays

What did they report?

  • Cases were more than twice as likely as controls to report having ever had a bitewings
  • individuals who reported receiving bitewings on a yearly basis or more had an elevated risk for ages <
  • An increased risk of meningioma also was associated with panorex films taken at a young age or on a yearly basis or more.
  • No association was appreciated for tumour location above or below the tentorium.

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What did they conclude

Our findings suggest that dental x-rays, particularly when obtained frequently and at a young age, may be associated with an increased risk of intracranial meningioma, at least for the dosing received by our study participants.

Claus, E. B., Calvocoressi, L., Bondy, M. L., Schildkraut, J. M., Wiemels, J. L. and Wrensch, M. (2012), Dental x-rays and risk of meningioma. Cancer. doi: 10.1002/cncr.26625

Things to consider

  • This was a large study but there is no formal power calculation.
  • The average length of the telephone interview was 52 minutes  – How effective are telephone interviews at eliciting this type of information , is recall and honesty a greater or lesser problem than with a face to face interview?
  • There is some discussion regarding the potential recall bias relating to the number and type of dental radiographs. This is discussed in the paper and  it is suggested that recall for dental radiographs high but the studies quoted were much smaller.
  • The controls were more likely to have ≥16 years of education and to have an annual salary >$75,000.
  • It is interesting that ORs are higher for ‘bitewings at any age’ when you would anticipate that for older patients with longer dental histories there may potentially be a dose related effect so you might expect the ORs to be greater in the >50s.
  • While the panorex data does suggest a higher risk these are all based on small numbers of patients.
  • As noted in the Daily telegraph article, this is a rare disease so if this evidence was confirmed it would mean that the lifetime risk of meningioma would increase from 15 in every 10,000 people to 22 in 10,000
  •  Finally while this study does not raise significant concerns it is a timely reminder that dental x-rays should only be prescribed where there is a clear clinical need so as to reduce unnecessary exposure to ionising radiation.

 Selection criteria for Dental radiographs from the Faculty of General Dental Practitioners

American Dental  Association-  use of dental radiographs

Further information on Meningiomas

Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010 Sep;99(3):307-14. Epub 2010 Sep 7. Review. PubMed PMID: 20821343; PubMed Central PMCID: PMC2945461.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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