This article objectively summarizes published clinical recommendations. Original source citation in footer.

By JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA
April 22, 2026

The 2026 joint recommendations from the American Dental Association and the American Academy of Oral and Maxillofacial Radiology (AAOMR) establish when dental radiographs and cone-beam computed tomography (CBCT) are clinically appropriate. These guidelines are the first major revision since 2012 and the first to address both 2-D radiography and 3-D CBCT under a single clinical framework.

The 2026 guidelines emphasize clinical necessity. The recommendations reinforce that radiographic exams should not be routine or automatic. Instead, clinicians must review medical and dental histories, examine prior radiographs, conduct a comprehensive clinical exam, and assess risk factors before deciding to expose the patient to radiation. Dental imaging should follow the same clinical rationale as medical imaging, ordered only when the clinical evaluation points to a clear need.

The guidelines provide expanded, scenario-specific recommendations, offering greater detail and broader applicability than the 2012 criteria. These include guidance for caries detection (anterior/posterior proximal, occlusal, root, and smooth surfaces), periodontal disease, endodontic diagnosis, implant planning and placement, temporomandibular disorders, and growth and developmental conditions. In each case, the choice between bitewings, periapical imaging, panoramic radiography, or CBCT depends on the lesion site, anatomic considerations, and clinical judgement.

Although CBCT provides valuable 3-D diagnostic information, especially for implants, pathology, and complex anatomical assessments, the guidelines call for careful, case-by-case application. CBCT should not replace 2-D radiography for routine examinations due to higher radiation exposure and interpretive responsibilities. This reflects the AAOMR’s longstanding position that providers must be qualified to interpret what CBCT imaging reveals.

The updated guidelines also make clear that imaging decisions must be individualized. The panel’s model accounts for caries risk, periodontal status, growth and development conditions, trauma or suspected pathology, and medical conditions that alter oral disease risk. This approach balances diagnostic benefit and radiation exposure, consistent with the foundational ALARA principle (as low as reasonably achievable).

Dental hygienists are often the first to evaluate patient risk, review histories, and identify conditions that may warrant imaging, which makes these recommendations directly relevant to daily practice. Because imaging should follow disease risk rather than a set schedule, hygienists are in a position to evaluate oral health status and weigh in on when imaging is warranted. Minimizing exposure is a core principle throughout. Hygienists can explain why an image is or is not indicated, address patient concerns about radiation safety, apply the ALARA principle, and cite the new guidance to support individualized imaging schedules.

Dental hygienists can also help identify which type of radiograph is best suited to a clinical question. Bitewings, for example, are the right call for proximal caries in high-risk patients. Periapicals are suited for suspected endodontic involvement, panoramic imaging works well for eruption patterns or developmental anomalies, and CBCT becomes relevant when 3-D visualization is essential. Each choice reflects the guidelines’ emphasis on the least invasive modality that will answer the diagnostic question. When CBCT may be warranted, hygienists contribute by recognizing the clinical indicators, gathering histories, documenting findings, and coordinating care for implants, orthodontics, or pathology referrals. This involvement strengthens clinical accuracy and keeps practice consistent with national guidelines.

The updated guidelines provide a modern, risk-based, and person-centered framework for radiographic imaging. Clinical necessity, individualized assessment, and judicious use of advanced imaging are at the core of recommendations that maximize diagnostic value while minimizing exposure. For dental hygienists, these guidelines reinforce and expand their role across risk assessment, patient education, imaging selection, and interdisciplinary care, pushing practice toward something safer, more precise, and grounded in current evidence.

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This article summarizes the findings of “American Dental Association and American Academy of Oral and Maxillofacial Radiology patient selection for dental radiography and cone-beam computed tomography: Clinical recommendations” by Erika Benavides, Joseph R. Krecioch, Trishul Allareddy, Allison Buchanan, Martha Ann Keels, Ana Karina Mascarenhas, Mai-Ly Duong, Kelly K. O’Brien, Kathleen M. Ziegler, Ruth D. Lipman, Roger T. Connolly, Lucia Cevidanes, Kitrina Cordell, Satheesh Elangovan, Ashraf F. Fouad, Carlos González-Cabezas, Sarandeep Singh Huja, Deepak Kademani, Asma Khan, Anchal Malik, Darshanjit Pannu, Zachary S. Peacock, Mario Ramos, Hector F. Rios, Parish Sedghizadeh, Marcela Romero-Reyes, James Hawkins, Elise Watson Sarvas, and Juan Yepes, published in the Journal of the American Dental Association, JADA 2026:157(1):20-35 (DOI: 10.1016/j.adaj.2025.10.013)

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JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA, is the ADHA Director of Education and Research, professor emerita in the Department of Dental Hygiene at Idaho State University, past president of the International Federation of Dental Hygienists 2013-2016, and past president of the American Dental Hygienists’ Association 1990-1991.