In traditional orthodontics, step one is often getting a dental X-ray before your doctor starts straightening any teeth.

The American Dental Association (ADA) has revised its guidelines to answer the question of how often dental X-rays are recommended. The ADA used to recommend yearly X-rays; now the group says adults with no apparent dental problems only need a dental X-ray every 2 or 3 years.

Dentists can overuse X-rays

Instead of an X-ray, SmileDirectClub-affiliated dentists rely on a 3D image of your teeth to prescribe aligners. A study by Harvard School of Dental Medicine suggests that 3D photography, like our scans, could offer better orthodontic diagnosis without radiation.

“A 3D impression or scan almost always eliminates the need for dental X-rays when planning your treatment,” says Dr. Jeffrey Sulitzer, Chief Clinical Officer at SmileDirectClub. Your treating doctor will review your 3D image, photographs of your teeth, and your medical and dental history, which is typically enough to determine if you’re eligible for treatment.

If they have any concerns after this, they may ask for additional documentation, such as clinical notes or an X-ray from your local dentist.

X-rays can increase risk of some types of cancer

Though dental X-rays produce a relatively low dose of radiation compared to other medical imaging, several studies have appeared to find a link to an increased risk of brain tumors associated with dental X-rays.

“There have been 21 studies recently that have found a correlation between dental diagnostic X-rays and overall health, with many finding a correlation between X-rays and brain and thyroid cancer,” Dr. Sulitzer says. “An unnecessary X-ray is unnecessary harm.”

And get this: Another study found that the vast majority of orthodontists make a treatment plan before viewing the X-rays they took.

That’s why at SmileDirectClub, X-rays are not always required before the dentists in our network prescribe aligners. They take it on a case-by-case basis.

“While some oral health issues require X-rays, the use of aligners is not typically one of those issues,” Dr. Sulitzer says. “You do not always need dental X-rays to get started on your Smile Journey.”