Practicing communication skills can make discussions about radiographs less exhausting. The entire team will need to be on board to create successful radiograph denial strategies. You probably will not ever eliminate this challenge, but you can reduce it by taking the following steps:


Clarify the doctor’s clinical philosophy

The ADA, in collaboration with the FDA, developed recommendations for dental radiographic exams to serve as an adjunct to the dentist’s professional judgment regarding treatment protocols. The doctor should share his/her philosophy about radiographic exams with the team.

Identify the benefits of radiographs

Radiographs can help the practitioner evaluate and definitively diagnose many oral diseases and conditions. Make a bulleted list of these benefits so everyone “speaks the same language.” Sometimes a patient’s refusal is actually a request to understand your recommendation.

Ask the patient why they are hesitant

Know the reason for the refusal. Stating a set x-ray interval as a part of an “office policy” will not address individual challenges. It will likely create further resistance. Once you have determined the specific challenge, you can address it confidently. Generally, refusals fall into one of 3 categories: cost, discomfort, and radiation exposure. You will be more successful if you acknowledge the reason for the resistance and work with the patient in a way that allows them to feel in control.

“May I ask why you don’t want to have x-rays taken today?”

Cost: “I understand cost is a concern for you. Other patients have found it is less expensive to pay for the diagnostic ability x-rays give us to catch things when they are small and less expensive to repair. I will take the minimum necessary.”

Discomfort: “I understand you have experienced a strong gag reflex in the past and I’m sure that is making you less likely to want to go through that again! Let’s work together. I will work quickly, and use a smaller sensor. Let’s get as far as we can together.”

Radiation exposure: “I certainly understand your perspective. We have had such advancements in technology that dental x-rays are quite safe. In fact, the amount of radiation is extremely small.” Be prepared to share a radiation chart that details various exposures; PST can provide this resource.


Improper diagnosis due to a lack of x-rays leaves the practice in a state of liability. A patient cannot waive their right to receive adequate care by signing a refusal for x-rays. If continued resistance occurs, determine at what point the practice will dismiss the patient.

The bottom line is, language shapes perception. You have the power to frame the conversation in a manner that opens further dialogue and reduces resistance. Need more scripting advice? Burkhart has it! Reach out to your Account Manager or PST for support on a variety of dental, treatment, and scheduling conversations.

Your success is our success. Please reach out to us anytime.
Learn more, visit the Practice Support Team page, email us at, or call 1.800.665.5323.

Burkhart Dental Supply – Practice Support Team


Category: Practice Consulting

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