Knowledge, Attitude, and Practice of Radiation Protection Safety Measures among Dental Students in a Dental College : Journal of Dental Research and Review

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Original Article

Knowledge, Attitude, and Practice of Radiation Protection Safety Measures among Dental Students in a Dental College

Simmarasan, Murugadharshini; Mohan, Karthik Rajaram; Vakayil, Anju

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Journal of Dental Research and Review 10(1):p 13-18, Jan–Mar 2023. | DOI: 10.4103/jdrr.jdrr_209_22
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Protection from radiation is defined as the practice and science of safeguarding the environment and humans against the hazardous effects of ionizing radiation.

Aim and Objective: 

This study aims to assess and evaluate the attitude, knowledge, and perception of measures against radiation protection of ionizing radiation in 310 dental students in a dental college.


A piece of sound knowledge on protection measures from radiation is essential among dental professionals in modern dental practices. The use of imaging modalities has become inadvertent and increased exponentially during recent years in the era of dentistry.


A 20- E- questionnaire was prepared in google forms after validation from external experts in the field of oral medicine and radiology and were shared to 310 participants comprising of 89 CRRIS, 99 third year BDS graduates, 90 final year BDS graduates, 32 Postgraduates. The responses were recorded, the descriptive statistics were determined in terms of frequencies and percentages.


Out of 310 dental undergraduates, 127 participants (40.97%) stated that the film is held in the mouth of the patient with their hand during radiation exposure and stated the lack of sound knowledge on the effects of radiation among dental undergraduates. Increased awareness and sound knowledge regarding protection measures on radiation during dental training is important for providing better radiation protection measures during practice in dentistry. One hundred and forty-nine (48.06%) answered that high-speed film does not reduce radiation exposure. This shows the lack of piece of sound knowledge about the optimization principle of protection from ionizing radiation among dental undergraduates, which states that the higher the speed of X-ray film, the lower the radiation exposure.


Radiation has become an inextricable component of modern life, affecting every facet of our culture. The ionizing radiation from X-rays plays an pertinent role in dental practice, from the diagnosis of carious lesions involving enamel, dentin, and pulp, chronic periapical infections such as chronic periapical abscess, osteomyelitis, to odontogenic cysts and tumors of the maxillofacial region.[1] Radiation protection standards are based on the safety principles, which are fundamental.

I principle: responsibility for safety. The organization in charge of the facilities and operations that pose radiation risks must bear the primary responsibility for safety. II principle: role of government. It is necessary to build and maintain an efficient governmental and legal structure for safety, including an unbiased regulating authority. III principle: management and leadership for radiation safety for safety. Managing and leading for safety organizations concerned with radiation hazards, as well as facilities and activities that do so, must build and maintain effective leadership and management for safety. IV principle: activities and facilities justification. Facilities and operations that expose people to radiation hazards must be enormously beneficial. V principle: protection from optimization: the best level of safety from ionizing radiation that can be obtained through protection by as low as reasonably achievable must be provided. VI principle: no person should be exposed to an unacceptable risk of injury from ionizing radiation, according to measures for controlling radiation hazards. VII principle: protection of present and future generations. Radiation dangers must be minimized to safeguard current and future generations of people and the environment. VIII principle: prevention of accidental exposure to ionizing radiation from nuclear accidents. Accidents involving nuclear material or radiation must be prevented and minimized using every available means. IX principle: emergency response and preparedness: emergency response and preparedness for nuclear or radiation incidents must be established. X principle: protective actions to reduce unregulated or existing radiation risks. Protection measures must be adjusted and justified to lower ionizing radiation dangers that are already present or unregulated.[1] The International Commission on Radiation Protection (ICRP) is an international regulatory agency that was established in 1928 to establish radiation protection standards and exposure limits for workers of ionizing radiation and the general population from the public. The Atomic Energy Regulating Board, established on November 15, 1983, is the Indian regulatory body for radiation protection. The board’s goal is to prevent the use of ionizing radiation from having an unreasonable negative impact on human health and the environment.

The three guiding principles in radiation protection include justification, optimization, and dose limitation. The justification principle states that the dentist should recognize situations where the advantage of diagnostic exposure to a patient outweighs the danger of harm. The principle of optimization states that every reasonable effort should be made by the dentist to reduce unwanted exposure to their patients and themselves. The dose limitation principle establishes dose limits for occupational and public exposures to ensure that no one is exposed to unnecessarily high doses.[2]


An E-questionnaire survey was conducted among the dental professionals in the Vinayaka Mission’s Sankarachariyar Dental College. About 310 participants, including the third year BDS and final-year undergraduates and Compulsory Rotatory Residential Internship, were included in the study. Eighty-nine compulsory postgraduates rotatory internship students, 99 third year bachelor of dental surgery graduates, ninety final-year bachelor of dental surgery graduates, and 32 postgraduates participated in the study. The questionnaire was prepared in Google Forms; 20 questions were self-designed, structured, and validated by two external expert professionals in the field of oral medicine and radiology for content, clarity, and shared. The questionnaire was approved by the Institutional Ethical commitee 04167022022/S/18. Twenty multiple-choice e-questions to assess their knowledge and attitude were given to the participants. In terms of frequencies and percentages, the descriptive statistics were determined [Table 1].

Table 1:
Questionnaire included in the study


The various responses to twenty multiple-choice E-questions by study subjects, which include undergraduate students and compulsory rotary residential internship students, were recorded [Table 2]. Out of 310 total study participants, around 121 participants (39.03%) stated that the composition of the thermoluminescent dosimeter (TLD) is lithium fluoride. Only 41 participants (13.23%) stated that TLD works on the principle of thermoluminescence. This shows the lack of in-depth knowledge among the dental undergraduates on TLDs. About 249 participants (80.32%) answered the ionizing radiation protection principle correctly as as low as reasonably achievable, according to the International Commission on Radiation Protection (ICRP). Moreover, 237 (76.45%) agreed that less radiation exposure is required in digital radiography, as in accordance with the study by Amol. A. Almohamaide et al. (2020).[3] About 127 participants (40.97%) stated that they held the radiographic film in the mouth of the patient during exposure to dental X-ray from intraoral periapical radiographs. This stated the lack of knowledge on the effects of radiation among dental undergraduates. One hundred and eighty-seven (60.32%) participants agreed that they stand at the time of radiation exposure, a six feet distance away from the direction of primary X-ray beam. One hundred and ninety-three (62.3%) of the participants answered that barium plaster is used for shielding the X-ray room from radiation. One hundred and forty-nine (48.06%) answered that high-speed film does not reduce radiation exposure. This shows the inadequate knowledge of the optimization principle of protection from ionizing radiation among dental undergraduates, which states that the higher the speed of X-ray film, the lower the radiation exposure. One hundred and seven (34.5%) stated that TLD gives an indirect reading of the radiation exposure. One hundred and sixty-eight (54.2%) agreed that pocket dosimeter is a highly fragile among the dosimeters and requires adequate care while handling.

Table 2:
Study subjects’ responses to questions on radiation protection measures


The practice and science of safeguarding the environment and humans against the damaging effects of ionizing radiation are known as radiation protection. Radiation protection is defined by the International Atomic Energy Agency as: “The protection of humans from the adverse consequences of exposure from ionising radiation, as well as the techniques to achieve this.”

Using TLDs and questionnaires, Basheer et al. carried out a pilot institution-based observational study with clinical year students and interns at KSAU-HS College of Dentistry. They came to the conclusion that pupils needed more instruction about radiation safety.[4]

A questionnaire survey by Almohaimede et al. in Saudi Arabia revealed that dental undergraduates need to be more aware of measures on safety from protection from ionizing radiation.[3]

After conducting a cross-sectional survey in 103 dental offices in Kermanshah Province (West of Iran), Rasoul Tohidnia et al. reported that the awareness and the use of radiation-protective measures were not sufficient.[5]

According to Naqvi et al., patients attending Karachi’s public sector tertiary care institutions appear to lack information and awareness about the dangers of ionizing radiation and the precautions taken during X-ray imaging.[6]

In a hospital in Northern Nigeria, 110 members of the radiology, radiotherapy, and dentistry staff participated in a cross-sectional study done by Awosan et al., using a universal sampling technique, and found poor radiation protection practices, with only 10.9% wearing personal protection dosimeters consistently while working.[7]

Praveen et al. stated that a survey conducted on practicing dentists in Bengaluru indicated that radiation protection awareness was inferior. As a result, the measures adopted to decrease exposure were insufficient among dental professionals, and patients must be exposed to as little radiation as possible. To mitigate these consequences, knowledge of several radiation protection measures is essential.[8] Dosimeters help in measuring absorbed dosage quantitatively and consistently by detecting changes in one or more of their physical characteristics after being exposed to ionizing radiation.[9] Hence, there is always a need for knowledge and attitude toward radiation protection measures among dental undergraduates, hence the need for this study. The recent survey by Prajapati et al. stated that there is a lack of knowledge among radiology students about personnel monitoring devices such as dosimeters.[10]


This study’s limitations were that the respondents belong only to the South Indian population, and the number of responders cannot be controlled.

Clinical significance

Knowledge about radiation protection measures is essential for dental students to overcome the hazardous effects of radiation during their clinical practice.


To avoid the harmful effects of radiation during clinical practice, dental students must have a thorough understanding of the various radiation protective techniques. Only if the benefit surpasses the risk, should a patient be exposed to radiation, according to instructions for health-care workers. However, dentistry students need to be more strongly persuaded of the requirement for radiation protection.

Ethical statement

Ethical approval was obtained from the Institutional Ethical commitee 04167022022/S/18.

Informed consent

Informed consent was obtained from all the study participants.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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2. Nenot, Jean-Claude, Brenot, Jean, Laurier, Dominique, et al. The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 2007;37:1–332.
3. Almohaimede AA, Bendahmash MW, Dhafr FM, Awwad AF, Al-Madi EM. Knowledge, Attitude, and Practice (KAP) of radiographic protection by dental undergraduate and endodontic postgraduate students, general practitioners, and endodontists. Int J Dent 2020;2020:1–8.
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8. Praveen BN, Shubhasini AR, Bhanushree R, Sumsum PS, Sushma CN. Radiation in dental practice:Awareness, protection and recommendations. J Contemp Dent Pract 2013;14:143–8.
9. Yusof N, Hilmy N. Radiation biology of tissue radiosterilization. Comprehensive Biomedical Physics Stockholm, Sweden Elsevier 2014 263–87.
10. Prajapati J, Kumar R, Boora N, Sah NK. Assessment of knowledge of radiography students about personnel radiation monitoring devices and their use. Indian J Radiol Imaging 2022;32:191–6.

Dental students; knowledge; radiation protection measures

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