Are Dental X-Rays Required by Law in Texas?

Dental X-rays are not required by law in Texas. No statute or regulation forces a patient to accept them at any visit, and none orders a dentist to take them on a fixed schedule. Whether imaging happens is a clinical decision, governed by the standard in 22 Texas Administrative Code Section 108.7, which requires a dentist to practice “in a manner consistent with that of a reasonable and prudent dentist under the same or similar circumstances.”¹ Within that standard, the dentist weighs your symptoms, history, and exam findings. You, in turn, keep the right to say no.

The American Dental Association and the FDA publish joint recommendations on when to image, but they are explicit that the guidelines “are not intended to be standards of care, nor requirements or regulations.”² They exist as a resource for professional judgment, not a legal checklist.

Your Right to Refuse Dental X-Rays

Texas law requires informed consent before dental treatment. Under 22 TAC 108.7, dentists must obtain written informed consent for any treatment plan or procedure involving a reasonable possibility of complications or risks that could influence a patient’s decision.¹ The right to consent carries with it the right to withhold consent. X-rays are no exception.

If you decline, expect to be asked to sign an informed refusal form. The form acknowledges that you understand the risks of proceeding without imaging, including undetected decay, infection, bone loss, and other problems that are invisible during a visual exam. The refusal becomes part of your permanent patient record. Documenting it protects both sides: it confirms you were told what you were turning down, and it shows the dentist followed the standard of care by raising the issue.

When a Dentist Can Refuse to Treat You Without X-Rays

A dentist is not required to treat you on your terms. If performing a procedure without current imaging would fall below the standard of care, the dentist can decline the work. This is where most friction arises: a patient wants a filling, crown, extraction, or root canal, and the dentist will not start until they can see what is happening below the surface.

Certain procedures effectively require imaging. Root canals, extractions, implant placement, and orthodontic treatment are the common examples. A dentist doing a root canal without an X-ray is working blind, and no reasonable practitioner takes that risk. You remain free to seek care elsewhere, but another competent dentist is likely to reach the same conclusion for the same procedure.

Routinely skipping clinically indicated X-rays can expose a dentist to discipline from the Texas State Board of Dental Examiners under Section 263.002 of the Texas Occupations Code, which authorizes warnings, reprimands, probated or enforced suspensions, and revocation.³ A patient harmed by a missed diagnosis that imaging would have caught can also pursue a health care liability claim under Texas Civil Practice and Remedies Code Chapter 74, which requires serving an expert report on each defendant within 120 days of the defendant’s original answer or facing dismissal with prejudice and attorney’s fees.⁴ Those pressures explain why dentists hold the line on imaging for higher-risk work.

Special Situations That Change the Usual Answer

Children

For patients under 18, parents or legal guardians decide. Texas Family Code Section 151.001 gives parents the right to consent to or refuse medical and dental treatment for their children.⁵ A dentist must respect that decision but may still decline to treat if imaging is clinically necessary.

One exception matters. If a dentist suspects child abuse or neglect, Texas Family Code Section 261.101 requires a report to the Texas Department of Family and Protective Services within 48 hours. The duty applies to all professionals, dentists included, with no exceptions. X-rays are often used to document dental trauma in abuse cases, and in extreme situations a court order can authorize imaging over a parent’s objection.

Emergencies

When a patient arrives unconscious, in severe pain, or otherwise unable to consent, Texas recognizes implied consent for necessary diagnostic measures. If waiting on consent would risk serious harm, X-rays can go forward. In hospital emergency departments and urgent dental clinics, imaging is a routine part of emergency assessment.

Pregnancy

Pregnant patients sometimes ask whether they should decline X-rays. The ADA’s current guidance states that dental radiographs are safe for pregnant patients at any stage and that abdominal or thyroid shielding is no longer recommended.⁶ The right to refuse is unchanged. The medical rationale for refusing has largely fallen away with modern low-dose digital equipment.

How Often X-Rays Are Typically Recommended

Because frequency is not set by law, the ADA/FDA clinical guidelines are the closest thing to a benchmark. They vary by age and risk, and they are starting points rather than mandates. The guidelines themselves say dentists “should only order radiographs when they expect that the additional diagnostic information will affect patient care.”²

Adults at higher risk for cavities: bitewing X-rays every 6 to 18 months.
Adults at lower risk: bitewings every 24 to 36 months.
Children with baby teeth, higher risk: bitewings every 6 to 12 months if the dentist cannot visually inspect between teeth.
Children with baby teeth, lower risk: bitewings every 12 to 24 months.
Adolescents with permanent teeth, lower risk: bitewings every 18 to 36 months.
New adult patients: an individualized exam, with a full-mouth series preferred if there is evidence of widespread disease or extensive prior treatment.

A dentist who spots early signs of a problem may image sooner. One who sees a healthy mouth may wait longer.

Insurance May Require X-Rays Even When the Law Doesn’t

Your dental plan can impose its own requirements. Many insurers will not approve or pay for major procedures without radiographic evidence. Crown placements commonly require a pre-operative periapical X-ray taken within the past year showing the tooth’s condition. Root canals typically require both pre-operative and post-operative X-rays for the claim to process. Without the imaging, the claim can be denied no matter how appropriate the treatment was.

Plans also cap how often they cover routine imaging. Bitewings are usually covered once every 12 months and a panoramic image once every three to five years, though specifics vary by carrier. If your dentist recommends X-rays more often than your plan covers, the difference is yours to pay.

Taking Your X-Rays With You

If you switch dentists or want a second opinion, federal law gives you the right under HIPAA to access your dental records, including X-ray images, and to have them sent to another provider you designate. The office must provide them in the format you request if it can readily produce them that way.⁷

A request to send records to another provider must be in writing. The office can charge a reasonable fee for copies. For electronic copies of records already maintained electronically, the office has the option of charging a flat fee not exceeding $6.50 instead of calculating actual costs.⁸ Because most Texas dental offices now use digital X-rays, transfers are usually straightforward. Bringing recent images to a new dentist can spare you a repeat set, saving cost and avoiding unnecessary radiation.

1
Legal Information Institute. 22 Tex. Admin. Code 108.7 – Minimum Standard of Care
2
U.S. Food and Drug Administration. The Selection of Patients for Dental Radiographic Examinations
3
Texas State Board of Dental Examiners. Disciplinary Actions
4
State of Texas. Texas Civil Practice and Remedies Code Section 74.351
5
State of Texas. Texas Family Code Chapter 151 – Rights and Duties in Parent-Child Relationship
6
American Dental Association. Pregnancy
7
HHS.gov. Individuals’ Right under HIPAA to Access their Health Information
8
HHS.gov. Clarification of Permissible Fees for HIPAA Right of Access