Background: Although exposure to even low doses of ionizing radiation can cause cell damage and increase the risk of cancer, dental radiography remains an essential tool for making the correct diagnosis and planning treatment. Despite the advancements in dental radiography, significant global variations in the knowledge, attitudes, and practices (KAP) of dental professionals persist, including those practicing in the Middle East and Saudi Arabia. Its continued necessity highlights the importance of continuously and thoroughly evaluating the compliance to safety standards according to international guidelines. Aim: This review aims to ascertain prevailing occupational radiation exposure levels, evaluate the knowledge and awareness, and assess their compliance with international safety standards across global, Middle Eastern, and Saudi Arabian contexts. Methods: This narrative review comprises articles published in the time frame from 2019 to 2025 and focuses on radiation exposure and safety practices in dental radiology. It gathers data from researches done internationally, regionally, and in Saudi Arabia, to appraise compliance and awareness regarding safety standards according to the international standards. The review evaluates the alignment of current practices with ICRP and ADA guidelines while identifying systemic gaps that require further intervention. Findings: The review revealed a low occupational exposure, which ranges from 0.1 to 1 mSv per year globally. As for the Middle East, measured exposure levels have been slightly increased to 0.2–1.0 mSv/year. In particular, a significant study cohort in Saudi Arabia showed an average annual exposure of 0.72 mSv, which is way below the allowed international limits stated by the International Commission on Radiological Protection (ICRP), these results reflect standardized digital settings and may not represent the full national workforce. The level of awareness about the ALARA (As Low As Reasonably Achievable) protocol was reported to be high, ranging from 60% to 90%. However, this understanding was improved by 15% to 25% with the addition of radiation safety training. Nevertheless, about 50% to 83% of the respondents did not comply with safety rules, mainly knowledge of ICRP guidelines. Unlike others, there is a 70% to 90% adoption of lead shielding practices. Digital radiography improvements raise the questions of the need for lead aprons, although personal protection is essential. The use of dosimeters remains low, particularly in the Middle East (20-30%) and Saudi Arabia (25-50%), due to the regulatory limitations and resource allocation. Conclusions: Although modern imaging systems have reduced risks, ongoing gaps in training and compliance emphasize the importance of stronger regulation and continuous education. To bridge these gaps, applying the ALADA principle (As Low As Diagnostically Acceptable) in daily practice and conducting long-term multicenter studies would further improve safety, helping to align future efforts with Saudi Vision 2030 goals for innovation and workforce development.
Alsubaie et al. (Thu,) studied this question.