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Dental radiography is common, accounting for about one quarter of global diagnostic radiological examinations in 2020, or approximately one billion dental x-rays per year. International guidelines generally advise an individualized, clinically-guided approach to screening radiography in people at low risk for dental caries: a goal is to minimize cumulative ionizing radiation exposure. Advocacy efforts by European and United States (US) dental experts include Image Gently (children), Image Wisely (adults), and As Low as Diagnostically Achievable being Indication-oriented and Patient-specific (ALADAIP). However, in the absence of high-quality evidence about clinical outcomes of interest for screening dental radiography, UK Faculty of General Dental Practice (2018), European Association of Paediatric Dentistry (2019), and American Dental Association (2024) guidelines have recommended routine screening x-ray frequencies based on consensus opinion. Dental research about routine screening x-rays has mainly focused on aspects such as comparisons of imaging techniques or associations with certain malignancies. Data are lacking about outcomes, such as infection or tooth loss, that are related to routine dental radiography for healthy people at low risk for caries who receive regular dental care. A 2021 Cochrane review that included 77 studies (multinational; 15,518 tooth sites or surfaces) concluded that low-certainty evidence suggested that imaging for the detection or diagnosis of early tooth decay may result in a relatively high proportion of false-negative results. The American Dental Association has noted that adult dentate recall patients without signs and symptoms of oral disease who receive regular dental care are at low risk for caries. Nevertheless, guidelines have recommended that low-risk adult recall patients receive bitewing x-rays every 2 years (UK) or 2–3 years (US). While still recommending an individualized approach to screening x-rays in children, expert opinion has varied for radiography of primary dentition at low risk of caries. UK guidelines recommended initial x-rays at every 12 to 18 months, while European guidelines did not recommend routine radiography. High-quality evidence concerning outcomes related to routine screening dental x-rays is needed and would inform an approach to risks and benefits of longitudinal clinical evaluation as compared to radiography for certain populations, such as healthy adults or children without clinical caries who are at low risk of caries.