Pediatric Restorative Dentistry with Radiographs: Importance and Protocols

1. Pediatric Restorative Dentistry with Radiographs Dr. Ha T. Jacklynn Thai Board Certified Pediatric Dentist Associate Professor, University of California, San Francisco Department of Pediatric Dentistry HRSA Program: Pediatric Dentistry in Hygiene Dentistry 24700 Calaroga Ave. Suite 104 ~ Hayward, CA 94545 ~ 510.785.9295

2. Pediatric Radiography

3. Significance • Diagnostic Aid • Proper diagnosis • Areas to be evaluated • Safety • Reimbursement of services • Quantity • Development • Age • Need

4. Significance • The risk of under diagnosing vs. the radiation exposure • Not all surfaces are visible to the naked eye • It’s not just the teeth that need to assessed • Periapical films • BW films • Panoramic film • Cephalometric film

5. Safety • Radiation Exposure • Adherence of radiation safety protocols • Dental x-rays are one of the lowest exposure of radiation dose • Absorbed radiation is measured in units of millirem(mrem) • In the United States, the average accumulated background radiation dose to an individual in a 1 year period is 620mrem • Radiation itself is measured in units of millisieverts (mSv) • Perspective • 4 bitewings 0.4 mrem • Chest xray 10 mrem • CT scan of head 200 mrem • CT scan of chest 700 mrem • 5 hours transcontinental flight 2-5 mrem • Banana 0.01 mrem • 1 cup of Brazil nuts 0.016 mrem • Living at high altitude for 1 year i.e. Denver, CO 50 mrem per year Source: National Council on Radiation Protection and Measurements (NCRP)

6. Other Common Day-To-Day Sources of Radiation • Televisions with cathode ray tubes • Flat screens do not have tube (1 mrem per year) • Drinking water • Sourced from rivers and lakes which pick up radiation from natural sources like the soil and rocks (5 mrem per year) • Natural gas stoves (9 mrem per year) • Cigarette smoking – quarter of a pack per day (1,300 mrem per year)

7. Reimbursement • Access to care barriers

8. Quantity of Radiographs • All primary dentition (baseline) • Upper and lower anterior • 2 BWs (size 0) • Early mixed dentition (~6-8 years) • Upper and lower anterior* • 2 BWs (attempt size 2) • Late mixed dentition (~8-12 years) • Upper and lower anterior* • 2 BWs (size 2) • Panoramic • Full permanent dentition (~13+ years) • Upper and lower anterior* • 4 BWs • Panoramic • Isolated/focused areas • Trauma areas

12. What You Don’t See With the Naked Eye

15. Film placement

16. Ectopic Eruption #3 6 years old

17. INVESTIGATE further when something looks suspicious

19. Cavity Control – Treatment Options • Sealant • Filling • Amalgam • Composite • Pulpotomy/pulpectomy • Crowns • SSC • Resin • Zirconia • Extraction • With space maintainer • Without space maintainer

20. Sealant • Isolation • Etch • To bond or not to bond • Sealant

21. Various options

22. Sealant Placement • Pumice/clean tooth – no fluoride products & rinse • Isolation • Air dry tooth • Apply etch • Explore • Bond (?) • Sealant application • Explore vs. microbrush • Cure • Assessment/self-critique • Check occlusion Total Working Time: 3-5 min per tooth

23. Clinical presentation

24. Broken, Defective, Displaced