Radiography of Patients with Special Needs

1. Radiography of Patients with Special Needs

3. II. Patients with Disabilities Physical Disabilities Developmental Disabilities Helpful Hints

4. III. Patients with Specific Dental Needs Pediatric Patients Helpful Hints Endodontic Patients Edentulous Patients

5. Patients with the Gag Reflex gagging = retching gag reflex = pharyngeal reflex = retching elicited by stimulation of the sensitive tissues of the soft palate region the soft palate and the lateral posterior third of the tongue***

6. 2 types of stimuli for the gag reflex Psychogenic - thinking about or anticipating the film placement Tactile - the palate, base of the tongue and posterior wall of the pharynx

7. Patient Management 1. Operator attitude 2. Patient and equipment preparations 3. Exposure sequencing 4. Film placement and technique 5. Helpful hints for preventing the gag reflex

8. 1. Operator attitude convey a confident attitude convey patience, tolerance, and understanding relax and reassure the patient

9. 2. Patient and equipment preparations limit the amount of time that a film remains in the mouth patient and equipment preparations are completed prior to film placement.

10. 3. Exposure sequencing start with the anterior exposures expose the premolar film before the molar film the maxillary molar film is the most likely to elicit the gag reflex.

11. 4. Film placement and technique � each film must be placed and exposed as quickly as possible � avoid the palate - do not slide the film along the palate demonstrate film placement - rub a finger along the tissues near the intended area of film placement

12. Extreme Cases of the Gag Reflex extraoral films : panoramic or lateral jaw radiographs

13. 5. Helpful hints for preventing the gag reflex Never suggest gagging. Do reassure the patient. Do suggest breathing. Do try to distract the patient. Do try to reduce tactile stimuli. Do use a topical anesthetic.

14. Patients with Disabilities Physical Disability Developmental Disability

15. Physical Disabilities Vision impairment - clear verbal explanations - never gesture to another person in the presence of a person who is blind. Hearing impairment - caretaker : interpreter - use gestures (sign language) - use written instructions Mobility impairment

17. Developmental Disabilities autism, cerebral palsy, epilepsy and other neuropathies and mental retardation

18. Helpful hints for treating a patient with a disability Do not ask personal questions about a disability. Do offer assistance to a person with a disability. Do talk directly to the person with a disability

19. Patients with Specific Dental Needs Pediatric Patients Helpful Hints Endodontic Patients Edentulous Patients

20. Pediatric Patients the prescribing of dental radiographs patient and equipment preparations recommended techniques patient management

21. the prescribing of dental radiographs

22. patient and equipment preparations explanation of precedure - tubehead : camera, lead apron : coat, radiograph : picture lead apron, thyroid collar exposure factors : reduced film size

23. recommended techniques prefer the bisecting technique : primary or transitional dentition bitewing and occlusal technique

24. Radiographs taken by having the child bite the film packet.

25. Reverse bitewing the film packet is placed on the cheek side of the teeth in the buccal sulcus. The child bites on the tab to hold the film packet. The x-ray beam is directed extraorally from under the opposite side of the mandible.

26. Reverse bitewing

27. Lateral oblique technique for detecting caries and pathologic conditions in children.

28. Radiograph made by using occlusal film packet extraorally.

29. Helpful hints for managing a pediatric patient be confident. show and tell. reassure the patient. demonstrate behavior. request assistance. postpone the examination.

30. Endodontic Patients EndoRay film holder hemostat or a wooden tongue depressor recommended technique : paralleling technique

31. Film holders used in endodontic procedures.

32. Edentulous Patients to detect the presence of root tips, impacted teeth , and lesions (cysts, tumors) to identify objects embedded in bone to establish the position of normal anatomic landmarks (e.g., mental foramen) relative to the crest of the alveolar ridge to observe the quantity and quality of bone that is present

33. Edentulous Patients panoramic radiograph periapical radiograph a combination of occlusal and periapical radiographs

34. panoramic radiograph the most common way quick and easy periapical of the specific area

35. An edentulous panoramic radiograph.

36. periapical radiograph 14 periapical films (six anterior and eight posterior) Size 2 film paralleling technique or bisecting technique severely resorbed alveolar ridge : bisecting technique

37. Cotton roll attached to a biteblock on the film holder will aid in radiographing edentulous areas.

38. Occlusal and periapical examination a total of 6 films one maxillary topographic occlusal projecction (Size 4 film) one mandibular cross-sectional occlusal projection (Size 4 film) 4 standard molar periapical films (Size 2 film) a periapical film of the specific area

39. Mixed occlusal-periapical edentulous survey.

40. Localization

41. 1. Right angle technique

43. 2.Tube shift technique

47. Reference Frommer HH (2001). Radiology for dental auxiliaries. 7th edition. Mosby: St. Louis, 286-311. Haring JI, Jansen L (2000). Dental radiography: principles and techniques. 2nd edition. WB Saunders Company: Philadelphia, 397-407. Mauriello SM, Overman VP, Platin E (1995). Radiographic imaging for the dental team. J.B. Lippincott Company: Philadelphia, 233-241.