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DA (Can) > Dental Radiograph 1 (Review: Outcomes 1-10) > Flashcards

Dental Radiograph 1 (Review: Outcomes 1-10) Flashcards

1
Q

What is the importance of dental images?

A

In dentistry, dental images enable the dental professional to identify many conditions that may otherwise go undetected and to see conditions that cannot be identified clinically

  • Many dental diseases and conditions have no clinical signs or symptoms and may go undetected without the use of dental images
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2
Q

Risk vs. Benefits of Dental Imaging

A

Dentists and Dental Hygienist should always weigh the benefits of dental images against increasing a patient’s exposure to radiation

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3
Q

What are the Uses of Dental Images?

A
  1. Detect lesions
  2. Confirm or classify suspected disease
  3. Localize lesions or foreign objects
  4. Provide information during dental procedures
  5. Evaluate growth and development
  6. Illustrate changes secondary to caries, periodontal disease, trauma
  7. Document the condition of a patient
  8. Aid in development of a clinical treatment plan
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4
Q

What are the roles of Dental Assistants in regards to Dental Radiography?

A
  1. DA’s must have a thorough knowledge and understanding of the importance and uses of dental imaging
  2. Dental imaging enables the dentist to see conditions that are not visible in the oral cavity
  3. DA’s must understand the fundamental concepts of atomic and molecular structure and have a working knowledge of ionizing radiation and the properties of x-rays
  4. Radiation used to produce dental radiographs has the capacity to cause damage to all types of living tissues
  5. Any exposure to radiation, no matter how small, has the potential to cause biologic changes to the operator and the patient
  6. DA’s must have a thorough understanding of the characteristics of radiation to minimize exposure to both the dental patient and operator
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5
Q

History surrounding the discovery of x-radiation:
Wilhelm Conrad Roentgen

A
  • Discovered x-ray on Nov. 8, 1895
  • x-rays were referred to as roentgen rays; radiology as roentgenology; radiographs as roentgenology
  • He placed his wife’s hand on a photographic plate and exposed her to the rays for 15 minutes to show that he was able to permanently capture the outline of her bones
  • This event was also recorded as the first radiograph of the human body
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6
Q

History surrounding the discovery of x-radiation:
Otto Walkhoff

A
  • Produced the first recorded dental radiograph by exposing a photographic plate in his own mouth for 25 minutes
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7
Q

History surrounding the discovery of x-radiation:
Dr. C. Edmund Kells

A
  • Credited with the first practical use of radiographs in dentistry in 1896
  • Exposed his hands to x-rays every day, eventually lost his fingers, hands, and later his arm as a result of cancerous tumors
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8
Q

Radiograph

A

A picture (visible photographic record) on film produced by the passage of x-rays through an object or body

  • Also called x-ray film
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9
Q

X-radiation (X-ray)

A

A beam of energy

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10
Q

Dental Radiograph

A

A photographic image produced on film by the passage of x-rays through teeth and related structures

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11
Q

Radiography

A

The art and science of making radiographs by the exposure of film to x-rays

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12
Q

Dental Radiographer

A

Any person who positions, exposes, and processes x-ray film

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13
Q

Image

A

A picture or likeness of an object

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14
Q

Image Receptor

A

A recording medium

Examples:
- x-ray film
- phosphor plate
- digital sensor

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15
Q

Imaging, dental

A

The creation of digital, print, or film representations of anatomic structure for the purpose of diagnosis

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16
Q

How do x-rays work?

A

When x-rays pass through the mouth, the teeth and bones absorb more of the ray than the gums and soft tissues
- teeth appear lighter on the final x-ray image (radiograph)
- areas of tooth decay and infection look darker because they don’t absorb as much of the x-ray

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17
Q

Explain the Production of X-radiation

A
  1. When the current travels to the x-ray tube, it creates an electron energy within the cathode
  2. High speed electrons are accelerated from the cathode to the anode. When they collide with positively charged matter, x-radiation is produced
  3. Electrons strike the target and their kinetic energy is converted to x-rays and heat
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18
Q

Exposure of x-ray films

A

Much like a camera, the x-ray film develops depending on the areas which were exposed to the x-rays

  • White areas show the denser tissues (e.g. bones) that have absorbed the x-rays
  • Black areas on an x-ray represent areas where x-rays have passed through soft tissues (e.g. organ, skin)
    –> they cannot absorb the high-energy rays
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19
Q

List the properties of x-radiation

A
  1. They have a shorter wavelength of the electromagnetic spectrum
  2. Requires high voltage to produce x-rays
    - produced when high-velocity electrons collide with the metal plates, which gives them the energy as x-rays and themselves absorbed by the metal plate
  3. They are used to capture the human skeleton defects
  4. They can travel in a straight line and do not carry an electric charge with them
  5. X-ray beams travels through the air and comes in contact with body tissues and produces an image on metal film
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20
Q

What are the biological effects of x-radiation?

A

Short-term & long-term effects

i. Short-term effects: Effects that are seen within minutes, day, or weeks after the latent period
- associated with LARGE AMOUNTS of radiation absorbed in a SHORT TIME
- e.g. exposure to a nuclear accident or the atomic bomb
- Acute Radiation Syndrome (ARS): short-term effect; includes nausea, vomiting, diarrhea, hair loss, hemorrhage
- Not applicable to dentistry

ii. Long-term effects: Effects that appear after years, decades, or generations
- associated with SMALL AMOUNTS of radiation absorbed repeatedly over a LONG PERIOD
- repeated low levels of radiation exposure are linked to the induction of cancer, birth abnormalities, and genetic defects

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21
Q

Genetic vs. Somatic Radiation

A

i. Genetic effects are not seen in the irradiated person, but are passed on to future generations
- genetic damage CANNOT be repaired
- reproductive cells (e.g. ova, sperm) are terms genetic cells

ii. Somatic cells are all the cells in the body except the reproductive cells
- damaged tissues, but is not passed down (in other words, these changes are not transmitted to future generations)

Exposure to radiation has a cumulative effect over a lifetime

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22
Q

What are the radiation effects on tissues and organs?

A
  • In dentistry, some tissues and organs are designated as “critical” because they are exposed to more radiation than others during imaging procedures
  • Critical organ = an organ that, if damaged, diminishes the quality of a person’s life
  • Critical organs exposed during dental imaging procedures in the head & neck region:
    1. Thyroid gland
    2. Bone marrow
    3. Skin
    4. Lens of the eye
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23
Q

ALARA Concept

A

As Low As Reasonably Achievable

  • Every possible method of reducing exposure to radiation should be employed
  • Our goal is to minimize the amount of radiation received by the patient and maximize the benefits
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24
Q

What are the 2 types of radiation monitoring?

A
  1. Equipment monitoring
    - Dental x-ray machines must be monitored for leakage radiation
  2. Personnel monitoring (Dosimeter)
    - A radiation monitoring badge (dosimeter) can be worn at waist level when taking images
    - It is mailed along with a control badge to the monitoring company once a month for evaluation
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25
Q

How are patients protected from x-radiation?

A
  1. Proper prescribing or order of dental images by dentist
    - dentist uses professional judgement to make decision about the number, type, and frequency of dental images
  2. Use of proper equipment
    - Dental x-ray tube head must be equipped with appropriate aluminum filters, a lead collimator, and a position-indicating device (PID)
    - longer (16-inch) PID is preferred vs. short (8-inch) because it produces less divergence of the x-ray beam

During exposure:
3. Patient protection measures are used before and during x-ray exposure
i. Thyroid collar
ii. Lead apron
iii. Digital Sensors or fast film
iv. Beam alignment devices

  1. Exposure Factor Selection
    - Adjustment of kVp, milliamperage, and time settings on the control panel to limit the amount of x-radiation exposure received by the patient
    - on most units, kilovolt peak and milliamperage are preset by manufacturer and cannot be adjusted
  2. Proper Technique
    - helps create a diagnostic image and reduce amount of exposure a patient receives
    - Nondiagnostic images must be retaken = additional exposure of patient to radiation
    RE-EXPOSURE OF AN IMAGE, OR RETAKE MUST BE AVOIDED AT ALL TIMES
    - To produce diagnostic images, the radiographer must have a thorough knowledge of techniques used in dental imaging

After exposure:
6. Proper receptor handling
- Artifacts caused by improper film handling result in nondiagnostic films

  1. Proper film processing/image retrieval
    - Improper film processing may require retakes, needlessly exposing the patient to excess x-radiation

*Proper selection of exposure factors and good technique further protect the patient from excessive exposure to x-radiation

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26
Q

What is a Thyroid Collar?

A

A flexible lead shield that is placed securely around the patient’s neck to protect the thyroid gland from scattered radiation
- the lead prevents radiation from reaching the gland and protects the highly radiosensitive tissues of the thyroid

  • Recommended for all intraoral exposures
  • NOT recommended for extraoral exposures
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27
Q

What is a Lead Apron?

A

A flexible shield placed over the patient’s chest and lap to protect the reproductive and blood-forming tissues from scatter radiation
- the lead prevents the radiation from reaching these radiosensitive organs

  • Recommended for both intraoral and extraoral exposures
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28
Q

What is a Beam Alignment Device?

A

Stabilizes the receptor in the mouth and reduces the change for movement

  • eliminates the need for the patient to hold the receptor in position with a finger, recuing unnecessary exposure
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29
Q

Which image receptor is best for limiting radiation exposure?

A
  • Compared with traditional film radiography, digital image receptors require less radiation exposure to patient
  • Digital receptor is the most effective method of reducing a patient’s radiation exposure
  • the lower absorbed dose is significant with regard to patient protection from excessive radiation
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30
Q

How is an operator protected from x-radiation?

A
  1. Must use proper protection measures to avoid occupational exposure to x-radiation (e.g. primary radiation, leakage radiation, scatter radiation)
  2. The use of proper operator protection techniques can minimize the amount of radiation
  3. Operator protection measures include following protection guidelines and using radiation-monitoring devices
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31
Q

Distance and Position Recommendations for Dental Radiographers

A
  1. Must stand at least 6 feet (2 meters) away from x-ray tube head during x-ray exposure
  2. Must never hold a receptor in place for a patient
  3. Must never hold or stabilize the x-ray tube head
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32
Q

Shielding Recommendations for Dental Radiographers

A

Whenever possible, stand behind a protective barrier (e.g. a wall) during x-ray exposure
- most dental offices incorporate adequate shielding in walls through the use of several thicknesses of common construction materials (drywall)

  • A leaded glass window or use of a mirror is beneficial to monitor the patient during exposure
  • At SAIT, we stand behind a glass window
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33
Q

Guidelines of Radiation Exposure

A
  1. Radiation Safety Legislation
  2. Maximum Permissible Dose
  3. Cumulative Occupational Dose
  4. ALARA Concept
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34
Q

Maximum Permissible Dose (MPD)

A

The maximum dose equivalent that a body is permitted to receive in a specific period

  • For occupationally exposed persons:
    50 mSv/year (0.05 Sv/year or 5.0 rem/year)
  • For non-occupationally exposed persons:
    1 mSv/year (0.1 rem/year)
  • For occupationally exposed pregnant women:
    0.5 mSv per month during pregnancy months
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35
Q

Cumulative Occupational Dose (COD)

A

The dose accumulated over a lifetime

  • An individual’s COD should not exceed the worker’s age multiplied by 10 mSv
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36
Q

Why is it important to understand x-rays?

A

An understanding of dental radiography equipment will permit the DA to practice safely, produce diagnostically acceptable radiographs, and troubleshoot as needed

  • Dental radiographer must be familiar with dental x-ray equipment and x-ray receptor holders and beam alignment devices used in digital and film-based imaging
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37
Q

X-ray Tube Head components

A

i. Tube head
- where x-rays are generated

ii. Position indicator device (PID)
- reduces exposure to the patient

iii. Extension arm
- allows positioning of tube head

See image in lecture slide - Outcome 3

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38
Q

The Cathode

A

NEGATIVE CHARGE

  • Consists of a tungsten filament
  • Purpose: supply electrons necessary to generate x-rays
  • Electrons are generated in x-ray tube at the cathode
  • The hotter the filament becomes, the more elections that are produced

See diagram in lecture slide - Outcome 3
Electrons travel from cathode to anode
CAT–>NAP
CAT = cathode
N = negative
A = anode
P = positive

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39
Q

The Anode

A

POSITIVE CHARGE

  • It is the target for the electrons
  • Composed of tungsten target
  • Purpose of tungsten target: serve as a focal spot and convert the bombarding electrons into x-ray photons

Electrons travel from cathode to anode
CAT–>NAP
CAT = cathode
N = negative
A = anode
P = positive

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40
Q

What are the different types of electric currents?

A
  1. Electricity
    - energy used to make x-rays
  2. Amperage
    - measurement of the number of electrons moving through a conductor
  3. Voltage
    - measurement of electrical force that causes electrons to move from a negative pole to a positive one
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41
Q

Transformers

A

A device that is used to either increase or decrease the voltage in an electrical circuit

  • Higher penetration = shorter wavelength
  • Lower penetration = longer wavelength
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42
Q

What are the factors affecting penetrating power?

A
  1. Wavelength:
    - shorter wavelengths = greater energy = greater penetrating power
  2. Distance:
    - from source to object
    - shorter distance = greater penetrating power
  3. Density:
    - of object to be penetrated
    - less dense object = greater penetrating power
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43
Q

Control Panel of the x-ray equipment

A

Used to adjust the:

i. milliamperage (mA): the amount of electrical current coming out of the cathode
- usually 10-15mA

ii. kilovoltage (kV): the amount of current passing from anode to cathode
- longer exposure (@ 70kV) = high contrast (fewer shades of gray - darker)
- less exposure (@90kV) = low contrast (more shades of gray - lighter)

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44
Q

Types of Radiation

A
  1. Primary
    - useful rays are produced from the x-ray tube
  2. Stray
    - rays that flow out from parts of the x-ray tube other than the window (faulty tube)
  3. Scatter or Secondary
    - reflected rays that have been reflected by objects in its path (patient or dental unit)
    - less penetrating than primary radiation
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45
Q

Differential Absorption

A

Different tissue types absorb different amounts of radiation

There are two different types:
i. Radiopaque (white on x-ray)
ii. Radiolucent (black on x-ray)

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46
Q

Radiopaque

A

Tissue with high absorption of x-radiation, appears white in a finished radiograph

ex. enamel, dentin, bone

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47
Q

Radiolucent

A

Tissue with low absorption of x-radiation, appear dark on the finished radiograph

ex. pulp

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48
Q

Composition of x-ray film

A
  1. Film base
    - polyester plastic, provides support and strength
  2. Adhesive layer
    - attaches emulsion to base
  3. Film emulsion
    - a mixture of gelatin and silver halide crystals (sensitive to radiation)
  4. Protective layer
    - protects emulsion from damage

*Halide is a chemical compound that is sensitive to radiation. Silver halide is used in dental radiographs

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49
Q

What are the 3 different types of conventional film?

A
  1. Intral Oral
    - placed inside the mouth
  2. Extra Oral
    - taken on the outside of the mouth
  3. Duplicating
    - produces 2 copies of the same image (special film)
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50
Q

Composition of Intraoral film

A

Composed of:
- paper wrapper
- lead foil
- outer package wrapping (has 2 sides)
i, Tube side = solid white (raised dot)
ii. Label side = colored, contains flap to open packaging (inverted dot)

Remember: WHITE in sight and DOT in the slot
- Tube side = dot is a bump
- Label side = dot is flat

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51
Q

What is a latent image?

A

Film that has been exposed to radiation and has not yet been developed

  • Silver halide crystals (coating on film) contain various levels of stored energy, depending on the density of the objects in the area exposed
  • the stored energy forms a pattern known as LATENT IMAGE

The latent image cannot be seen until chemical processing occurs to produce a visible image

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52
Q

How is film speed determined?

A

Film speed = sensitivity

Determined by:
1. Size of the silver halide crystals
2. Thickness of the emulsion
3. Presence of radiosensitive dyes

Speed ratings are from A-F
A (slowest), F (Fastest)
** ONLY D, E, F, speed film used for intraoral radiology **

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53
Q

2 Types of Extraoral Film

A

2 types of extraoral films that are placed outside the mouth for x-ray exposure:

  1. Screen
    - film placed between 2 intensifying screens for exposure
  2. Non-screen
    - film is exposed directly to x-rays, requires longer exposure time, NOT recommended for use in dentistry
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54
Q

Duplicating Film

A

Photographic film used to make an identical copy of an intraoral or extraoral radiograph

Used only in a darkroom setting and is NOT exposed to raadiation

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55
Q

Film storage

A

Film must be kept in a cool, dry place
(At SAIT, keep film in the fridge)

  • Must be stored in an area adequately shielded from radiation
  • Film MUST be used before expiration date (can cause fogged films)
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56
Q

Benefits of Digital Radiography

A

Digital imaging eliminates chemical processing and hazardous waters (lead foil, chemicals)

  • Require less radiation to expose
  • Allows for digital enhancements, measurements and corrections
  • Images can be electronically transferred to other health care providers
  • Sensors are VERY expensive
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57
Q

What are the 2 different types of sensors for digital radiography?

A
  1. Direct digital imaging
  2. Indirect digital imaging
58
Q

Direct Digital

A

Solid-state sensor that contains an x-ray sensitive silicon chip with an electronic circuit embedded in the silicon

  • most commonly used
  • instantly transmits image to computer screen
59
Q

Indirect Digital

A

Phosphor Storage Imaging (PSP)
- Thin, flexible plate that is covered in phosphor crystals
- Plates are the same size as conventional x-ray film
- Phosphor layer stores energy of x-ray photons
- After exposure, plates are placed into a scanner
- Scanner laser reads the latent image and converts it to digital image
- Films are exposed to a bright light to “erase” the image

60
Q

What are the 3 different types of intraoral radiographs that can be taken to assess the patients dentition?

A
  1. Periapical (PA)
    - used to view entire tooth (root and crown)
    - Size #2 are used for posterior
    - Size #1 for anterior
  2. Interproximal (Bitewings)
    - used to detect interproximal (between the teeth) caries and bone loss
    - can be taken vertically and horizontally
  3. Occlusal
    - used to determine tooth development
    - can determine if patients are missing teeth
    - film is placed in mouth horizontally and the patient down bites on film like a cookie
61
Q

What is a Periapical (PA)?

A

Periapical radiographs show the entire tooth from occlusal surface or incisal edge to about 2-3mm beyond apex

  • used to diagnose pathologic conditions of the tooth, root, and bone
  • shows tooth formation and eruption
  • essential in endodontics and oral surgery
62
Q

What is a Bite Wing (BW)?

A

Image shows the upper and lower teeth in occlusion
- only crowns and small portion of root are seen

Used for detecting:
- interproximal decay
- early periodontal disease
- recurrent decay under restorations
- fit of metallic fillings or crowns

63
Q

What are the considerations for producing diagnostically acceptable radiographs?

A
  1. All required anatomy must be present
  2. Contrast (also referred to as grey scale)
  3. Density (also referred to as darkness)
  4. Sharpness
  5. Magnification
  6. Distortion
64
Q

Parallel (PA)

A

Moving or lying in the same plane
- never intersecting paths

65
Q

Intersecting (PA)

A

To cut across or through

66
Q

Perpendicular (PA)

A

Intersecting at, or forming, a right angle

67
Q

Right Angle (PA)

A

An angle of 90 degrees formed by two lines

68
Q

Long axis of the tooth

A

An imaginary line that divides the tooth longitudinally into 2 equal halves

69
Q

Central Ray

A

The central portion of the primary beam of radiation

70
Q

What are the 2 basic techniques for obtaining periapical images?

A
  1. Paralleling technique
    - extension cone paralleling technique (XCP) ALARA
  2. Bisecting Angle Technique
    - Uses a Snap-A-Ray
    - not as frequently used
71
Q

The Paralleling Technique

A
  • Receptor is parallel to long axis of tooth
  • X-ray beam is perpendicular to the long axis of the tooth
  • Face of cone is parallel with the face of the film
  • Common errors: incorrect placement and alignment
72
Q

Paralleling Techniques Steps

A
  1. Explain procedure to patient
  2. Position receptor close to midline for a maxillary PA and between tongue and teeth for mandibular exposure
  3. Position receptor centered on the required anatomy/teeth
  4. Position receptor parallel to the long axis of the teeth
  5. Seat bite block on the incisal edge or occlusal surface for support
  6. Ask patient to relax and slowly close down to support the XCP holder, and breath slowly through their nose
  • Position the face of the open cone/PID parallel to the ring
  • To do this, you will be adjusting the horizontal and vertical angulation of the PID
73
Q

Advantages and Disadvantages of the Parelleling Technique

A

Advantages:
1. Accurate
- produces an image that has dimensional accuracy
- the image represents the actual tooth
- image exhibits maximum detail and definition

  1. Simple
    - simple to use and easy to learn
    - because it uses a beam alignment device, the radiographer doesn’t need to determine horizontal and vertical angulation
    - reduces dimensional distortion
  2. Least amount of radiation
    - minimizes exposures and having to re-take images

Disadvantages:
1. Uncomfortable
- may impinge on oral tissue and cause discomfort for patient

  1. More limited
    - film placement may be difficult in child patient or adult patient with small mouth or shallow palate
  2. XCP Kit has to be sterilized
    - they are not disposable and must be sterilized
74
Q

Receptor Holding Devices

A

The paralleling technique requires the use of a beam alignment instrument or receptor holding device to position the receptor parallel to the long axis of the tooth

75
Q

X-ray exposure & overlap

A

When lining the PID up to expose, the central ray of the x-ray beam must be directed through the contacts.
- When it is not, this creates “overlap”

76
Q

Bisecting Technique

A

The Bisecting Angle Technique is another method that can be used to expose periapical films

  • Major disadvantage: image is dimensionally distorted
  • This technique should used only as an alternative method in special circumstances, when it is not possible to use the paralleling technique
77
Q

Bisecting Technique Steps

A
  1. Position the occlusal plane parallel to the floor and the midsagittal plane perpendicular to the floor
  2. Place film against the lingual (backside) of the tooth
  3. Visualize an imaginary line that bisects (divides in half) the angle formed by the film and the tooth
  4. Center the PID over the film and position the opening of the PID parallel to this imaginary line.
    - This will direct central ray of x-ray beam perpendicular to the imaginary line
78
Q

Film Holders for Bisecting Technique

A

Available types of film/sensor holders for bisecting technique include:
- EeZee-Grip Holder
- Snap-A-Ray
- Stabe Disposable holder

79
Q

Responsibilities of Dental Personnel operating x-ray equipment

A

Plan dental radiographic procedures carefully and avoid unnecessary retakes

  • every image that must be repeated results in excess patient radiation exposure
  • retakes represent one of the greatest cause of excessive radiation exposure in dental radiography
  • obtaining a quality dental radiographic image is a complex process demanding careful attention to many details
80
Q

Pregnancy and X-rays

A

Avoid taking x-rays on pregnant patients unless it is an emergency
- the benefits should always out weight the risks

81
Q

Why do Dentists requisition bitewings?

A

Interproximal radiographs are commonly used to assess and/or confirm general defects in teeth and/or surrounding tissues

  • they are commonly requisitioned during recall/check up appointments
  • they can be taken both vertically and horizontally
82
Q

Purpose of Bitewing (BW) Radiographs

A
  • Detects interproximal decay
  • Detect loss of alveolar bone
  • Changes in the pulp
  • Overhanging restorations
  • Poor margins on crowns
  • Recurrent decay beneath restorations
83
Q

Bitewing Exposure

A
  • Can be taken using a beam alignment device (e.g. RINN XCP) or bitewing tab
  • When exposing a BW, the angulation of the PID is critical
  • Both vertical angulation (up & down) and horizontal angulation (side to side) must be correct to expose a proper BW
84
Q

Vertical Angulation for Bitewings

A
  • Vertical angulation of the PID must be at +10 degrees
  • If vertical angulation is incorrect, it will lead to a distorted image
85
Q

Horizontal Angulation for Bitewings

A
  • To maintain the correct horizontal angulation, the central ray must be directed perpendicular to the curvature of the arch through the contact areas of the teeth
86
Q

What is the sequence for a Bitewing?

A

Typically on adults, 4 bitewings are taken
- 1 premolar and 1 more BW on each side

Premolar BW: must include edges of canines, premolars visible, open contacts

Molar BW: must include entire lower second molar, open molar contacts, no cone-cuts

87
Q

Bitewing Film Sizing

A

i. Size 0 = primary dentition
- posterior teeth
- one on each side

ii. Size 1 = mixed dentition
- posterior teeth
- one on each side

iii. Size 2 = permanent dentition
- premolar teeth and molar teeth
- two on each side

88
Q

What is a cone cut?

A
  • The PID is not covering the entire film (PID is not align with the target)
  • The PID is covering the target and should be close to patient’s face
89
Q

How to avoid cone-cuts during BW exposures?

A
  • Ensure sensor is lined up properly inside ring of XCP positioning device BEFORE exposure
  • Ensure PID is steady and ask patient to not move once it’s placed
  • When not using a positioning device, ensure entire film is covered by PID
90
Q

What is the criteria for premolar bitewings?

A
  • Front edge in middle of lower mandibular canine
  • Premolars visible
  • Occlusal plane in middle of receptor
  • Occlusal plane parallel with bottom receptor edge
  • Correct horizontal = open premolar contacts
  • Correct vertical angulation of +10 degrees
  • No cone-cuts

Make sure the receptor is covering the distal surface of the canines

91
Q

What is the criteria for molar bitewings?

A
  • Front edge in middle of lower mandibular 2nd premolar
  • Molars visible
  • Occlusal plane in middle of receptor
  • Occlusal plane parallel with bottom receptor edge
  • Correct horizontal = open molar contacts
  • Correct vertical angulation of +10 degrees
  • No cone-cuts

Make sire the receptor covers the distal of the second molar

92
Q

How to successfully expose bitewings?

A
  1. Position patient’s head parallel to the floor
  2. Ensure that the film or sensor is placed in the correct position for the BW being exposed
  3. Stand directly behind the tube-head and look along the side of the PID, no portion of the receptor should be visible
93
Q

Processing traditional film - Responsibilities of a Dental Assistant

A
  1. Process films/image
  2. Keep records of processed films/image
  3. Maintain darkroom
  4. Maintain processing equipment
94
Q

What is the importance of film processing?

A
  • Use of traditional film is still currently being used in dental practices (although increasing numbers of dentists have transitioned to digital imaging, many offices still rely on film and processing)
  • Film processing procedures directly affect the quality of a dental radiograph
  • it is important to have a working knowledge of film processing procedures, problems, and solutions
95
Q

What is film processing?

A

A series of steps that produce a visible permanent image on a dental radiograph

Purpose of film processing:
1. Convert latent (invisible) image on the film into a visible image
2. Preserve the visible image so that it is permanent and does not disappear from the dental radiograph

96
Q

Film Processing Techniques

A
  1. Manual (hand processing)
    - requires a dark room and processing solution
    - not recommended as it is very technique sensitive
  2. Automatic processing
    - automatic film processing machine or automatic processor
97
Q

What are the 5 steps in manual & automatic film processing?

A
  1. Development
  2. Rinsing
  3. Fixing
  4. Washing
  5. Drying
98
Q

Manual Film Processing

A
  • Must be completed in a darkroom
  • Any white light that “leaks” into the darkroom (e.g. from around a door or through vent) is termed a light leak
  • In a dark room, when all lights are turned off and the door is closed, no white light should be seen
  • Any light leak must be immediately corrected with weather stripping or black tape (white light affects the film)
99
Q

What is Safe Lighting?

A

A special type of lighting used to provide illumination in the darkroom

  • it is a low-intensity light (15 watts or less) composed of long wavelengths in the red-orange portion of the visible light spectrum
  • provides sufficient illumination in the darkroom to carry out processing activities safely without exposing or damaging film
  • Under safelight conditions, it is necessary to maintain an adequate safelight illumination distance of min. 4 feet
  • a film exposed to safelight for more than 2-3 minutes will appear fogged
100
Q

Components of an Automatic Processor

A
  1. Film feed slot
    - where the film is inserted
  2. Roller film transporter
    - primary function: transport the film through the processor and helps to remove excess solutions on the film
  3. Developer compartment
    - holds the developer solution (a special chemical solution for high temp. processing between 80-95F)
  4. Fixer compartment
    - holds the fixer solution which has chemical hardening agents that fix and harden
  5. Water compartment
    - holds circulating water that washes the film after the fixer to remove all excess solutions
  6. Drying chamber
    - holds heated air and is used to dry the wet film
  7. Film recovery slot
    - an opening on the outside of the processor housing where the dry processed radiograph emerges from the automatic processor
  8. Processor housing
  9. Replenisher pump
  10. Replenisher solutions
    - the pump and solutions are required to maintain proper solution concentration and levels automatically in some automatic processors, whereas other processors require the operator to add the necessary replenishing solutions
101
Q

Advantages of Automatic Processing

A

Many dental personnel prefers automatic processing as a method of film processing for the following reasons:

  1. Less processing time is required
  2. Time and temperatures are automatically controlled
  3. Less equipment is used
  4. Less space is required
102
Q

Are the solutions used in the automatic processor and the manual processor the same?

A

No, the solutions are different in both

103
Q

How long does it take for the film to be processed in the automatic processor?

A

4 to 5 minutes

104
Q

How to maintain the automatic processor?

A
  1. Processor chemicals should be checked and topped up daily
  2. Processing solutions should be replaced every 2-6 weeks (this can depend on the number of films being processed)
  3. The rollers within the processor should also be cleaned weekly (dependent on manufacturer instructions)
    - to do this, the rollers are removed and rinsed in warm running water and then soaked for 10-20 minutes
    - cleaning film can be used at the beginning of each day to remove any residual gelatin or dirt on the rollers
105
Q

Film Duplication

A

An identical copy of an intraoral or extraoral radiograph
- may be used when referring patients to specialists, for insurance claims, and as teaching aids

  • before duplication occurs, the films are to be duplicated, the duplicating film, and the film duplicator must be present in the darkroom
  • similar to film processing = light-tight darkroom
106
Q

What are some processing errors for traditional films that may arise?

A
  1. Time and temperature errors
  2. Chemical contamination errors
  3. Film handling errors
  4. Lighting errors

*As a DA, it is important that we understand what actions are needed to prevent these errors

107
Q

List the types of time & temperature errors on film

A
  1. Underdeveloped film
    - Appearance: light
    - Problems:
    i. inadequate film time
    ii. developer solution too cool
    iii. inaccurate timer or thermometer
    iv. depleted or contaminated developer solution
  2. Overdeveloped film
    - Appearance: dark
    - Problems:
    i. excessive developing time
    ii. developer solution too hot
    iii. inaccurate timer or thermometer
    iv. concentrated developer solution
  3. Reticulation of emulsion
    - Appearance: cracked
    - Problem:
    i. sudden temperature change between developer and water bath
108
Q

List the types of chemical contamination errors on film

A
  1. Developer spots
    - Appearance: dark or black spots
    - Problem:
    i. developer comes in contact with film before processing
  2. Fixer spots
    - Appearance: white or light spots
    - Problem:
    i. fixer comes in contact with film before processing
  3. Yellow-brown stains
    - Appearance: yellow-brown stains
    - Problem:
    i. exhausted developer or fixer
    ii. insufficient fixing time
    iii. insufficient rinsing
109
Q

List the types of film handling errors on film

A
  1. Developer cutoff
    - Appearance: straight white border
    - Problem:
    i. undeveloped portion of film caused by low level of developer
  2. Fixer cutoff
    - Appearance: straight black border
    - Problem:
    i, unfixed portion of film caused by low level of fixer
  3. Overlapped films
    - Appearance: white or dark areas appear on film where overlapped
    - Problem:
    i. two films contacting each other during processing
  4. Air bubbles
    - Appearance: white spots
    - Problem:
    i. air trapped on film surface after being placed in the processing solutions
  5. Fingernail artifact
    - Appearance: black crescent-shaped marks
    - Problem:
    i. film emulsion damaged by operator’s fingernail during rough handling
  6. Fingerprint artifact
    - Appearance: black fingerprint
    - Problem:
    i. film touched by fingers that are contaminated with fluoride or developer
  7. Static electricity
    - Appearance: thin, black, branching lines
    - Problem:
    i. occurs when a film packet is opened quickly
    ii. occurs when film pack is opened before radiographer touches a conductive object
  8. Scratched film
    - Appearance: white lines
    - Problem:
    i. soft emulsion removed from film by a sharp object
110
Q

List the types of lighting errors on film

A
  1. Light leak
    - Appearance: exposed area appears black
    - Problem:
    i. accidental exposure of film to white light
  2. Fogged film
    - Appearance: gray; lack of detail and contrast
    - Problem:
    i. improper safelighting
    ii. light leaks in darkroom
    iii. outdated films
    iv. contaminated solutions
    v. developer solution too hot
111
Q

How are conventional films/images labeled?

A
  • Must be labeled once they have been developed on the film mount as well as documented in patient chart
  1. Record patient’s first and last name
  2. Date they were taken
  3. Type of radiograph(s) and how many
  4. Name of the Dentist or Hygienist who prescribed
112
Q

Occlusal Technique

A
  • Used to examine large areas of the maxilla or the mandible
  • technique is named so because the patient bites or “occludes” on the entire receptor
  1. Size 4 receptors: traditionally used for adults
  2. Size 2 receptors:
    traditionally used for children
113
Q

What is the purpose and use for occlusal technique?

A

A supplementary imaging technique used in conjunction with periapical or bite-wing images

  1. Used when large areas of the maxilla or mandible must be visualized
  2. Preferred when area of interest is larger than a periapical receptor or when placement of periapical receptors is too difficult for the patient
114
Q

What are the principles for occlusal technique?

A
  1. The receptor is placed with the tube side facing the arch that is being exposed
  2. The receptor is placed in the mouth between the occlusal surfaces of maxillary and mandibular teeth
  3. The receptor is stabilized when the patient bites on the surface of the receptor

It is important to stress to the patient to gently bite on the receptor to avoid seeing permanent bite marks on the surface of the sensor

115
Q

What are the steps for occlusal technique procedure?

A
  1. Patient preparation
  2. Equipment preparation
  3. Maxillary occlusal projections
  4. Mandibular occlusal projections
  5. Vertical angulations
116
Q

Patient Preparation for Occlusal Technique

A
  1. Explain the imaging procedure to the patient
  2. Adjust the chair so that the patient is positioned upright and level of the chair is at a comfortable working height
  3. Adjust the headrest to support and position the patient’s head
  4. Place the lead apron with thyroid collar on the patient and secure it
  5. Request that the patient remove eyeglasses and any objects in the mouth
  6. Be sure the occlusal plane is parallel to the floor and patient is in an upright position
  7. Patient should gently bite down; otherwise the patient can damage the receptor
117
Q

Equipment Preparation for Occlusal Technique

A

Set the exposure control factors on the x-ray unit according to the recommendations of the receptor manufacturer

  • Either a short (8-inch) or a long (16-inch) PID may be used
118
Q

Maxillary Occlusal Projections

A
  1. Topographic projection
    - used to examine the palate and the anterior teeth of the maxilla
  2. Lateral (left or right) projection
    - used to examine the palatal roots of the molar teeth
    - may also be used to locate foreign bodies or lesions in the posterior maxilla
  3. Pediatric projection
    - used to examine the anterior teeth of the maxilla
    - recommended for use in children 5 years old or younger

The central ray (CR) is directed at +65 degrees vertical angulation to the plane of the receptor

119
Q

Mandibular Occlusal Projections

A
  1. Topographic projection
    - used to examine the anterior teeth of the mandible
  2. Cross-sectional projection
    - used to examine the buccal and lingual aspects of the mandible
    - used to locate foreign bodies or salivary stones in the region of the floor of the mouth
  3. Pediatric projection
    - used to examine anterior teeth of the mandible
    - recommended for use in children 5 years old or younger

**Central ray (CR) is directed at -55 degrees vertical angulation to the plane of the receptor

120
Q

Localization Techniques

A
  1. A method used to locate the position of a tooth or object in the jaws
    - a thorough understanding of basic concepts is necessary
    - a knowledge of step-by-step procedures is required
  2. The dental image is a 2-dimensional picture of a 3-dimensional object
    - it does not depict the depth of the object
  3. Can be used to locate the object
121
Q

Purpose and Use for Localization Techniques

A

May be used to locate:
1. Foreign bodies
2. Impacted teeth
3. Unerupted teeth
4. Retained roots
5. Root positions
6. Salivary stones
7. Jaw fractures
8. Broken needles and instruments
9. Dental restorative materials

122
Q

Importance of Interpretation of Images

A

A lot of info. about teeth and supporting bone is obtained from image interpretation

  1. All dental images must be carefully reviewed and interpreted
  2. Paramount importance to dental professional and plays a vital role in the detection of diseases, lesions, and conditions of the teeth and jaws that cannot be identified clinically
123
Q

Who interprets images?

A

Any dental professional with training in interpretation can examine images

Identification of:
1. Normal anatomy
2. Dental restorations, dental materials, and foreign objects
3. Dental caries
4. Periodontal disease
5. Traumatic injuries and periapical lesions
6. Common artifacts and errors

124
Q

Interpretation vs. Diagnosis

A

Interpretation = an explanation of what is viewed on an image

Diagnosis = the identification of disease by examination or analysis

  • The final interpretation and diagnosis are the responsibilities of the dentist
  • Dental hygienist and DA are restricted by law from rendering a diagnosis
125
Q

When and Where are Images Interpreted?

A
  1. Best to have images taken at the beginning of the appointment and interpreted immediately after mounting in the presence of the patient
  2. Suspicious or questionable areas can be examined by dentist or dental hygienist to obtain additional info. or confirm a suspected problem
126
Q

How is Interpretation of images documented?

A

1, All dental images must be reviewed and interpreted

  1. Interpretation must be documented and include:
    - date of exposure
    - number/type of images
    - evaluation of diagnostic quality
    - list of limiting factors, retakes, or additional images needed
    - description of teeth

Must also include:
i. description of bone and supporting structures of the teeth
ii. description of artifacts
iii. indication of any areas that require additional images or clinical evaluation/confirmation

127
Q

Interpretation and Patient Education

A

Images may be an educational tool in the dental setting

  1. Patient may be educated through discussion of normal findings on dental images
  2. Specific problems and areas of concern may be identified
128
Q

What is the purpose of understanding normal anatomy intraoral images?

A

The dental radiographer must be able to recognize the normal anatomic landmarks on intraoral images in order to mount and interpret intraoral films accurately

129
Q

What are the 2 types of bone found in the oral cavity?

A
  1. Cortical bone
    - dense outer layer of bone
    - appears radiopaque on an image
  2. Cancellous bone
    - soft, spongy bone located between 2 layers of dense cortical bone
    - appears primarily radiolucent
    (Trabeculae appear radiopaque, marrow spaces appear radiolucent)
130
Q

List the different types of prominences of bone

A
  1. Process
    - marked prominence or projection
    - ex. Coronoid process
  2. Ridge
    - linear prominence or projection
    - ex. Mental ridge
  3. Spine
    - sharp, thornlike projection
    - V-shaped radiopaque area located at the intersection of the floor of the nasal cavity and the nasal septum
    - ex. Anterior nasal spine
  4. Tubercle
    - small bump or nodule
    - ex. Genial tubercles
  5. Tuberosity
    - rounded prominence
    - radiopaque bulge distal to the third molar region
    - ex. Maxillary Tuberosity
131
Q

List the different types of spaces & depressions in bone

A
  1. Canal
    - tube-like passageway through bone that contains nerves and blood vessels
    - narrow radiolucent band bounded by 2 thin radiopaque lines
    - ex. incisive canal
  2. Foramen
    - opening or hole that permits the passage of nerves and blood vessels
    - radiolucent area between maxillary canine and lateral incisors
    - ex. incisive foramen
  3. Fossa
    - broad, shallow, scooped-out, or depressed area
    - ex. Lateral fossa
  4. Sinus
    - hollow space, cavity, or recess
    - ex. Maxillary sinus
  5. Septum
    - bony wall or partition that divides 2 spaces or cavities
    - radiopaque
    - ex. vertical radiopaque partition that divides the nasal cavity
  6. Suture
    - immovable joint representing a line of union between adjoining bones of the skull
    - ex. median palatal suture. Thin radiolucent line between the maxillary central incisors
132
Q

List the different types of supporting structures

A

Anatomy of the alveolar bone:
1. Lamina dura
- appears as a dense, thin radiopaque line around the root of a tooth

  1. Alveolar crest
    - typically appears 1.5 to 2.0mm below the cemento-enamel junction
  2. Periodontal ligament space
    - appears as a thin radiolucent line around the root of the tooth

Shape and density of alveolar bone:
4. Anterior regions
- anterior alveolar crest normally appears pointed and sharp

  1. Posterior regions
    - posterior alveolar crests normally appears flat and smooth
133
Q

What is the purpose of identifying restorations, dental materials, and foreign objects in dental imaging?

A

Dental professional should interpret all dental images while the patient is present

  • when dental images are interpreted with the patient present, some important clinical info. is not available
134
Q

Identification of Restorations

A
  1. Amalgam restorations
  2. Gold restorations
  3. Stainless steel and chrome crowns restoration
  4. Post and core restorations
  5. Porcelain restorations
  6. Composite restorations
  7. Acrylic restorations
135
Q

List the different types of amalgam restorations

A
  1. One-surface amalgam restorations
    - appear as distinct, small, round or void radiopacities
    - may be seen on buccal, lingual, or occlusal surfaces
  2. Larger two-surface and multi-surface amalgam restorations
    - appear radiopaque and are characterized by irregular outlines or borders
  3. Amalgam overhangs
    - extensions of amalgam seen beyond the crown portion of tooth in the interproximal region
  4. Amalgam fragments
    - fragments of amalgam may be inadvertently embedded in adjacent soft tissue during restoration of a tooth
136
Q

List the different types of Gold restorations

A
  1. Gold crowns and bridges
    - appear completely radiopaque and unlike amalgam, exhibit a smooth marginal outline
  2. Gold onlays
    - seen on maxillary premolars
137
Q

List the different types of restorations

A
  1. Stainless Steel and Chrome Crowns
    - appear radiopaque, but not as dense as amalgam or gold
  2. Post and core restorations
    - can be seen in endodontically treated teeth
  3. Porcelain Restorations; All-porcelain crowns and bridges
    - appearance is slightly radiopaque and resembles the radiopacity of dentin
  4. Porcelain-fused-to-metal crown
    - metal component appears completely radiopaque; porcelain component appear slightly radiopaque
  5. Composite restorations
    - may vary in appearance from radiolucent to slightly radiopaque depending on composition of composite material
  6. Acrylic restorations
    - least dense of all nonmetallic restoration
    - appear radiopaque or barely visible on dental image
138
Q

List the identification of materials used in Dentistry

A
  1. Restorative dentistry (Base materials)
    - used as cavity liners placed on the floor of a cavity preparation to protect pulp
    - appear radiopaque, less radiodense than amalgam
  2. Restorative dentistry (Metallic pins)
    - used to enhance retention of amalgam or composite
    - appear as cylindrical or screw-shaped radiopacities
  3. Endodontics (Gutta percha)
    - a claylike material used to fill pulp canals
    - appears radiopaque, similar to base materials, is less radiodense than metallic restorations
  4. Endodontics (Silver points)
    - used to fill pulp canals
    - very radiopaque, similar to other metallic materials, appear more radiodense than gutta percha
  5. Prosthodontics (complete dentures)
    - patients should be instructed to remove all complete and partial dentures before dental images are taken
    - a complete denture that is not removed gives the illusion of rootless, or “floating” teeth
  6. Prosthodontics (Removable partial dentures)
    - RPD with a metal base with acrylic saddles appears densely radiopaque where metal is present and slightly radiopaque in the areas of acrylic
  7. Orthodontics (orthodontic bands, brackets and wires)
    - have a characteristic appearance
139
Q

List the types of materials used in oral surgery

A
  1. Implants are being used with increased frequency
    - appearance varies based on shape and design of implant used
  2. Suture wires, metallic splints and plates, bone screws, and stabilizing arches
    - used in oral surgery to stabilize fractures of the maxilla and mandible
140
Q

List the types of identification of objects

A
  1. Jewelry
    i. Earrings - ghost images seen on panoramic image
    ii. Necklaces - metallic necklace appear radiopaque loop in the region of the mandible
    iii. Nose jewelry - maxillary anterior PA
  2. Eyeglasses
    - metal framework of sides of eyeglasses
    - appear radiopacity
  3. Hearing aids
  4. Shrapnel
    - or small metal fragments that scatter outward from an exploding device

DA (Can) (21 decks)

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