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DENTAL NURSING revision dec 7th exam > DN14 > Flashcards

DN14 Flashcards

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1
Q

WHAT DO DENTAL RADIOGRAPHS DETECT AND DIAGNOSE?

A

lesions and structures such as:

  • DENTAL CARIES - this shows up as a dark area of destruction extending inwards from the enamel surface
  • PRESENCE AND EXTENT OF PERIODONTAL DISEASE - this shows up as a loss of the laina dura forming the crest of the alveolar bone, loss of height of the alveolar bone, and a widening of the periodontal ligament
  • PERIODONTAL AND PERIAPICAL ABSCESSES - chronic alveolar abscesses show up as a dark circular area at the apex of an affected tooth, caused by destruction of the apical lamina dura and spongy bone
  • CYSTS AFFECTING THE DENTAL TISSUES - tehse can show up as enlarged darker areas surrounding other structures, and can sometimes be seen to be pushing tooth roots out of their normal positions
  • LATROGENIC PROBLEMS - i.e. those caused by the dentist, such as overhanging restorations or tooth perforations by posts
  • to detect SUPERNUMERARY teeth and UNERUPTED teeth or to determine the CONGENITAL ABSENCE of unerupted teeth
  • to diagnose HARD TISSUE LESIONS, such as bone cysts and tumours, salivary calculi and jaw fractures
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2
Q

WHAT TREATMENTS MAY REQUIRE RADIOGRAPHS TO AVOID PROBLEMS OCCURING AND TO ENSURE TREATMENT IS SUCCESSFUL?

A
  • to aid in ENDODONTIC treatment
  • to determine the number and position of tooth roots before EXTRACTION
  • to ensure the health of a tooth before it undergoes CROWN OR BRIDGE preparation
  • to ensure the health of a tooth before it is used as an abutment during DENTURE CONSTRUCTION
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3
Q

WHAT ARE THE LEGISLATIONS AND GUIDELINES PUT IN PLACE WHEN USING X-RAYS IN DENTISTRY?

A
  • all use of dental imaging has to be CLINICALLY JUSTIFIED - so there must be a clinical reason why the patient is being exposed to the x-rays
  • the dose of x-rays used must be kept AS LOW AS REASONABLY ACHIEVABLE (ALARA) - so that the minimum dose of x-rays must be used, for the shortest time, and aimed at the smallest area of tissue possible to produce a functional image, this is now more usually reffere to being AS LOW AS REASONABLY PRACTICABLE/POSSIBLE (ALARP)
  • only the patient should be exposed to the x-ray beam - all staff and family members must be outside the CONTROLLED ZONE during the exposure
  • machines must be well maintained and serviced regularly
  • no untrained personnel can be invloved in radiation exposure procedures
  • QUALITY ASSURANCE (QA) SYSTEMS must be operated to ensure that the dental images produced are to a consistently high standard
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4
Q

WHAT LEGISLATIONS ARE PUT IN PLACE TO ENSURE HEALTH AND SAFETY OF IONISING RADIATION?

A
  1. IONISING RADIATION REGULATIONS 1999 - IRR99 - this is concerned with the protection of staff
  2. IONISING RADIATION (MEDICAL EXPOSURE) REGULATIONS 2000 - IR(ME)R 2000 - this is concerned with the protection of patients
    - the aim of both sets of regulations is to keep the number of X-ray exposures and their dose levels, to the absolute minimum required for clinical necessity at all times.
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5
Q

WHAT ARE THREE FACTORS THAT HELP REDUCE THE AMOUNT OF SCATTERED RADIATION CREATED DURING A DENTAL EXPOSURE BY 40%?

A

USE OF FAST FILMS - f speed intra-oral films are currently availible and require the shortest possible exposure time to create the radiographic image, once processed.
SHORT EXPOSURE TIME - achievable with a combination of modern x-ray machines, fast films and intensifying screens in extra-oral cassettes
RECTANGULAR COLLIMATOR TUBES - these have replaced the old plastic aiming cones of intra-oral machines, and produce a parallel x-ray beam rather than a disorganised ‘spray’ effect with lots of scattered rays

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6
Q

COMPLIANCE WITH IRR99 REGULATION

A

the initial act of compliance is to inform the health and safety executive of its use on the premises. three formal appointments must then be made by the workplace owner:
LEGAL PERSON - a designated person who is to ensure the workplace’s full compliance with both sets of regulation (this is usually the employer)
RADIATION PROTECTION ADVISER (RPA) - a medical physicist who is appointed in writing by the dental workplace and is availibile to give advice on staff and public safety in relation to both sets of regulations
RADIATION PROTECTION SUPERVISOR (RPS) - a designated person in the workplace who can assess risks and ensure precautions are taken to minimise them, in accordance with IRR99

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7
Q

THE ROLE OF THE RADIATION PROTECTION ADVISER (RPA) WITH IRR99

A
  • the correct installation of all new x-ray machines
  • the regular maintenance and certificated checks that are required for each X-ray machine to ensure that the minimum exposure to radiation occurs
  • the CONTINGENCY PLANS that need to be in place in case of an x-ray machine malfunctioning
  • the investigation of any malfunction of an x-ray machine
  • the designation of a 1.5 metre controlled area around each x-ray machine and within the primary beam direction, where no one but the patient may be present during an exposure
  • advice on RISK ASSESSMENTS with regard to restricting staff and patient exposure to ionising radiation, and review the assessments every five years
  • advice on the necessary staff training required so that designated duties are carried out competently and safetly
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8
Q

THE ROLE OF THE RADIATION PROTECTION SUPERVISOR (RPS) WITH IRR99

A

the role of the RPS is to carry out the following:

  • ensure all staff members have suitable training according to the level of their legal responsibility
  • carry out risk assessments with regard to restricting radiation exposure
  • ensure the local rules remain current, updating as necessary
  • maintain teh contents of the necessary ‘radiation protection file’
  • organise and run QA programmes in relation to the safe use of ionising radiation
  • organise and run quality control tests or delegate the tests to suitably trained members of staff
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9
Q

ROLES AND RESPONSIBILITIES WITH IR(ME)R 2000

A

REFERRER - the dentist who refers the patient for radiation exposure, either to themselves or another dentist or specialist dental radiographer who can carry out the exposure
IRMER PRACTITIONER - the dentist or specialist dental radiographer who takes responsibility for JUSTIFYING the taking of the radiograph, by determining that the diagnostic benefits gained will outweigh the risks of the exposure to the patient
OPERATOR - any member of the dental team who carries out all or part of the practical duties involved with the exposure and processing of the radiograph, including:
- patient identification
- positioning of the film, the patient and the machine tube head
- setting the exposure controls
- pressing the exposure button
- processing the film
- evaluating the quality of the radiograph
- carrying out test exposures for QA purposes
- running QA programmes

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10
Q

KEY POINTS OF PATIENT PROTECTION WITH IR(ME)R REGULATION

A
  • PATIENT IDENTIFICATION - to avoid the wrong patient being exposed, name, address and date of birth should be used as a minimum
  • REFERRER AND IRMER PRACTITIONER - can only be dentists, as only they have the training to determine when an exposure is required for diagnosis and treatment
  • JUSTIFICATION - the benefit of exposing the patient should outweigh the risk of causing tissue damage
  • OPTIMISATION - the dose of radiation should be in line with ALARA/P principles at all time
  • PREGNANT PATIENTS - routine dental exposure techniques do not irridate the pelvic area and involve such low doses that pregnancy is not considered a contraindiction to undergoing irridation
  • STAFF TRAINING - written evidence of all necessary training pertinent to ionising radiation techniques must be kept for all personnel in the radiation protection file, as documented proof of their competence in the duties that they undertake
  • QUALITY ASSURANCE - QA programmes and audits provide a valuable tool for determining wherher the systems in place protect patients (and staff) from any potential harm from ionising radiation are actually working, by looking at the procedures in place and the results achieved
  • ACCIDENTAL EXPOSURE - all x-ray machines must have an isolation switch outside the controlled are, an illuminated control panel or switch to indicate when the mains power is on, and an additional light and an audible buzzer that are activated during exposure time itself.
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11
Q

WHAT IS THE RADIATION PROTECTION FILE AND WHAT DOES IT CONTAIN?

A

this acts as a summary document that holds as much information as possible about the procedures in place to ensure radiation protection within the a=particular workplace. it should be reviewed and kept updated anually to ensure that it remains relevent and effective. it should contain all the following information:

  • formal appointments of staff on the premises
  • reference to the initial risk assessment carried out by the legal person, in consultation with the RPA
  • local rules for each x-ray set out on the premises
  • procedures for ensuring patient protection
  • information on how ALARA/P is achieved
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12
Q

WHAT DO INTRA-ORAL FILMS CONTAIN?

A
  • plastic envelope to protect the contents from saliva contamination
  • wrap-around black paper to prevent exposure of the film to light
  • film - which is exposed to the ionising radiation and producers the dental image once processed or loaded onto the computer
  • lead foil to prevent scatter of the ionising radiation past the film packet
  • raised pimple marker on the film and packet side towards the x-ray tube, which is used to correctly determine the left and right sides of the image produced
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13
Q

WHAT DO EXTRA-ORAL FILMS CONTAIN?

A
  • cassette case that is loaded into special imaging machines for use
  • intensifying screens in both sides of the cassette, to reduce the dose of radiation exposure required ro produce a dental image
  • film, of a compatible type with the intensifying screens, to produce the dental image once exposed and processed
  • marker to correctly determine the left and right sides of the image produced
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14
Q

WHAT ARE THE INTRA-ORAL VIEWS?

A
  • HORIZONTAL BITEWING
  • VERTICAL BITEWING
  • PERIAPICAL
  • ANTERIOR OCCLUSAL
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15
Q

WHAT ARE THE EXTRA-ORAL VIEWS?

A
  • DENTAL PANORAMIC TOMOGRAPH (DPT) - shows both jaws and their surrounding bony anatomy, and is taken for orthodontic and wisdom tooth assessments, as well as to help diagnose pathology and jaw structures
  • LATERAL OBLIQUE - shows the posterior portion of one side of the mandible, including the ramus and angle and the lower molar teeth, and is an alternative to a DPT to view the position of unerupted third molar teeth
  • LATERAL SKULL RADIOGRAPH - this is a view of the side of the head, and is taken in a specialised machine called a CEPHALOSTAT and is used to monitor jaw growth and determine orthognathic surgery techniques in complicated cases of maloclussion
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16
Q

WHAT IS HORIZONTAL BITEWING FOR?

A

shows the posterior teeth in occlusion, and is taken to view:

  • interproximal areas and diagnose caries in these regions
  • restoration overhangs in these areas
  • recurrent caries beneath exsisting restorations
  • occlusal caries
17
Q

WHAT IS VERTICAL BITEWING FOR?

A

shows an extended view of the posterior teeth, from mid-root of the lowers as a minimum, as it taken to view:

  • periodontal bone levels of the posterior teeth
  • true periodontal pockets
18
Q

WHAT IS A PERIAPICAL FOR?

A

shows one or two teeth in full length with their surrounding bone, and is taken to view the area and the teeth in close detail

19
Q

WHAT IS A ANTERIOR OCCLUSAL FOR?

A

shows a plane view of the anterior section of either the mandible or the maxilla, and are used especially to view the area for unerupted teeth, super-numerary teeth, and cysts

20
Q

WHAT IS THE PARALLELING TECHNIQUE?

A

the paralleling technique holds the film exactly parallel to the long axis of the tooth being exposed, so that the image produced is exactly the same size as the actual tooth. this is especially important during endodontic procedures.

21
Q

WHAT IS THE BISECTING ANGLE TECHNIQUE?

A

sometimes the film cannot be placed parallel to the tooth, becuase of the size restriction of the patient’s mouth. in these situation, the bisecting angle technique is used. the film is placed intra-orally and the angulation of the long axis of the tooth against the film is determined by the operator, this angle is then halved (bisected) and the collimator of the tube head is angled to beat right angles to it before the film is exposed

22
Q

ADVANTAGES OF DIGITAL RADIOGRAPHY:

A
  • financial savings of not having to buy film packets and processing chemicals and equipment
  • avoidance of health and safety issues surrounding COSHH and the handling of the waste processing chemical.
  • help towards achieving ALARA/ALARP, as the use of the sensor always ensures a lower dose of radiation compared with conventional film
  • the image is produced in seconds at the chairside, rather than several minutes in the processing area
  • patients are able to view the magnified image on the computer screen at the chairside and with the dentist, whereas they can only view the actual size conventional radiograph on the light box viewer
  • the magnified image can give greater clarity in some instances
  • the same sensor can be used over and over again, as long as adequate infection control techniques are in place to avoid cross-infection, by encasing the sensor in a single-use plastic sheath before each exposure
23
Q

DISADVANTAGES OF DIGITAL RADIOGRAPHY:

A
  • the issue of adequate infection control to avoid cross-infection, although this should be manageable using the sheaths described and wiping the plate with a compatible disinfectant wipe alter each use
  • costs of buying the computer with suitable specifications for use with the digital radiography software, the comuter software itself, and the sensor plates and their attachments
  • the ability to alter the image without detection raises dento-legal concerns in complaint and fraud cases, unless an expert is employed to examine the computer hard drive.
24
Q

FORMATION OF THE CONVENTIONAL IMAGE:

A

an intra-oral X-ray film packet contains a celluloid film coated with light-sensitive silver bromide salts in an emulsion, surrounded by black paper to protect it from unwanted light, and enclosed in a waterproof plastic packet. on one side of the film is a lead foil which prevents the emulsion coat being exposed twice, by absorbing scattered radiation during the actual exposure to X-rays.

25
Q

DIGITAL RADIOGRAPHY FILM PROCESSING:

A

intra-oral digital films are transmitted directly to the computer and can be viewed within seconds on the computer screen. all other films require chemical processing to convert the latent image to a visible image for viewing, and this can be done using an AUTOMATIC PROCESSING MACHINE or by MANUALLY processing the film, passing it through the chemical tanks by hand and in the correct sequence

26
Q

AUTOMATIC PROCESSING

A

the machine used consist of a base containing the chemical and water tanks, with conveyor belt-style rollers that carry the film through the machine during processing. these are all beneath a removable, light-tight lid which has hand entry ports so that the film packet or cassette can be put into the light-tight chamber before being opened. if the film is exposed to visible light before being processed, the image will be permanently lost.
the automatic processing procedure is as follows:
- observe the warning light system to check that the chemical and water levels are adequate, and that the tempreture is correct for processing
- when the tempreture is correct, the warning light will go out and the machine is ready for use
- intra-oral film packets are taken into the machine through the hand ports while wearing clean gloves
- extra-oral cassettes are placed into this section by lifting and replacing the lid, and they can be opened and handled via the hand ports
- the rollers become operational once the processing start button within this first chamber is pressed
- the film packet is carefully opened and the plastic envelope, black paper and lead foil are all dropped to the base of the tank, for removal letter
- the film is then held by its sides only, as finger marks on the surface will damage the image
- the film is carefully inserted into the entrance to the rollers, and it will be gently tugged into the machine to be processed
- once the film has passed through the machine, processed and dried, it will reappear at the delivery port and can be safely handled and viewed

27
Q

THE TANKS FOR MANUAL PROCESSING:

A

four tanks will be present, as follows:
- LIDDED DEVELOPING TANK - containing the alkaline developing fluid that produces the initial LATENT IMAGE, the lid is only removed during developing as the solution will deteriorate in air
FIRST WATER TANK - to wash off the developing solution after the correct developing time, usinng tap water
FIXING TANK - containing the acid fixing solution which permanently fixes the image on to the celluloid film, so that it can be viewed in visible light
SECOND WATER TANK - to wash off the fixing solution after the suitable fixing time, again using tap water

28
Q

MANUAL PROCESSING PROCEDURE:

A
  • check that the chemical and water levels are adequate
  • check the tempreture of the solutions and determine the developing and fixing times required from the chemical manufacturer’s guidelines provided
  • check that a timing clock and suitable film hangers are available in the room
  • wipe surfaces dry of any previously spilt chemicals or water, if necessary
  • lock the door and switch off all the lights except the safe light
  • open the film packet or cassette, locate the film and clip it to the one of the hangers available, carefully handling the film by its edges only, to acoid spoiling with fingerprints
  • remove the developer lid, immerse the hanger in the solution so that the film is completely covered by the solution and start the timer
  • when the timer sounds, remove the hanger and film and immerse in the first water tank, agitating the hanger to ensure thorough washing occurs
  • shake off excess water, then fully immerse the hanger and film in the fixer solution, and start the timer
  • replace the developer lid to prevent the solution being weakened by exposure to air, which would allow oxidation to occur otherwise
  • when the timer sounds, remove the hanger and film and immerse in the second water tank, agitating the hanger to ensure thorough washing occurs
  • switch on the ordinary light
  • shake off excess water and dry the film - a slow-running hairdryer is suitable for this, as the radiograph must not be dried too quickly
29
Q

MOUNTING AND VIEWING FILMS

A

extra-oral cassettes are marked with an “L” to indicate the patient’s left side, and unless the cassette has been placed upside down in the machine, the film is easily orientated on the viewer so that it is viewed as if looking at the patient from the front.
all intra-oral films have a raised pimple in one corner which must be facing out to view the film correctly, and not back to front.
dental workplaces are likely to use one of the the various different methods of patient identification and storage of the films, and dental nurses have to be aware of the methods in use in their workplace and use them appropriately. these may include any of the following:
- digital images will be stored on the computer or downloaded onto disks, and they will be individually saved to the patient’s own file
- intra-oral films may be mounted in plastic envelopes, with patient identification details written on in indelible ink
- these may be stored within each patient’s record card and filed
- if clinical notes are computerised, there may be a seperate filing system used exclusively for films
- extra-oral films may be too large to store within the record chart cards, so may also have their own exclusive filing system

30
Q

CARE OF PROCESSING EQUIPMENT AND FILM PACKETS:

A
  • ensure adequate training in processing techniques has been given, with a written record kept in the radiation protection file
  • always carry out the pre-processing checks corrrectly
  • always wear suitable personal protective equipment (PPE) when handling all processing chemicals, as they are toxic
  • follow the surgery policy on topping up and changing spent solutions - normally all will require full replacement on a monthly basis
  • dispose of all waste solutions as NON-INFECTIOUS HAZARDOUS WASTE, under the health and safety policy
  • follow the training given and the manafacturer’s guidelines on cleaning the processing area or the automatic processor, to avoid film contamination
  • this is especially important with regard to the roller system in automatic machines, as films can stick to dirty rollers and their images will be destroyed
31
Q

UNEXPOSED FILM PACKETS MUST BE STORED AS FOLLOWS:

A
  • away from all sources of radiation
  • away from all heat sources, and ideally room temperature
  • away from all liquids that may penetrate the packets and destroy the films before use
  • in stock rotation, so that older films are used first
32
Q

EXPOSURE FAULTS:

A

ELONGATION OF IMAGE - collimator angulation is too shallow, producing a long image
FORESHORTENING OF IMAGE - collimator angulation is too steep, producing a squat image
CONING - collimator angulation is central to the film, so film is only partly exposed
BLURRED IMAGE - patient or collimator moved during exposure
TRANSPARENT FILM, OR FAINT IMAGE WITH OVERLYING PATTERN - filmed placed the wrong way round to the collimator for exposure, with the lead foil pattern superimposed onto the film - this may not always appear as the traditional “herringbone” pattern
FOGGED FILM - exposed to light before X-ray exposure
BLANK FILM - X-ray machine not switched on, although this is unlikely to happen with modern machines, as they have exposure lights and audi signals installed

33
Q

HANDLING FAULTS

A

SCRATHES OR FINGERPRINTS - catching the film on the tank side during immersion or not holding the film by the edges
BLANK SPOTS - films splashed with fixer before developing
BLACK LINE ACROSS FILM - film bent or folded during processing
BROWN OR GREEN STAINS - inadequate fixing due to old solution
CRAZED PATTERN ON FILM - film dried too quickly over a strong heat source
PRESENCE OF CRYSTALS ON FILM - insufficient washing after fixing

34
Q

PROCESSING FAULTS

A

poor quality radiographs can also be produced due to equipment preparation faults, and especially lack of solution preparation and maintenence of the automatic processor.
some common processing faults:
DARK FILM - developer solution too concentrated
developer solution tempreture too high
over developed
BLANK FILM - film placed in fixer solution before devloper solution, so the image is destroyed
PARTLY BLANK FILM - film partially immersed in developer solution
FOGGED FILM - processing room or machine is non light-tight, so the film is exposed to light before processing
FAINT IMAGE - developer solution too weak
developer solution temperature too low
under-developed
FADING IMAGE - inadequate fixing time so image is not permanently held on the film
LOSS OF FILM - film stuck in roller system due to poor cleaning and maintenence of automatic processor
VISIBLE ARTEFACTS - film contaminated with solution spillages, in cassetes or on work surfaces

35
Q

QUALITY ASSURANCE OF FILMS

A

a simple-to-use scoring system set out in clinical governance guidelines is as follows:
- SCORE 1 - EXCELLENT quality radiograph with no errors present
- SCORE 2 - DIAGNOSTICALLY ACCEPTABLE quality, minimal errors present that do not prevent the radiograph from being used for diagnosis
- SCORE 3 - UNACCEPTABLE QUALITY, where errors present prevent the radiograph from being used for diagnosis, and will therefore invlove a retake.
score 1 should be at a minimum of 70% off all exposures, while score 3 should be at a maximum of 10%

36
Q

HANDLING OF CHEMICALS:

A

when dilutijng solutions, filling or topping up the processor tanks, or draining the tanks when the solutions require replacement, adequate PPE must be worn and the correct equipment used to avoid accidents, include spillages, as follows:

  • gloves should be worn to prevent skin contamination from splashed chemicals, which may be irritant - heavy-duty gloves rather than surgery gloves would be ideal
  • eye protection should also be worn for the same reason
  • the chemicals should not be handled in an enclosed space, so an extractor fan should be in use in small areas
  • a mask should be worn to reduce the inhalation of the vapours as far as possible - a visor alone is not sufficient in these circumstances
  • a disposable plastic apron should be worn to prevent splashes on the uniform
  • full bottles of either chemical might be too heavy too lift for some staff, so a plastic jug might be required to carry smaller volumes safely
  • if one jug is provided, it must be thoroughly rinsed and dried between chemicals to avoid contamination of one solution with the other
  • when filling or topping up the processor tanks, step ladders may be required to allow the staff member to stand safely above the machine and enable them to see clearly into the various tanks
  • a plastic funnel must be used to pour the solutions accurately into the tanks and avoid spillages, and again it must be rinsed and dried between chemicals
  • it may require a colleague to assist by holding the funnel firmly while the solutions are being poured, to avoid spillages
  • any spilled chemicals should be wiped away or mopped up immediatlely and the area washed with a detergeent solution to prevent the staining of the work surface by the chemicals
  • all PPE and used disposable cloths should be disposed of appropriately as non-infectious hazardous waste
37
Q

STORAGE AND WASTE COLLECTION:

A

as with all chemicals stored and used in the dental workplace, processing solutions are subject to the conditions of the Special Waste and Hazardous Waste Regulations (2005).
the waste solutions must only be collected and removed from the premises by licensed waste contractors, as disposal of the chemicals must follow strict environmental legislation, in accordance with the Environmental Protection Act.

38
Q

SPILLAGES:

A

if a spillage does occur, the procedure to follow is:

  • Wear suitable PPE before handling any of the chemicals
  • although the vapours may be irritant to some staff, especially in an enclosed space, they are not toxic
  • the chemicals themselves are harmful, particularly if they are splashed into the eyes or ingested, so eye protection must always be worn and common sense should dictate that no chemical used in the dental workplace is ingested by anyone
  • if splashes to the eye or ingestion do occur, the COSHH file must be consulted for the correct emergency first aid treatment to be provided to the casualty
  • if a spillage occurs, it should be covered with paper towels to minimise the release vapours and soak up the majority of the liquid
  • wash down the spillage area with a warm detergent solution and then dry thoroughly with more paper towels or a mop, or allow evaporation to take place
  • any wet floor area should be highlighted to staff and workplace visitors using the necessary signage
  • a risk assesment should be carried out to determine the cause of a large spillage, so that appropriate action can be taken to avoid a similar incident in the future

DENTAL NURSING revision dec 7th exam (17 decks)

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