imaging of patients with special needs

Question 1

what is gagging? what is the gag reflex? where are people with gag reflexes most sensitive?

Answer 1

• gagging: the strong involuntary effort to vomit
• gag reflex: retcing that is elicited by stimhulation of the sensitive tissues of the soft palate region
• areas that are most likely to elicit the gag reflex: soft palate, lateral posterior third of the tongue

Question 2

2 precipitating factors for the initiation of the gag reflex

Answer 2

• psychogenic stimuli (originating in the mind)

- tactile stimuli (originating from touch)

Question 3

patient management:

Answer 3

• operator attitude
• patient and equipment preparations
• exposure sequencing
• receptor placement and technique

Question 4

operator attitude

Answer 4

• the dental radiographer must convey: a confident attitude, patience, tolerance, and understanding
• the dental radiographer should explain the imaging procedure about to be performed

Question 5

patient and equipment preparations

Answer 5

• every effort should be made to limit the amount of time that a receptor remains in the mouth
• when preparations are completed before receptor placement, valuable time is saved and there is less likelihood of stimulating the gag reflex

Question 6

exposure sequence for patients with gag reflexes

Answer 6

• start with anterior exposures: with posterior receptor placements, expose the premolar receptor before the molar receptor
• the maxillary molar receptor is most likely to elicit the gag reflex

Question 7

receptor placement and technique for patients with gag reflexes

Answer 7

• avoid the palate: do not slide the receptor along the palate, firmly bring the receptor into contact with palatal tissues using one decisive motion
• demonstrate receptor placement: rub a finer along the tissues near the intended area of receptor placement, tell the patient, ‘this is where the receptor will be positioned’

Question 8

what can we do in extreme cases of gag reflex

Answer 8

• if the gag reflex is uncontrollable, the dental radiographer must use extraoral images such as panoramic or lateral jaw images to obtain diagnostic images

Question 9

helpful hints

Answer 9

• 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

Question 10

what is a disability?

Answer 10

• a physical or mental impairment that substantially limits one or more of an individual’s major life activities

Question 11

physical disabilities and how to deal with them

Answer 11

• visual impairment: must communicate using clear verbal explanations
• hearing impairment: ask the patient how he or she prefers to communicate. can ask a caregiver to serve as interpreter
• mobility impairment: ask whether a patient needs assistance

Question 12

what are developmental disabilities?

Answer 12

• developmental disabilities are ‘a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration’
• may have problems with coordination or comprehension
• in patients who cannot tolerate intraoral receptor exposure, extraoral exposures may be used

Question 13

patient management helpful hints

Answer 13

• do practice the golden rule
• do not ask personal questions about a disability
• do think before you speak
• do offer assistance
• do talk directly to the person with a disability

Question 14

what is paediatrics?

Answer 14

• a brand of dentistry dealing with the diagnosis and treatment of dental diseases of children

Question 15

what must the dental radiographer be aware of in paediatrics?

Answer 15

• tooth eruption sequence
• prescribing of dental images
• recommended techniques
• types of examinations
• digital sensor issues
• patient and equipment preparations
• patient management

Question 16

prescribing of dental images

Answer 16

• depends not only on the individual needs of the child but also on the age of the child and his or her ability to cooperate with the procedures
• an imaging examination that includes all of the tooth-bearing areas is recommended at the early mixed dentition stage, after the first permanent tooth has erupted

Question 17

recommended techniques

Answer 17

• imaging techniques are similar to those used in adults

- typical examinations of primary and transitional dentitions use various techniques

Question 18

types of examinations

Answer 18

• when a paediatric patient is first treated and does not have previous dental images, it is necessary to obtain a baseline series of images that show all tooth-bearing areas
• examinations may include:
  
  • four-image series
  • eight-image series
  • 12-image series
  • 16-image series

Question 19

digital sensor issues

Answer 19

• paediatric patients may or may not be able to tolerate the use of a wired digital sensor
• using the correct size of a digital sensor is critical
• wireless sensors are preferred over wired sensors in paediatric dentistry

Question 20

patient and equipment preparations

Answer 20

for a paediatric patient, special attention must be devoted to:

• explanation of the procedure
• lead apron
• exposure factors
• receptor size

Question 21

patient management helpful hints

Answer 21

• be confident
• show and tell
• reassure the patient
• demonstrate behaviour
• request assistance
• postpone the examination

Question 22

what is endodontics?

Answer 22

• the branch of dentistry concerned with the diagnosis and treatment of diseases of the dental pulp within the tooth
• the dental image is indispensable during root coronal procedures, a series of exposures is used to evaluate the tooth before, during and after treatment

Question 23

receptor placement in endodontic patients

Answer 23

• the dental radiographer must modify the receptor placement in the endodontic patient
• the endoray alignment device can be used to aid in positioning the receptor during a root canal procedure

Question 24

recommended technique for radiographing endodontic patients

Answer 24

• the paralleling technique whenever possible

Question 25

edentulous patients may require a dental imaging exam to

Answer 25

• detect the presence of root tips, impacted teeth and lesions
• identify objects embedded in bone
• establish the position of normal anatomic landmarks relative to the crest of the alveolar ridge
• observe the quantity of bone that is present

Question 26

panoramic exams for edentulous patients

Answer 26

• the most common way of evaluating the edentulous jaw

Question 27

periapical exams for edentulous patients

Answer 27

• used if a panoramic machine is not available

- may be used as a follow-up to the panoramic exam

Question 28

what other exams can aid for edentulous patients?

Answer 28

occlusal and periapical