Modifications and Legal Issues Flashcards
Gag reflex
Begin with anteriors as they are easier to tolerate. Follow with the premolars, then the molars
Expose the maxillary molars last (most likely to provoke gag reflex)
Avoid the palate, slide the receptor along the teeth, then firmly bring the receptor to the palate
Demonstrate with a finger where the receptor will be placed and rub the area to desensitize it
Use fewer motions and use distractions (arms up, salt on the tongue, etc.).
Topical anesthetics can be used. Avoid on patients with benzocaine allergy
For extreme cases, use extraoral techniques.
Edentulous (lacking teeth) Patient
Use cotton rolls to stabilize the receptors with partially edentulous patients
Bisecting technique may be easier to achieve than paralleling technique with partially edentulous patients
Occlusal, periapical, and panoramic images may be used
*Radiographs are still important for edentulous patients, as the images can detect **bone level, lesions, fractures, root tips, etc. ** (Take images of all areas)
Pregnancy
According to the ADA and FDA, dental radiographic procedures don’t have to be altered because of pregnancy
- NOTE: some other resources recommend holding off radiographic exposure during pregnancy. Such claims are not part of the ADA or FDA guidelines.
The use of a lead apron reduces the amount of fetal radiation exposure to almost none
The environment surrounding the fetus provides extra protection
Pediatric Patient
Size 0 or 1 receptors should be used for small children
Size 1 and 2 receptors should be used for mixed dentitions
Refer to the exposure as “taking a picture” and the lead apron as a “coat” to facilitate the child’s understanding and cooperation
The child may be seated on the caregiver’s lap in the dental chair. Both the child and the caregiver should wear lead aprons.
For a single exposure, it is acceptable to have the parent hold the sensor
Endodontic treatments
Rubber dam, clamps, and other instruments/materials create challenges for radiographic exposures
Endoray (Dentsply) image receptor holder fits around clamps and allows space of other endodontic instruments/materials
Center the tooth on the image
Allow at least 5 mm of bone to be captured beyond the tooth apex
Use paralleling technique to provide proportional accuracy
Informed consent
Patient must give an informed consent prior to radiographic surveys
Thus, patient agrees to the procedure presented and will follow treatment
Implied consent
implied by the actions of the patient (e.g., if a patient comes to the dental office, this action is an “implied consent” that he/she agrees to receive a dental examination and consultation)
Expressed consent
agreement given verbally or in writing
If the patient is unconscious and needs emergency treatment, it is legal to treat the patient without the patient’s or the guardian’s consent
If the patient has not consented, ..
he/she may claim malpractice or negligence
Consent valid only if the following requirements are present and met:
*Includes the procedure, complications, and alternative choices
*Includes the prognosis (benefits and risks) and results of not treating the condition
*Presented in a language that the patient understands
*Patient is legally competent to provide consent. If patient is mentally challenged or underage, caregiver may provide consent. Legal age will depend on State/Province.
*Patient can ask questions
*Consent must not be obtained through deceit
Informed refusal
patient declines treatment after a treatment plan is presented
When the patient refuses the use of radiographs, ..
the standard of care may be affected
Effort should be made to educate the patient about the importance of dental radiographs as a diagnostic/treatment tool
When negative consequences arise from not taking radiographs, an informed refusal form does not protect the dentist from legal consequences
The dentist should decide whether to treat the patient who refuses radiographs
Patient records
Dental records are considered legal documents
Dental radiographs are the property of the dentist. However, the patient has the right to access them and request a copy
When providing radiographs to the patient, a reasonable fee may be charged
Documentation related to radiographs include:
*Informed consent
*Type or radiographs and number of exposures
*Reason for radiographic survey
*Interpretation of the radiographs
*Radiographs in film or digital form
