Prescribing dental radiographs for infants, children, adolescents and individuals with special health care needs Flashcards
What can the radiography recommendations be used for?
1) optimize patient care
2) Minimize radiation burden
3) Allocate healthcare resources responsibly
What are radiographs used for?
1) Dx/monitor oral disease
2) Eval dentoalveolar trauma
3) Monitor dentofacial dev and the progress of therapy
The timing of the first radiograph should be based on what?
Patient’s individual circumstances, not age.
What do you need to do prior to taking x-rays?
1) review medical/dental hx
2) Complete clinical exam
3) assess vulnerability to environmental factors that affect oral health and assess caries risk
What do you do when you can’t obtain radiographs of diagnostic quality?
Discuss with the parent appropriate management technique and go over risk/benefit. For instance:
1) preven/resto dentistry
2) advanced behavior guidance
3) Deferral/referral
What are the examples of good radiation practice?
1) Use fastest image receptor compatible with the diagnostic task ( F-speed film or digital)
2) Collimation of the beam to the size of the receptor
3) Poper film exposure and processing
4) Protective apron and thyroid collar
5) limiting number of imaging to minimum necessary
CBCT use
1) Orthodontic treatment planning
2) Surgical planning for impacted teeth
3) Diagnosing temporomandibular joint disorder
4) Detecting, measuring and treating jaw tumors
5) Determining bone structure and tooth orientation
6) Locating the origin of pain or pathology
7) Cephalometric analyses
8) Reconstructive surgery
assessing PAP in endo, oral path, anomalies in den dentition, oral reconstructive sx, dental/facial trauma
Benefits:
Focused x-ray beam reduces scatter radiation
Results in better image quality
Single scan produces wide variety of views and angle to provide more complete evaluation
CBCT provides more information than conventional dental x-ray with reduced radiation compared to medical grade CT scan
CBCT often utilized in patients with: cleft lip and/or palate, pathology or trauma.
The use of CBCT should be considered when conventional x-rays are inadequate to complete dx and tx planning and potential benefits outweigh the risk of additional radiation dose
Basic principals and guidelines for use of CBCT:
1) use an appropriate size image or field of view
2) assess radiation dose risk
3) minimize radiation exposure
4) maintain professional competency in performing and interpreting CBCT
The resulting image should include an accompanying written report in the patient’s records that includes full interpretation of findings.
When is panx taken?
Routine times to take this x-ray for the first time is around seven or eight years of age as permanent teeth start erupting. At that time, we check for correct development of all permanent teeth, missing or additional teeth, health of the TMJ and correct angulation of erupting teeth as well as for any cysts, growths and other bone problems. The next time this x-ray is taken is around twelve years of age after permanent dentition has replaced baby teeth. At that age, we check for all of the above conditions and readiness for orthodontic treatment as well as health of the jaw, teeth and all oral structures before such treatment begins. The final time that a pediatric dentist takes this x-ray is around seventeen years of age in order to evaluate condition of wisdom teeth and their need or readiness for extractions in addition to all of the previous reasons. Other dental specialists might require it for reasons mentioned previously throughout a patient’s adult life.
A child with only primary dentition:
New patient: Clinical judgment, if spaces between posterior teeth and no oral disease evident- no x-rays
Recall ( caries/ oral pathology): 6-12 months if interproximal spaces can’t be visualized or clinically probed
Recall (no caries): 12-24 months 6-12 months if interproximal spaces can’t be visualized or clinically probed
Child with transitional dentition
New patient: Individual radiograph exam consisting of post.BWX with panx or post. bwx with selected PAs
Recall ( caries/ oral pathology): 6-12 months if interproximal spaces can’t be visualized or clinically probed
Recall (no caries): 12-24 months 6-12 months if interproximal spaces can’t be visualized or clinically probed
An adolescent with perm dentition prior to 3rd molars
New patient: Individual radiograph exam consisting of post.BWX with panx or post. bwx with selected PAs. Or FMX if generalized oral disease or extensive dental tx
Recall ( caries/ oral pathology): 6-12 months if interproximal spaces can’t be visualized or clinically probed
Recall (no caries): 18-36 months if interproximal spaces can’t be visualized or clinically probed
Adult, dentate or partially edentulous
New patient: Individual radiograph exam consisting of post.BWX with panx or post. bwx with selected PAs. Or FMX if generalized oral disease or extensive dental tx
Recall ( caries/ oral pathology): 6-18 months if interproximal spaces can’t be visualized or clinically probed
Recall (no caries): 24-36 months if interproximal spaces can’t be visualized or clinically probed
