Xray - Outcome 9 Flashcards
Patients with a Gag Reflex
The term gagging refers to the strong involuntary effort to vomit. The gag reflex (also called the pharyngeal reflex) can be defined as retching that is elicited by stimulation of the sensitive tissues of the soft palate region. This gag reflex is a protective mechanism of the body that serves to clear the airway of obstruction. All patients have a gag reflex; some are more sensitive than others. A hypersensitive gag reflex is a common problem in dental radiography
Factors that are responsible for initiating the gag reflex include..
-psychogenic stimuli - stimuli originating in the mind
- tactile stimuli - stimuli originating from touch
To suppress the gag reflex, the operator must elimate or decrease these precipitating factors
Areas that are most likely to elicit the gag reflex hen stimulated include..
the soft palate and the lateral posterior third of the tongue
Prior to the gag reflex, two reactions occur:
-cessation of respiration
-contraction of the muscles of the throat and abdomen
Importance of the operator’s attitude..
The attitude of the operator is critical to preventing the gag reflex. The operator must convey a confident attitude. The patient must feel secure in the radiographer’s ability to perform the clinical procedures. If the operator appears nervous or unsure of oneself, this may act as a psychogenic stimulus and elicit the gag reflex
The operator must also convey patience, tolerance, and understanding. Every effort should be made to relax and reassure the patient with a hypersensitive gag reflex. As always, the operator should explain the procedures to be performed and then compliment the patient as each exposure is completed. As the patient becomes more comfortable, confidence increases and he/she is less likely to gag
Time when exposing intra oral xrays
Every effort should be made to limit the length of time that a film remains in the mouth. The longer a film stays in the mouth, the more likely the patient is to gag. Have everything prepared in advance of film placement to decrease the likelihood of stimulating the gag reflex
Exposure Sequence and the gag reflex
Exposure sequencing plays an important role in preventing the gag reflex. As previously discussed, the operator should always start with the anterior exposures. Anterior films are easier for the patient to tolerate, less likely to elicit the gag reflex, and therefore, begin to build up the patient’s confidence
Film placement and the gag reflex
Film placement and technique also play an important role in preventing the gag reflex. To avoid stimulating the gag reflex, each film must be placed and exposed as quickly as possible.
Another suggestion is to run your finger along the tissues near the intended area of film placement, telling the patient, “This is where the film will be positioned”. Then, quickly place the film. This technique is used to desensitize the tissues in the area.
Helpful hints for preventing gag reflex
-Never suggest that the patient might gag! The power of suggestion can act as a strong psychogenic stimulus and can elicit the gag reflex.
-Reassure the patient. If the patient gags, the operator should reassure the patient that such a response is not unusual.
-Suggest breathing. Tell the patient to “breathe deeply” through the nose during film placement and exposure. The breathing should be audible. (You can also suggest very quick little breaths.)
-Distract the patient. Instruct the patient to do one of the following during film placement and exposure:
*bite hard on the film holder
*suspend a leg or arm in the air
*breathe through their nose
These acts divert the patient’s attention and lessen the likelihood of eliciting the gag reflex.
-Reduce tactile stimuli. Reducing tactile stimuli helps to prevent the gag reflex. Before placing and exposing the film:
*have the patient drink a glass of ice water
*have the patient rinse with mouthwash
*place a small amount of table salt on the tip of the tongue
These techniques help to confuse the sensory nerve endings and lessen the likelihood of stimulating the gag reflex.
Topical Anesthetic for Gag Reflex
Should all other tactics fail, consult the dentist regarding the possibility of applying a topical anesthetic sufficient to permit the placement of the film. The use of topical anesthetic is not advocated as a standard procedure, but only for those rare situations when all other means of controlling the gag reflex fail and when the radiograph(s) is essential for diagnostic purposes.
Occasionally, you might encounter a patient with a gag reflex that is uncontrollable. In such a patient, extra-oral films must be used to obtain diagnostic data
Importance of xrays for children
Radiographs of children are necessary if a complete and thorough diagnosis is to be made. The roots of erupted primary teeth as well as the developing permanent teeth located within the alveolar bone are seen on these radiographs. So much development is taking place underneath the surface of the gingiva that this is the only accurate way of examining the area. Many carious lesions, which are quite prevalent in this age bracket, are overlooked without radiographs. An X-ray can demonstrate interproximal decay in the early stages so that it can be remedied before the tooth is placed in jeopardy. Without radiographs, up to 50% of carious lesions may be overlooked
Disturbances in normal development generally can be diagnosed only through adequate radiographs. Periapical infection and other disease processes are diagnosed with radiographs of the area. Quite frequently, children injure their teeth in a fall or a blow to the mouth. The extent of damage as a result of the trauma needs to be determined with a radiograph
Frequency of xrays for children
Interproximal surveys are made at definite intervals - usually once a year - although some children’s specialists suggest bite-wing radiographs every six months.
Some practitioners routinely take full-mouth surveys; others only if they suspect a problem. As with any patient, the number of radiographs prescribed is based on individual need, taking into consideration the patient’s caries history and clinical presentation. This is always keeping in perspective that the benefit outweighs the risk specifically being developing cells are extremely sensitive to x-radiation
The frequency of interproximal radiographic exposure is based on the history of caries activity. A pantomograph or full mouth series (FMS) would only be requisitioned when clinically demonstrated circumstances exist.
Suggested films for Primary Dentition (6 months to 5.5 years)
2 bite-wings
#0 film
Initial bite-wing examination may be made by 3½ years of age. Subsequent BW exposures or selected PA exposures would be based upon the frequency and extent of interproximal carious lesions.
At the mixed dentition stage, occlusal films using #2 size film may be made.
Xray taking for Pediatric Patients
Children have the same basic needs for dental treatment as adults and the proper care of children’s teeth is one of the responsibilities of the dentist; however, because of their sensitivity to ionizing radiation, caution should be exercised when taking radiographs of the pediatric patient.
If it is necessary to radiograph an infant, the child sits or lies on a parent’s lap, both with lead aprons in place. Both parent and child face the same way with the child’s head cradled against the parent. The parent’s left arm and hand encompass the child and restrain his hands. The parent’s right hand supports the head and x-ray film
Because the child patient is smaller than the adult patient, and the bone is less dense, the exposure factor should be reduced accordingly.
A thyroid collar should be used during all exposures.
Child-size film holders are available. It may be necessary to use the bisecting angle technique because of the size of the mouth.
Suggested films for Early Transitional Dentition (5.5 to 9 years)
Pantomograph (after the eruption of first molars and lower incisors) 2 bite-wings
#0 film
