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3/2/2011 1 DENTAL RADIOLOGY FOR THE PEDIATRIC AND SPECIAL NEEDS PATIENT Dr. Tannen St. Barnabas Hospital NEW PATIENT - Posterior bitewings- 2 * if contacts are closed -* behavior dependent, sometimes try nitrous * 4 BW when 12 yr molars erupt - Periapicals * if you require more than 4 PA’s and/or - Panoramic (>5 years) *Caries is deep or clinical pathology * Disturbance in eruption sequence * Family history of dental anomalies * Eruption of permanent maxillary lateral incisors (8-9 years old) - Occlusal *History of trauma *Disturbance in eruption sequence Do Not Take Routine Bitewings on orthodontic patients with wires RECALL PATIENT Clinical caries or HIGH risk factors for caries Primary and Transitional Dentition Posterior bitewings at 6 month intervals or until no carious lesions are evident Permanent Dentition Posterior bitewings at 6-12month intervals or until no caries is evident Panoramic /Periapical * permanent maxillary lateral incisors * Disturbance in eruption sequence *Growth and Development *Third Molar development and position RECALL PATIENT No Clinical caries and No risk factors for caries Primary and Transitional Dentition Posterior bitewings at 12-24 month intervals if proximal surfaces are not visible Permanent Dentition Posterior bitewings at 18-36 month intervals Panoramic /Periapical *Eruption of permanent maxillary lateral incisors *Disturbance in eruption sequence *Growth and Development *Third Molar development and position PATIENTS AT HIGH RISK FOR CARIES High level of caries History of recurrent caries Existing restoration of poor quality Inadequate fluoride exposure Prolonged nursing Diet with high sucrose frequency High medication frequency Developmental defects Developmental disabilities, special health care needs Xerostomia Genetic abnormalities Many multisurface restorations Chemo/radiation therapy Social, cultural, financial, psychological risk factors POSITIVE CLINICAL SIGNS/SYMPTOMS Clinical evidence of periodontal disease Large or deep caries Malposed or clinically impacted teeth Swelling Evidence of facial trauma Mobility of teeth Fistula or sinus tract infections Growth abnormalities Oral involvement in known or suspected systemic disease Positive neurologic findings in the head and neck Evidence of foreign objects Pain/or dysfunction of the TMJ Facial asymmetry Unexplained bleeding Unusual sensitivity of teeth Unusual eruption, spacing or migration of teeth Missing teeth with unknown cause

Occlusal DENTAL RADIOLOGY FOR THE PEDIATRIC AND

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PERIODONTAL EVALUATIONNEW PATIENT - Posterior bitewings- 2
* if contacts are closed -* behavior dependent, sometimes try nitrous * 4 BW when 12 yr molars erupt
- Periapicals * if you require more than
4 PA’s and/or
pathology * Disturbance in
maxillary lateral incisors (8-9 years old)
- Occlusal
•Do Not Take Routine Bitewings on orthodontic patients with wires
RECALL PATIENT
Transitional Dentition
Posterior bitewings at 6 month intervals or until no carious lesions are evident
• Permanent Dentition
Posterior bitewings at 6-12month intervals or until no caries is evident
Panoramic /Periapical
RECALL PATIENT
factors for caries
• Permanent Dentition
Panoramic /Periapical
*Disturbance in eruption sequence
History of recurrent caries
Inadequate fluoride exposure
High medication frequency
Xerostomia
POSITIVE CLINICAL
Swelling
Growth abnormalities
Evidence of foreign objects
Facial asymmetry
Unexplained bleeding
Missing teeth with unknown cause
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Oral Hygiene
Attachment Levels • Permanent incisors and
molars
• Interdental horizontal or vertical bone loss
• Furcation involvement
RADIOGRAPHIC TECHNIQUES
FOR THE
sedative, oral/IM/IV sedation, general anesthesia)
Protective stabilization Digital Radiography is Visual!
POSITIVE INDICATIONS FOR
Pediatric patients
RADIATION PHYSICS
The image is a "photographic negative" of the object - the "shadows" are white regions (where the X-rays were blocked by the object)
90% of the xray photons are absorbed by the tissues
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RADIATION PHYSICS
A chest x-ray has almost three times the exposure of a periapical film because of the chest projection’s much larger field size
A full mouth series is not equal to the sum of the individual exposures because of movement of the tube (1-30% of total beam exposure, Alcox/Jameson, 1974)
RADIATION PHYSICS
As kVp (tube voltage) is increased there is an increase in the energy each electron has when it strikes the target
Increase the quality of the xray beam by removing the less penetrating photons with an aluminum filter in the path of the beam
Collimation reduces patient exposure and increases film quality by reducing the size of the xray beam and volume of irradiated tissue within the patient by reducing scattered radiation
If the kilovoltage is increased to reduce contrast than the mAs must be decreased or the radiograph will be over exposed
For a given beam, the intensity is inversely proportional to the square of the distance from the source (modify kVp or mA)
TECHNIQUES
The film should ideally be parallel to the object and the central ray should be perpendicular to the object and film
Bisecting the angle technique
What is the difference?
Foreshortening results when the central ray is perpendicular to film but object is not parallel to film
Elongation of radiographic image results when central ray is perpendicular to object but not film
TECHNIQUES
SLOB rule- if the tooth moves in the same direction of the central X-ray beam from the first film to the second, the tooth is lingual or palatal to the other teeth ( opposite – buccal)
OFFICE MAINTENANCE AND
DIGITAL
RADIOGRAPHY Digital systems are
compared with film and those studies which have evaluated the effects • on diagnostic accuracy
of contrast and edge enhancement
• image size, • variations in radiation
dose and image compression are reviewed together with the use of automated image analysis for caries diagnosis
• as accurate as the currently available dental films for the detection of caries, sensitivities are relatively high (0.6-0.8) for detection of occlusal lesions into dentine with false positive fractions of 5-10%.
• for detection of approximal dentinal lesions, sensitivities, specificities as well as the predictive values are fair, but are very poor for lesions known to be confined to enamel
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THE SENSOR
is radiated precisely by your existing system at about 10% the exposure to radiation when compared to conventional film X-rays.
is connected to a computer in the operatory for file management of captured images
sensors are shared between rooms minimizing the cost of equipment duplication. Concise, Simple, Precise.
DIGITAL RADIOGRAPHY
Patient education
DIGITAL
RADIOGRAPHY
improve the contrast and enhance the density of the image immediately
computer based imaging facilitates automatic analysis of images and image reconstruction from two or more component images
EXTRAORAL RADIOGRAPHIC
TECHNIQUE MAXILLARY
• Open mouth as wide as possible
• Sensor is placed on the external surface of the cheek directly buccal to the tooth with a cotton roll between the sensor and face
• Xray cone is angled -55 degrees from the horizontal and perpendicular to the sensor
MANDIBULAR • Patient’s chin is raised
• Sensor is placed on the external surface of the cheek directly buccal to the tooth with a cotton roll between the sensor and face
• Xray cone is angled -35 degrees from the horizontal and perpendicular to the sensor
DOCUMENTATION
Document radiographic analysis and indication(s) for taking or not taking radiographs
Document number of radiographs, type and who took them
Documentation of succedaneous tooth when restorative or extraction is indicated
Document when you cannot obtain a radiograph and reason. Explain risks/benefits/alternatives
REVIEW AAPD GUIDELINES