Patients With Special Needs

1. Patients With Special Needs

2. Gagging • The term “gagging” refers to the strong involuntary need to vomit. • The gag reflex can be defined as retching that is elicited by stimulation of the sensitive tissues of the soft palate area. • The gag reflex is a protective mechanism which serves to clear the airway of obstruction.

3. Gagging • ALL patients have a gag reflex. • It is important to remember that it is a more exaggerated reflex in some than in others. • But is IS a REFLEX, and not a fault of the patient.

4. How the Gag Reflex works • Before the gag reflex is initiated, the following two reactions occur: • Cessation of respiration • Contraction of the muscles of the throat and abdomen • Precipitating factors for initiation of the gag reflex include: • Psychogenic Factors • Tactile Stimuli

5. Patient Management • Operator attitude • Patient and Equipment Preparations • Exposure Sequencing • Receptor Placement and Technique

6. Operator Attitude • Convey a confident attitude • Demonstrate: • Patience • Tolerance • Understanding • EXPLAIN the imaging procedures, and then COMPLIMENT the patient as each exposure is completed.

7. Patient and Equipment Preparations • Limit the amount of time that the receptor stays in the mouth. (Move it, or they WILL lose it!) • When patient and equipment preparations are completed before receptor placement, valuable time is saved, and the likelihood of stimulating the gag reflex is reduced.

8. Exposure Sequencing • Always begin with the anterior exposures, as you have been taught. • With posterior exposures, always expose the premolar exposures before the molar exposures, as you have been taught. • THE MAXILLARY MOLAR EXPOSURE IS THE MOST LIKELY EXPOSURE TO INITIATE THE GAG REFLEX. • In a patient with a hypersensitive gag reflex, these two exposures should come last

9. Receptor Placement and Technique • To avoid stimulating the gag reflex, each receptor must be placed and exposed as quickly as possible. • DO NOT SLIDE THE RECEPTOR ALONG THE PALATE. • Demonstrate film placement • If a patient does gag, remove the film as quickly as possible.

10. Extreme Cases of Gag Reflex • Occasionally the dental radiographer encounters a patient with a gag reflex that is uncontrollable. • Here, we resort to EXTRAORAL images such as a Pan or a lateral jaw image.

11. Patients With Disabilities

12. Special Needs • A disability can be defined as “a physical or mental impairment that substantially limits one or more of an individual’s major life activities”. • The DA must be prepared to modify imaging techniques to accommodate persons with disabilities.

13. Physical Disabilities • Vision • Use clear verbal explanations • Explain each step before performing it • Hearing • May ask caregiver to act as interpreter • Use gestures or sign language • Use written instructions • If patient can lip read • Speak slowly, clearly and FACE THE PATIENT!

14. Physical Disabilities • Mobility Impairment • When there is a loss of use of the lower limbs • Ask patient how they would like to be transferred to the dental chair • DA may offer to assist • Caregiver may assist • Patient may do on their own

15. Physical Disabilities • Mobility Impairment • If there is a loss of use of the upper limbs, and the use of a beam alignment device cannot be used, the DA may ask the caregiver to assist with holding the receptor. • If so, the caregiver MUST wear a lead apron also. • Give caregiver specific instructions on how to hold the receptor • DA must never hold a receptor for a patient

16. Physical Disabilities • Remember, extraoral images are always an option.

17. Developmental Disabilities • A developmental disability is “a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration”. • Examples include: • Autism • Cerebral palsy • Epilepsy • Mental retardation

18. Developmental Disabilities • Here, there may be problems with coordination and comprehension of instructions. • With coordination issues: • Mild sedation may be effective • With comprehension issues: • Caregiver may be asked to assist

19. Developmental Disabilities • There are some situations where intraoral exposures cannot be tolerated by the patient. • In such cases, no intraoral exposures should be performed because • They will only result in non-diagnostic images • This would result in needless exposure of radiation to the patient. • Turn to page 293 of your texts for Helpful Hints

20. The Pediatric Patient

21. Pediatric Patient • Pediatrics is the branch of dentistry dealing with the diagnosis and treatment of dental diseases in children. • When treating the Pediatric Patient the dental radiographer must be aware of : • Prescribing of dental images • Patient and equipment preparations • Recommended techniques • Patient management

22. Prescribing Dental Images • Based on individual needs based on the age of the child and their ability to cooperate during the procedure

23. Patient and Equipment Preparations • Explanation of the procedure • tubehead = camera • Lead apron = winter coat • Image = picture of their teeth • Lead apron • As with all patients, a lead apron with a thyroid collar must be placed on all peds patients. • Exposure factors • Receptor size

24. Patient and Equipment Preparations • Exposure factors • Reduction of mA, kVp and exposure time • Reduced exposure time is preferred because a shorter exposure time will reduce the chance of a blurred image if the child moves • Receptor size • Primary dentition – size 0 • Transitional dentition – size 1 or 2 • Use size 2 for occlusal exposures

25. Bite-wings on a 6 ½ year old- Size 1 film

26. Panoramic Film- How Old??

27. Recommended Techniques • Turn to page 294, Table 24 – 1 for recommendations on dental imaging examinations of the Pediatric Patient. • Bisecting Angle technique is often preferred because of the small size of the mouth and hence no depth of palate. • Turn to page 294 for Helpful Hints with the Pediatric Patient

28. The Endodontic Patient

29. Endodontic Patients • Endodontics is the branch of dentistry concerned with the diagnosis and treatment of diseases of the pulpal tissues of the tooth. • Challenges arise with the placement of the film during endodontic procedures because of the rubber dam, clamp, etc. • Use of a special film holder (Endo-ray film holder) may be helpful. • Hemostat may also be used.

30. The Edentulous Patient

31. Edentulous Patients • The edentulous patient requires a dental imaging examination to : • Detect the presence of root tips, impacted teeth and lesions (cysts and tumors) • Identify objects imbedded in the bone • To observe the quality and quantity of bone that is present

32. Edentulous Patients • The panoramic image is the most common way of examining the edentulous jaw. • If a panoramic machine is not available, 14 periapical projections (6 anterior and 8 posterior) can be used to examine the edentulous arches. • Generally, the #2 size film is used • If the paralleling technique is used, cotton rolls must be placed on the bite block in place of the missing teeth

33. Edentulous Patients • If the paralleling technique is used, cotton rolls must be placed on the bite block in place of the missing teeth • If the bisecting angle technique is used the receptor should be positioned so that approximately 1/3 of it extends beyond the edentulous ridge.