Chapter 24 Imaging of Patients with Special Needs
Dental Radiography • Questions • What techniques can be utilized to help manage patients with the gag reflex? • What modifications in technique may be necessary for patients with disabilities? • What modifications in imaging technique may be required for patients with specific dental needs?
Dental Radiography • Chapter 24 Reading • Iannucci & Howerton (pp. 290-299)
Dental Radiography • Chapter 24 Outline • Imaging of Patients with Special Needs • Patients with the gag reflex • Patients with disabilities • Patients with specific dental needs
Introduction • Iannucci & Howerton (p. 290) • Purpose • To introduce the dental radiographer to the problems encountered in dealing with patients with special needs • To manage patients with a hypersensitive gag reflex, patients with physical or developmental disabilities, pediatric patients, endodontic patients, and edentulous patients
Patients with Gag Reflex • Patient Management • Extreme Cases of Gag Reflex • Helpful Hints
Patients with Gag Reflex • Gagging • The strong involuntary effort to vomit • Gag reflex • Retching that is elicited by stimulation of the sensitive tissues of the soft palate region • Includes the soft palate and the lateral posterior third of the tongue • Psychogenic stimuli • Originating in the mind • Tactile stimuli • Originating from touch
Patient Management • Iannucci & Howerton (p. 291) • Operator attitude • Patient and equipment preparations • Exposure sequencing • Receptor placement and technique
Operator Attitude • Iannucci & Howerton (p. 291) • The dental radiographer must convey • A confident attitude • Patience, tolerance, and understanding • The dental radiographer should explain the radiographic procedures about to be performed.
Patient and Equipment Preparations • Every effort should be made to limit the amount of time that a receptor remains in the mouth. • When preparations are completed before receptor placement, valuable time is saved, and there is less likelihood of stimulating the gag reflex.
Exposure Sequencing • Start with anterior exposures. • With posterior receptor placements, expose the premolar receptor before the molar receptor. • The maxillary molar receptor is the most likely to elicit the gag reflex.
Receptor Placement and Technique • Avoid the palate. • Do not slide the receptor along the palate. • Firmly bring the receptor into contact with palatal tissues using one decisive motion. • Demonstrate receptor placement • Rub a finger along the tissues near the intended area of receptor placement. • Tell the patient, “This is where the receptor will be positioned.”
Extreme Cases of Gag Reflex • Iannucci & Howerton (p. 291) • If the gag reflex is uncontrollable, the dental radiographer must use extraoral images such as panoramic or lateral jaw images to obtain diagnostic information.
Helpful Hints • Iannucci & Howerton (pp. 291-292) • Never suggest gagging • Do reassure the patient • Do suggest breathing • Do try to distract the patient • Do try to reduce tactile stimuli • Do use a topical anesthetic
Patients with Disabilities • Physical Disabilities • Developmental Disabilities • Helpful Hints
Patients with Disabilities • Iannucci & Howerton (p. 292) • Disability • A physical or mental impairment that substantially limits one or more of an individual’s major life activities
Physical Disabilities • Vision impairment • Hearing impairment • Mobility impairment
Developmental Disabilities • Iannucci & Howerton (pp. 292-293) • Developmental disabilities are “a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration.” • May have problems with coordination or comprehension of instructions. • In patients who cannot tolerate intraoral receptor exposure, extraoral exposures may be used.
Helpful Hints • Iannucci & Howerton (p. 293) • Do not ask personal questions about a disability. • Do offer assistance. • Do talk directly to the person with a disability.
Patients with Specific Dental Needs • Pediatric Patients • Helpful Hints • Endodontic Patients • Edentulous Patients
Pediatric Patients • Iannucci & Howerton (pp. 293-295) (Figs. 24-1 through 24-5) • Pediatrics • The branch of dentistry dealing with the diagnosis and treatment of dental diseases in children • The dental radiographer must be aware of • Prescribing of dental images • Patient and equipment preparations • Recommended techniques • Patient management
Prescribing of Dental Images • Iannucci & Howerton (pp. 293, 47) (Table 5-1) • Depends not only on the individual needs of the child but also on the age of the child and his or her ability to cooperate with the procedures
Patient and Equipment Preparations • Explanation of the procedure • Lead apron • Exposure factors • Receptor size
Recommended Techniques • Iannucci & Howerton (pp. 293-294) (Table 24-1) • In children with a primary or transitional dentition, the bisecting technique is preferred. • The bite-wing and occlusal techniques are also used in pediatric patients.
Helpful Hints • Iannucci & Howerton (pp. 294-295) • Be confident. • Show and tell. • Reassure the patient. • Demonstrate behavior. • Request assistance. • Postpone the examination.
Endodontic Patients • Iannucci & Howerton (pp. 295-296) • Endodontics • The branch of dentistry concerned with the diagnosis and treatment of diseases of the dental pulp within the tooth • The dental image is indispensable during root canal procedures. • A series of exposures is used to evaluate the tooth before, during, and after treatment.
Endodontic Patients • Receptor placement • The dental radiographer must modify receptor placement in the endodontic patient. • The EndoRay film holder can be used to aid in positioning the receptor during a root canal procedure. • Recommended technique • The paralleling technique should be used whenever possible.
Edentulous Patients • Iannucci & Howerton (p. 296) • The edentulous patient may require a dental imaging examination: • to detect the presence of root tips, impacted teeth, and lesions • to identify objects embedded in bone • to establish the position of normal anatomic landmarks relative to the crest of the alveolar ridge • to observe the quantity and quality of bone that is present
Edentulous Patients • Iannucci & Howerton (pp. 294-298) (Figs. 24-6 through 24-9) • Panoramic examination • The most common way of evaluating the edentulous jaw • Periapical examination • Used if a panoramic machine is not available • May be used as a follow-up to the panoramic examination • Occlusal and periapical examination