Download Imaging of Patients

Chapter 24
Imaging of Patients
with Special Needs
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
Dental Radiography
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Questions
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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?
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Dental Radiography
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Chapter 24 Reading
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Iannucci & Howerton (pp. 290-299)
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Dental Radiography
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Chapter 24 Outline
Imaging of Patients with Special Needs
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Patients with the gag reflex
 Patients with disabilities
 Patients with specific dental needs
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Introduction
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Iannucci & Howerton (p. 290)
Purpose
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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
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patients with Gag Reflex
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Patient Management
Extreme Cases of Gag Reflex
Helpful Hints
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patients with Gag Reflex
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Gagging
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Gag reflex
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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
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The strong involuntary effort to vomit
Originating in the mind
Tactile stimuli
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Originating from touch
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patient Management
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Iannucci & Howerton (p. 291)
Operator attitude
Patient and equipment preparations
Exposure sequencing
Receptor placement and technique
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Operator Attitude
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Iannucci & Howerton (p. 291)
The dental radiographer must convey
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A confident attitude
 Patience, tolerance, and understanding
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The dental radiographer should explain the
radiographic procedures about to be
performed.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patient and Equipment Preparations
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Every effort should be made to limit the
amount of time that a receptor remains in the
mouth.
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When preparations are completed before receptor
placement, valuable time is saved, and there is
less likelihood of stimulating the gag reflex.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Exposure Sequencing
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Start with anterior exposures.
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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.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Receptor Placement and Technique
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Avoid the palate.
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Do not slide the receptor along the palate.
Firmly bring the receptor into contact with palatal
tissues using one decisive motion.
Demonstrate receptor placement
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Rub a finger along the tissues near the intended
area of receptor placement.
Tell the patient, “This is where the receptor will be
positioned.”
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Extreme Cases of Gag Reflex
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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.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Helpful Hints
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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
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patients with Disabilities
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Physical Disabilities
Developmental Disabilities
Helpful Hints
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patients with Disabilities
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Iannucci & Howerton (p. 292)
Disability
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A physical or mental impairment that substantially
limits one or more of an individual’s major life
activities
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Physical Disabilities
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Vision impairment
Hearing impairment
Mobility impairment
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Developmental Disabilities
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Developmental disabilities are “a substantial
impairment of mental or physical functioning
that occurs before the age of 22 and is of
indefinite duration.”
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Iannucci & Howerton (pp. 292-293)
May have problems with coordination or
comprehension of instructions.
In patients who cannot tolerate intraoral
receptor exposure, extraoral exposures may
be used.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Helpful Hints
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Iannucci & Howerton (p. 293)
Do not ask personal questions about a
disability.
Do offer assistance.
Do talk directly to the person with a disability.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patients with Specific Dental Needs
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Pediatric Patients
Helpful Hints
Endodontic Patients
Edentulous Patients
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Pediatric Patients
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Pediatrics
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Iannucci & Howerton (pp. 293-295) (Figs. 24-1
through 24-5)
The branch of dentistry dealing with the diagnosis
and treatment of dental diseases in children
The dental radiographer must be aware of
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Prescribing of dental images
 Patient and equipment preparations
 Recommended techniques
 Patient management
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Prescribing of Dental Images
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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
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Patient and Equipment Preparations
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Explanation of the procedure
Lead apron
Exposure factors
Receptor size
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Recommended Techniques
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Iannucci & Howerton (pp. 293-294) (Table 24-1)
In children with a primary or transitional
dentition, the bisecting technique is preferred.
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The bite-wing and occlusal techniques are also
used in pediatric patients.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Helpful Hints
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Iannucci & Howerton (pp. 294-295)
Be confident.
Show and tell.
Reassure the patient.
Demonstrate behavior.
Request assistance.
Postpone the examination.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Endodontic Patients
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Endodontics
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Iannucci & Howerton (pp. 295-296)
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.
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A series of exposures is used to evaluate the tooth
before, during, and after treatment.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Endodontic Patients
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Receptor placement
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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
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The paralleling technique should be used
whenever possible.
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Edentulous Patients
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Iannucci & Howerton (p. 296)
The edentulous patient may require a dental
imaging examination:
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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
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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Edentulous Patients
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Panoramic examination
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Iannucci & Howerton (pp. 294-298) (Figs. 24-6
through 24-9)
The most common way of evaluating the
edentulous jaw
Periapical examination
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Used if a panoramic machine is not available
 May be used as a follow-up to the panoramic
examination
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Occlusal and periapical examination
Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
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