Radiographic Techniques for Children Chapter 23

How does the child patient differ from the adult? Radiographs necessary to detect disease, and to assess growth and development of jaws and teeth; same basic radiographic needs as adults. Radiographic techniques similar to adult patient; smaller film, shorter exposure time, steeper vertical angulation. Smaller oral cavity, tongue resistance and gagging or behavioral considerations may require changes to standard procedures used. Why do you need to increase the vertical angulation? The child has a lower palatal vault so the film in not totally parallel with the tooth—it slides diagonally and so therefore requiring you to ADJUST the CONE AS WELL to compensate for this.

Why should you x-ray children? Detect disease (caries, periodontal disease) For congential abnormalities (anodontia, supernumerary teeth). Assess growth and development. Perform an Orthodontic evaluation. Evaluate 3rd molars. Diagnose pathological conditions (abscess or other infection). Evaluate of trauma (fall, other accident). My son was born with a congenitally missing right lateral. The buds were fused at birth.

What do the experts say about children’s first x-rays? American Academy of Pediatric Dentistry recommends first dental visit about 6-12 months of age. Too early for radiographs. Clinical exam only, unless they have had an accident, toothache or other unusual circumstance. Most doctors attempt to take x-rays at age 3 or 4.

When should you x-ray children? First radiographic survey not necessary until all primary teeth have erupted; about age 3. unless accident or trauma, or other unusual circumstances. Patient presents with high risk factors for caries (poor oral hygiene, inadequate fluoride exposure). 50% of decay might be missed w/o radiographs.

What size film should you use? Child’s age, size of oral cavity and cooperation level must be considered when determining size and type of films to expose. Size #0 and #1 usually used. Size #2 used on older children with erupted permanent 2nd molars. Size #0 on primary dentition Size #1 on transitional Size #2 on erupted 2nd molars (aka 12 yr molars)

How many x-rays should you take? One bitewing on each side prior to eruption of 2nd molars. After eruption of 2nd molars, two bitewings on each side are required. Advisable to expose four films on pts. when problems exist, 1 anterior occlusal on each arch, and 1 posterior bitewing on each side; pg. 311 Recall visits = 2 occl + 2 BW After 12 yr molar = 2 premolar BW + 2 molar BW

What is a Pedo FMX? See table 23-1 for considerations for choosing number and size of films to expose on the child patient. At age six, typical to expose 12 radiographs; 10 pa’s, 2 bitewings. Age 12 and over, full-mouth set (18 films; 14 pa’s, 4 bitewings)

When do you take a pano on a child? Panoramic radiograph may be necessary when intraoral radiographs can not be tolerated. Not very clear Not good for diagnosing decay in early stages. Good for viewing overall jaw development and eruption pattern. Usually well tolerated by children who can be still long enough.

Which technique do you use on children? Paralleling technique preferred for all patients. Using smaller film and smaller film holder, or modifying adult film holder can make acceptable radiographs on children. Vertical angulation may need to be increased due to shallow palatal vault. Film will lay flatter.

What are other considerations with kids? Bisecting technique useful when paralleling is not possible. Occlusal radiographs also useful; size #2 film can be used to expose occlusals on small children. Always use lead apron and thyroid collar; children very sensitive to radiation exposure. Less radiation required. Expose easiest films first, usually anteriors.

How should you communicate with children? Communication very important; always explain procedure so child understands. “Camera”, “Picture”, “superman cape”. If child too small to understand or hold film, parent or guardian should hold film (they should also be given lead apron to wear). Radiographer must never hold film!

How should you handle the child patient? Allow child to touch film and film holder to alleviate fear. Praise child for cooperation and good behavior. Place and expose film as quick as possible to avoid problems with restlessness and fidgeting. Begin with max. ant. Films b/c they are easier. Distraction techniques can help.