Pediatric Restorative Dentistry with Radiographs Dr. Ha T. Jacklynn Thai Board Certified Pediatric Dentist Associate Professor, University of California, San Francisco Department of Pediatric Dentistry HRSA Program: Pediatric Dentistry in Hygiene Dentistry 24700 Calaroga Ave. Suite 104 ~ Hayward, CA 94545 ~ 510.785.9295

Pediatric Radiography

Reimbursement of services Quantity Significance Diagnostic Aid Proper diagnosis Areas to be evaluated Safety Reimbursement of services Quantity Development Age Need

Significance The risk of under diagnosing vs. the radiation exposure Not all surfaces are visible to the naked eye It’s not just the teeth that need to assessed Periapical films BW films Panoramic film Cephalometric film

Safety Radiation Exposure Adherence of radiation safety protocols Dental x-rays are one of the lowest exposure of radiation dose Absorbed radiation is measured in units of millirem(mrem) In the United States, the average accumulated background radiation dose to an individual in a 1 year period is 620mrem Radiation itself is measured in units of millisieverts (mSv) Perspective 4 bitewings 0.4 mrem Chest xray 10 mrem CT scan of head 200 mrem CT scan of chest 700 mrem 5 hours transcontinental flight 2-5 mrem Banana 0.01 mrem 1 cup of Brazil nuts 0.016 mrem Living at high altitude for 1 year i.e. Denver, CO 50 mrem per year Source: National Council on Radiation Protection and Measurements (NCRP)

Other Common Day-To-Day Sources of Radiation Televisions with cathode ray tubes Flat screens do not have tube (1 mrem per year) Drinking water Sourced from rivers and lakes which pick up radiation from natural sources like the soil and rocks (5 mrem per year) Natural gas stoves (9 mrem per year) Cigarette smoking – quarter of a pack per day (1,300 mrem per year)

Reimbursement Access to care barriers

Quantity of Radiographs All primary dentition (baseline) Upper and lower anterior 2 BWs (size 0) Early mixed dentition (~6-8 years) Upper and lower anterior* 2 BWs (attempt size 2) Late mixed dentition (~8-12 years) 2 BWs (size 2) Panoramic Full permanent dentition (~13+ years) 4 BWs Isolated/focused areas Trauma areas

What You Don’t See With the Naked Eye

Film placement

Ectopic Eruption #3 6 years old

INVESTIGATE further when something looks suspicious

Cavity Control – Treatment Options Sealant Filling Amalgam Composite Pulpotomy/pulpectomy Crowns SSC Resin Zirconia Extraction With space maintainer Without space maintainer

Sealant Isolation Etch To bond or not to bond Sealant

Various options

Total Working Time: 3-5 min per tooth Sealant Placement Pumice/clean tooth – no fluoride products & rinse Isolation Air dry tooth Apply etch Explore Bond (?) Sealant application Explore vs. microbrush Cure Assessment/self-critique Check occlusion Total Working Time: 3-5 min per tooth

Clinical presentation

Broken, Defective, Displaced