Patients With Special Needs

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.

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.

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

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

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

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.

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

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.

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.

Patients With Disabilities

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.

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!

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

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

Physical Disabilities Remember, extraoral images are always an option.

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

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

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

The Pediatric Patient

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

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

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

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

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

Panoramic Film- How Old??

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

The Endodontic Patient

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.

The Edentulous Patient

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

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

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.