1. 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 ~

2. Pediatric Radiography

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

4. 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

5. 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 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)

6. 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)

7. Reimbursement
Access to care barriers

8. 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

12. What You Don’t See With the Naked Eye

15. Film placement

16. Ectopic Eruption #3
6 years old

17. INVESTIGATE further when something looks suspicious

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

20. Sealant
Isolation
Etch
To bond or not to bond
Sealant

21. Various options

22. 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

23. Clinical presentation

24. Broken, Defective, Displaced