1. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chapter 24 Imaging of Patients with Special Needs

2. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2 Dental Radiography  Questions  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?

3. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 3 Dental Radiography  Chapter 24 Reading  Iannucci & Howerton (pp. 290-299)

4. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 4 Dental Radiography  Chapter 24 Outline  Imaging of Patients with Special Needs  Patients with the gag reflex  Patients with disabilities  Patients with specific dental needs

5. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 5 Introduction  Iannucci & Howerton (p. 290)  Purpose  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

6. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 6 Patients with Gag Reflex  Patient Management  Extreme Cases of Gag Reflex  Helpful Hints

7. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 7 Patients with Gag Reflex  Gagging  The strong involuntary effort to vomit  Gag reflex  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  Originating in the mind  Tactile stimuli  Originating from touch

8. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 8 Patient Management  Iannucci & Howerton (p. 291)  Operator attitude  Patient and equipment preparations  Exposure sequencing  Receptor placement and technique

9. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 9 Operator Attitude  Iannucci & Howerton (p. 291)  The dental radiographer must convey  A confident attitude  Patience, tolerance, and understanding  The dental radiographer should explain the radiographic procedures about to be performed.

10. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 10 Patient and Equipment Preparations  Every effort should be made to limit the amount of time that a receptor remains in the mouth.  When preparations are completed before receptor placement, valuable time is saved, and there is less likelihood of stimulating the gag reflex.

11. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 11 Exposure Sequencing  Start with anterior exposures.  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.

12. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 12 Receptor Placement and Technique  Avoid the palate.  Do not slide the receptor along the palate.  Firmly bring the receptor into contact with palatal tissues using one decisive motion.  Demonstrate receptor placement  Rub a finger along the tissues near the intended area of receptor placement.  Tell the patient, “This is where the receptor will be positioned.”

13. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 13 Extreme Cases of Gag Reflex  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.

14. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 14 Helpful Hints  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

15. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 15 Patients with Disabilities  Physical Disabilities  Developmental Disabilities  Helpful Hints

16. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 16 Patients with Disabilities  Iannucci & Howerton (p. 292)  Disability  A physical or mental impairment that substantially limits one or more of an individual’s major life activities

17. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 17 Physical Disabilities  Vision impairment  Hearing impairment  Mobility impairment

18. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 18 Developmental Disabilities  Iannucci & Howerton (pp. 292-293)  Developmental disabilities are “a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration.”  May have problems with coordination or comprehension of instructions.  In patients who cannot tolerate intraoral receptor exposure, extraoral exposures may be used.

19. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 19 Helpful Hints  Iannucci & Howerton (p. 293)  Do not ask personal questions about a disability.  Do offer assistance.  Do talk directly to the person with a disability.

20. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 20 Patients with Specific Dental Needs  Pediatric Patients  Helpful Hints  Endodontic Patients  Edentulous Patients

21. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 21 Pediatric Patients  Iannucci & Howerton (pp. 293-295) (Figs. 24-1 through 24-5)  Pediatrics  The branch of dentistry dealing with the diagnosis and treatment of dental diseases in children  The dental radiographer must be aware of  Prescribing of dental images  Patient and equipment preparations  Recommended techniques  Patient management

22. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 22 Prescribing of Dental Images  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

23. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 23 Patient and Equipment Preparations  Explanation of the procedure  Lead apron  Exposure factors  Receptor size

24. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 24 Recommended Techniques  Iannucci & Howerton (pp. 293-294) (Table 24-1)  In children with a primary or transitional dentition, the bisecting technique is preferred.  The bite-wing and occlusal techniques are also used in pediatric patients.

25. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 25 Helpful Hints  Iannucci & Howerton (pp. 294-295)  Be confident.  Show and tell.  Reassure the patient.  Demonstrate behavior.  Request assistance.  Postpone the examination.

26. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 26 Endodontic Patients  Iannucci & Howerton (pp. 295-296)  Endodontics  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.  A series of exposures is used to evaluate the tooth before, during, and after treatment.

27. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 27 Endodontic Patients  Receptor placement  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  The paralleling technique should be used whenever possible.

28. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 28 Edentulous Patients  Iannucci & Howerton (p. 296)  The edentulous patient may require a dental imaging examination:  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

29. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 29 Edentulous Patients  Iannucci & Howerton (pp. 294-298) (Figs. 24-6 through 24-9)  Panoramic examination  The most common way of evaluating the edentulous jaw  Periapical examination  Used if a panoramic machine is not available  May be used as a follow-up to the panoramic examination  Occlusal and periapical examination