1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Managing Patients with Special Needs Chapter 27

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives  Define key words.  Discuss five actions for managing the apprehensive patient.  Identify the areas of the oral cavity that are most likely to initiate the gag reflex.  List the two stimuli that commonly initiate the gag reflex.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives  Describe five methods to reduce psychogenic stimuli to control the gag reflex.  Describe four methods to reduce tactile stimuli to control the gag reflex.  Discuss ways to manage radiographic procedures for the older adult patient.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives  Discuss ways to manage radiographic procedures for the patient with motor disorders and conditions of involuntary movement.  Discuss ways to manage radiographic procedures for the patient with disabilities.  Explain necessary radiographs for the cancer patient.

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Objectives  Explain necessary radiographs for the pregnant patient.  Value the need for cultural sensitivity.

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Introduction  Each patient presents with unique characteristics.  The dental radiographer should be familiar with possible medical, physical, psychological, emotional, and cultural conditions that may require additional knowledge and skills to successfully produce diagnostic quality radiographs while practicing ALARA.

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson TABLE 27-1 Conditions Prompting Alterations to Radiographic Procedures

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson The Apprehensive Patient  Develop a rapport  Project confidence  Maintain authority  Be organized  Reassure the patient

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson A Hypersensitive Gag Reflex  Reducing psychogenic stimuli  Do not suggest gagging  Empathize  Use of power of suggestion  Apply distraction techniques  Give the patient breathing instructions

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 27-1 Distraction techniques. To help control a gag reflex, this patient has been given an exercise to bend and straighten her index finger. She has been instructed to keep a steady motion while continuing to watch her finger.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson A Hypersensitive Gag Reflex  Reducing tactile stimuli  Begin exposures in the anterior region first  Place the image receptor firmly and expertly  Use the bisecting technique  Confuse the senses  Use special products  Extreme cases of the gag reflex

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 27-2 Edge protectors. Applying a commercial product to reduce the edge sharpness of the film packet.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 27-3 Edge protectors. Film is available with commercially applied edge softeners.

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Aging  Normal changes in the body due to aging do not necessarily mean that all older adult patients will present with unique conditions that require alterations in the radiographic procedure.  The dental radiographer should be aware that there is an increased incidence of conditions and diseases that are seen with aging.

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Aging  It is important to communicate with the older adult patient to ensure that they can follow instructions for a successful outcome to the radiographic procedure.

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson TABLE 27-2 Suggested Exposure Times When Changing the mA Setting* for Adult Patients

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Disabilities  Talk directly to the patient  Offer assistance to disability patients  Do not ask personal questions about the patient’s disability

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Disabilities  Wheelchair-bound patient  Visually impaired patient  Hearing impaired patient

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 27-4 Panoramic unit that can accommodate wheelchair-bound patients. (Courtesy of Planmeca.)

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Figure 27-5 Example of signing. The radiographer is letting this hearing-impaired patient know that she is doing a good job cooperating with the radiographic procedure. (A) Right hand on chin. (B) Drops to left hand open palm. Communicating “Good patient.”

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Cancer  There is often a concern whenever the necessity arises to expose dental radiographs on any patient who is currently receiving or has recently undergone radiation therapy.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Cancer  Although the patient may already have received large therapeutic doses of radiation, this is not a contraindication to exposing dental radiographs provided that they are deemed necessary to make an oral diagnosis.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Pregnancy  Research has linked dental x-ray exposure with low birth weights  The American Dental Association (ADA) recommends that necessary dental radiographs be exposed on pregnant females and elective dental x-rays be postponed until after delivery.  Thyroid collar use strongly recommended

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson The Culturally Sensitive Radiographer  The diversity of culture in today’s global society means that the radiographer is more likely to find him/herself performing radiographic examinations on patients of a variety of racial, ethnic, and cultural backgrounds.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson The Culturally Sensitive Radiographer  Educating these patients regarding the role radiographs play in the diagnosis and treatment of oral diseases requires that the radiographer be aware of possible cultural barriers, such as language, beliefs, traditions, and familial influences.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson The Culturally Sensitive Radiographer  Communication style  Comfortable personal space zone  Gestures and body language

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Review: Chapter Summary  The dental radiographer must be competent in altering procedures to meet the needs of individual patients.  To help manage apprehension, the dental radiographer should develop a rapport with the patient, project confidence, maintain authority, be organized, and reassure the patient throughout the procedure.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Recall: Study Questions  General  Chapter Review

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study  You have just greeted your patient in the reception area, introduced yourself, and asked her to follow you to the operatory, where you will be taking a full mouth series of radiographs. Once seated, you notice that the patient appears apprehensive. As you get ready to begin the procedure, you engage her in a conversation to assess why she appears so nervous.

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study  The patient eventually tells you that her last experience taking radiographs could not be completed because she experienced a gagging problem. She states that she was so embarrassed by it that she never went back to that practice.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 1.Explain how you would respond to this patient. Include how you would develop a rapport, project confidence, and maintain authority.

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 2.Prepare a conversation with this patient where your responses reassure her about your ability to perform the procedure; how the procedure today can be different than her past experience; and what techniques you have to help her control the gag reflex.

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 3.Answer the following questions: a.Why should you not tell this patient that gagging is all in her mind? b.Which film packet (what area of the oral cavity) should you try placing first, and why? c.What is the purpose of thanking and praising the patient for her cooperation with the procedure? d.What is the difference between psychogenic and tactile stimuli? Give an example of each.

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Reflect: Case Study 3.Answer the following questions: e.What is the purpose of asking the patient to do breathing exercises during radiographic exposures? f.What is the purpose of rinsing with ice water or placing salt on the tongue? g.If you use any of these tricks and techniques, why is it best to tell the patient what trick you are planning to use?

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition Evelyn M. Thomson Orlen N. Johnson Relate: Laboratory Application