Modern Dental Assisting - E-Book - (Patients with Special Medical Needs) PDF

Preview

Summary

Dental Assisting Lecturer's Notes, Central University Of Technology...

Description

660 PART EIGHT Radiographic Imaging

views necessary is based on the curvature of the arch and the number of teeth present in the posterior areas. The curvature of the arch often differs in the premolar and molar areas. If the curvature of the arch differs, it is impossible to open all the posterior contact areas on a single bitewing view. Consequently, two bitewing views are usually exposed on each side of the arch. Because the curvature of the arch differs in most adult patients, a total of four bitewing views are exposed: one right premolar, one right molar, one left premolar, and one left molar. The image receptor is positioned (with a bite tab or an image receptor–holding device) parallel to the crowns of both upper and lower teeth, and the central ray is directed perpendicular to the image receptor. The premolar bitewing image should include the distal half of the crowns of the canines, both premolars, and often the first molars on both maxillary and mandibular arches. The molar view should be centered over the second molars. See Procedure 41.5: Producing Four-View Radiographic Survey Using Bitewing Technique. 11 What is the purpose of bitewing images? 12 What horizontal angulation should be used for bitewing images?

 

Occlusal Technique

Copyright © 2017. Elsevier - Health Sciences Division. All rights reserved.

The occlusal technique is used to examine large areas of the upper or lower jaw. The occlusal technique is so named because the patient bites or “occludes” the entire film. In adults, size #4 intraoral film is used, but #2 film is used in children. The occlusal technique is used when large areas of the maxilla or mandible must be radiographed. See Procedure 41.6: Producing Maxillary and Mandibular Radiographs Using Occlusal Technique. Occlusal radiographs can be used for the following purposes: • Locate retained roots of extracted teeth. • Locate supernumerary (extra) unerupted or impacted teeth. • Locate salivary stones in the duct of the submandibular gland. • Locate fractures of the maxilla and mandible. • Examine the area of a cleft palate. • Measure changes in the size and shape of the maxilla or mandible.

• Do not ask personal questions about the patient’s disability. • Do offer assistance, for example, to push a wheelchair or direct a person who is blind. Often, a blind patient may prefer to hold your arm rather than having you hold the patient’s arm. • Do talk directly to the person with a disability. It is rude to talk to the caregiver instead of the patient. For example, instead of asking the caregiver, “Can Mrs. Jones get out of her wheelchair?” speak directly to Mrs. Jones.

Patients with Special Medical Needs Radiographic examination techniques often must be modified to accommodate patients with special needs. You must be prepared to alter your radiographic technique to meet the specific needs of the individual patient. A person with a physical disability may have problems with vision, hearing, or mobility. You must make every effort to meet the individual needs of such patients. In many cases, a family member or a caregiver accompanies the person with a physical disability to the dental office. You can ask this person to assist you with communicating or with the physical needs of the patient. You should be aware of common disabilities and the modifications necessary to assist patients who have such problems.

Vision Impairment If your patient is blind or visually impaired, you must communicate using clear verbal explanations. You must keep your patient informed of what you are doing and explain each procedure before performing it. You must never gesture to another person in the presence of a person who is blind. Blind persons are sensitive to this form of communication and perceive that you are “talking behind their backs.” 

Hearing Impairment If your patient is deaf or hearing impaired, you have several options. You may ask a caregiver to act as an interpreter, use gestures, or use written instructions. If the patient can read lips, you will need to remove your mask, face the patient, and speak clearly and slowly. 

Mobility Impairment

The basic principles of the occlusal technique follow: • The film is positioned with the white side facing the arch that is being exposed. • The film is placed in the mouth between the occlusal surfaces of the maxillary and mandibular teeth. • The film is stabilized when the patient gently closes on the surface of the film. 13 What size film is used for adults in the occlusal technique? 14 When are occlusal radiographs indicated?

Guidelines for Dental Treatment of Patients with Disabilities

 

If your patient is in a wheelchair and does not have use of the lower limbs, you may need to expose the necessary radiographs with the patient seated in the wheelchair (Fig. 41.25). If your patient does not have use of the upper limbs, and a holder cannot be used to stabilize the image receptor in the mouth, you may ask the patient’s caregiver to assist with holding the image receptor. This person must wear a lead apron and a thyroid collar during exposure of the images. In this case give the caregiver specific instructions on how to hold the image receptor or the patient. Remember, regardless of the situation, you must never hold an image receptor for a patient during an exposure. 

Bird Doni L and Debbie S Robinson Modern Dental Assisting - E-Book Elsevier - Health Sciences Division 2017 ProQuest Ebook Central

CHAPTER 41 Intraoral Imaging

Developmental Disabilities A developmental disability is a substantial impairment of mental or physical functioning that occurs before adulthood and lasts indefinitely. Examples of developmental disabilities include autism, cerebral palsy, epilepsy, and mental impairment. You must make every effort to meet the individual needs of the patient with a developmental disability. A person with a developmental disability may have problems with coordination or comprehension of instructions. As a result, you may have difficulties in obtaining intraoral images. If coordination or comprehension is a problem, mild sedation may be useful. It is important that you recognize situations in which the patient cannot tolerate intraoral exposures. Intraoral images should not be attempted in these patients; such exposure results only in nondiagnostic images and needless radiation exposure of the

661

patient. In patients who cannot tolerate intraoral exposures, extraoral images such as lateral jaw and panoramic x-rays may be used. 15 What physical disabilities may affect dental patients? 16 Under what circumstance would you hold a film sensor for a patient?

 

Patients with Special Dental Needs Dental images are indicated for a variety of patient needs. Often, you may need to modify the basic x-ray techniques to accommodate patients with special dental needs, including edentulous, pediatric, and endodontic patients.

Edentulous Patient Edentulous means “without teeth.” Dental images on edentulous patients may be required for the following reasons: • Detect retained root tips, impacted teeth, and lesions (cysts, tumors). • Identify objects embedded in bone. • Observe the quantity and health of the bone.

FIG. 41.25 X-rays can be taken with a patient sitting in his or her

Copyright © 2017. Elsevier - Health Sciences Division. All rights reserved.

wheelchair.

Radiographic examination of an edentulous patient may include a panoramic image (see Chapter 42), periapical images, or a combination of occlusal and periapical views (Fig. 41.26). Radiographic images must be taken in all areas of the arches, whether or not teeth are present. For edentulous patients, the bisecting or the paralleling technique may be used. Because no teeth are present, the distortion inherent in the bisecting technique does not interfere with diagnostic intrabony conditions. For partially edentulous patients, image receptor–holding instruments can be used by placing a cotton roll on the

FIG. 41.26 Mixed occlusal-periapical edentulous survey.

Bird Doni L and Debbie S Robinson Modern Dental Assisting - E-Book Elsevier - Health Sciences Division 2017 ProQuest Ebook Central...