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  • 1. Dental Radiography Update Dental Radiography Update: Putting the Guidelines into Action Shaunda Clark, CDA, RDH, MEd
  • 2. Course Objectives
    • Identify the new FDA standards developed by ADA.
    • Recognize changes in the type and number of radiographs, leading to improved patient care.
    • Describe the concept of As Low As Reasonably Achievable.
    • Summarize how the new standards can increase the safety and efficacy of radiographs utilized in private practice.
  • 3. Recognizing New Procedures for Patient Protection
  • 4.  
  • 5. November 2004
    • FDA accepted updated guidelines for dental radiography to achieve ALARA as presented by ADA representing many dental professional organizations.
  • 6. What do these updated guidelines mean?
    • Very simply stated, treat each patient as an individual.
    • Expose patients to radiographs as needed to provide them comprehensive care.
    • Determine risk factors prior to exposing.
  • 7.  
  • 8. New Patients
    • Child with primary dentition
      • BW only if interproximal spaces cannot be viewed or probed
    • Child with transitional dentition
      • Add periapicals or panoramic to evaluate development
    • Adolescents
      • Because of increase in possibility of periodontal disease panoramic is recommended
  • 9.
    • Adult
      • Posterior bitewings, and selected periapicals or panoramic, a full-mouth series is preferred when the patient has evidence of disease or history of extensive treatment
    • Adult edentulous
      • Individualized exam based on clinical signs and symptoms
  • 10. Recall Patients
  • 11. Recall patients with increased risk for caries
    • Child or adolescent
      • Every 6-12 months
    • Adult dentate or partially edentulous
      • Caries risk assessment should determine frequency
      • Every 6-18 months
    • Adult edentulous
      • Radiographs should not be performed without evidence of pathology
  • 12. Recall patients with no increased risk for caries
    • Children with primary or transitional dentition
      • BW every 12-24 months
      • If proximal surfaces cannot be examined visually or with a probe
    • Adolescents
      • BW every 18-36 months
    • Adult
      • BW every 24-36 months
  • 13. Recall patient with periodontal disease
    • Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease.
    • May include BW and or periapical images of selected areas where periodontal disease can be identified clinically.
  • 14. Clinical situations for which radiographs may be indicated but are not limited to:
    • 1. Positive clinical findings
      • Previous treatment
      • History of pain or trauma
      • Familial history of dental anomalies
      • Etc….
    • 2. Positive clinical signs and symptoms
      • Clinical evidence of periodontal disease
      • Large or deep restorations
      • Deep carious lesions
      • Malposed or impacted teeth
      • Swelling
      • Etc……
  • 15. Factors increasing risk for caries may include but are not limited to:
    • High level of caries experience or demineralization
    • History of recurrent caries
    • High number of cariogenic bacteria
    • Poor quality of existing restorations
    • And the list goes on…….
  • 16. The concept of ALARA As Low As Reasonably Achievable
  • 17. What does it mean?
    • As Low As Reasonably Achievable
    • Try to stay as far below dose limits as possible
    • Be consistent with the purpose for which the activity is undertaken
    • Use procedures that require the least amount of radiation exposure possible to produce the greatest amount of data
  • 18. Protective Devices
    • Lead apron-not required if all other guidelines in 2004 report are followed rigorously
    • Thyroid Collars-provide for all children and for adults when it won’t interfere with examination
  • 19.
    • Collimation-Rectangular collimation should be used for periapical radiography and when feasible for bitewing radiography
  • 20. Another note on collimation….
    • Round cones can be adapted rather than replaced……
  • 21. Another thought…..
  • 22. Protective Devices
    • Cephalometric imaging-filters for imaging the soft tissues of the facial profile together with the skeleton should be placed at the x-ray source rather than at the image receptor, the x-ray beam should be collimated to the area of clinical interest
    • Sight development-should not be used
  • 23. Protective Devices
    • Image receptor (film speed)-use no speed slower than E speed
    • Shielding, barriers and dosimetry-shielding design should be provided by a qualified expert, operator should maintain visual contact with patient during exposure
    • Selection criteria-Dentist must examine their patients before ordering radiographs
  • 24. Office Radiation Protection Program
    • Have a written quality assurance protocol manual
    • Have equipment inspected by a qualified expert
    • Evaluate chemistry daily
    • Evaluate each type of film used monthly for fog or artifacts
  • 25.
    • Repair any defect found
    • Evaluate darkroom monthly
    • Visually inspect lead aprons monthly
    • Provide training to all x-ray personnel in radiation protection
  • 26. Improving Patient Care with ALARA
  • 27.  
  • 28. Patient A
    • 22 year old female
    • Recall patient-every 6 months
    • Negative medical history
    • Lives in a community with fluoridated water
    • Has had no previous dental restorations in permanent teeth
  • 29. When should BW radiographs be made?
    • A. Every 6 months
    • B. Every year
    • C. Every 2 years
    • D. None of the above
  • 30. Answer
    • C. Every two years
  • 31. Patient B
    • 5 year old male
    • New patient
    • Negative medical history
    • No obvious carious lesions
    • Interproximal surfaces can be easily viewed and explored
  • 32. What type of radiographs should be made?
    • A. 4 posterior periapicals and 2 BW
    • B. 4 BW
    • C. Panoramic
    • D. Radiographs are not indicated
  • 33. Answer
    • D. Radiographs not indicated
  • 34. Patient C
    • 36 year old male
    • Recall patient with sporadic appointments
    • Medical history indicates
      • Takes several RX medications that have dry mouth as a side effect
    • Poor diet, consumes sugared beverages regularly
    • History of extensive dental treatment of carious lesions
  • 35. When should bitewing radiographs be made?
    • A. Every 6-18 months
    • B. Every 24-36 months
    • C. When obvious lesions are present
    • D. None of the above
  • 36. Answer
    • A. 6-18 months
  • 37. Patient D
    • 74 year old female
    • New patient-in good health
    • Edentulous on maxillary
    • Partially edentulous on mandibular
    • Pt reports pain in maxillary right posterior
    • Expresses an interest to have a lower partial denture made
  • 38. Which of the following issues indicates the need to make radiographs?
    • A. Pain reported on maxillary
    • B. Interest in partial denture
    • C. New patient
    • D. A & B
  • 39. Answer
    • D. A & B
  • 40. Patient E
    • 46 year old male
    • Recall patient
    • Diagnosed with moderate chronic periodontitis
    • Probing depths have increased by 2mm generalized in the posterior
    • Patient has not had a full mouth series of radiographs since 2002
  • 41. Are radiographs advised at this time?
    • A. Yes
    • B. No
  • 42. Answer
    • A. Yes
  • 43. Sources
    • Perry, D.A., Beemsterboer, P.L., & Taggart, E.J.(2001). Periodontology for the dental hygienist. Philadelphia, PA: W.B. Saunders Company .
    • Iannucci-Haring, J. & Jansen, L. (2000). Dental radiography: Principles and techniques. Philadelphia, PA: W.B. Saunders Company .
    • DiGangi, P. (2006) ALARA: What does it mean? Contemporary Oral Hygiene, March 2006, 22-28.
    • Thompson, E.M. (2006) Radiation safety update. Contemporary Oral Hygiene, March 2006, 10-17.
  • 44. Sources
    • FDA website http://www.fda.gov/cdrh/radhlth/adaxray-1.html
    • Radiation Health in Dentistry
    • Procter & Gamble Website for Professionals
    • Continuing Education Section www.dentalcare.com
  • 45. To print 6 slides per page, when you click on the print button and get the print menu, where it says print what, change to handouts and select 6 per page. Print handouts for this lecture at www.iowadental.org
  • 46. Thanks for your attention!