Transcript Dental Radiography Update 2005

Dental Radiography Update
Dental Radiography Update:
Putting the Guidelines into Action
Shaunda Clark, CDA, RDH, MEd
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.
Recognizing New Procedures for
Patient Protection
November 2004
• FDA accepted updated guidelines for
dental radiography to achieve ALARA as
presented by ADA representing many
dental professional organizations.
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.
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
• 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
Recall Patients
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
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
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.
Clinical situations for which
radiographs may be indicated but
are not limited to:
• 1. Positive clinical findings
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Previous treatment
History of pain or trauma
Familial history of dental anomalies
Etc….
• 2. Positive clinical signs and symptoms
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Clinical evidence of periodontal disease
Large or deep restorations
Deep carious lesions
Malposed or impacted teeth
Swelling
Etc……
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…….
The concept of
ALARA
As Low As Reasonably
Achievable
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
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
• CollimationRectangular
collimation should be
used for periapical
radiography and
when feasible for
bitewing radiography
Another note on collimation….
• Round cones can be adapted rather than
replaced……
Another thought…..
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
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
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
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Repair any defect found
Evaluate darkroom monthly
Visually inspect lead aprons monthly
Provide training to all x-ray personnel in
radiation protection
Improving Patient Care with
ALARA
Patient A
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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
When should BW radiographs
be made?
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A.
B.
C.
D.
Every 6 months
Every year
Every 2 years
None of the above
Answer
• C. Every two years
Patient B
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5 year old male
New patient
Negative medical history
No obvious carious lesions
Interproximal surfaces can be easily
viewed and explored
What type of radiographs
should be made?
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A.
B.
C.
D.
4 posterior periapicals and 2 BW
4 BW
Panoramic
Radiographs are not indicated
Answer
• D. Radiographs not indicated
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
When should bitewing
radiographs be made?
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A.
B.
C.
D.
Every 6-18 months
Every 24-36 months
When obvious lesions are present
None of the above
Answer
• A. 6-18 months
Patient D
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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
Which of the following issues
indicates the need to make
radiographs?
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A. Pain reported on maxillary
B. Interest in partial denture
C. New patient
D. A & B
Answer
• D. A & B
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
Are radiographs advised at this
time?
• A. Yes
• B. No
Answer
• A. Yes
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.
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
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for this lecture at
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Thanks for your attention!