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Patients With Special Needs

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Gagging

• The term “gagging” refers to the strong involuntary need to vomit.

• The gag reflex can be defined as retching that is elicited by stimulation of the sensitive tissues of the soft palate area.

• The gag reflex is a protective mechanism which serves to clear the airway of obstruction.

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Gagging

• ALL patients have a gag reflex. • It is important to remember that it is a more

exaggerated reflex in some than in others.• But is IS a REFLEX, and not a fault of the

patient.

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How the Gag Reflex works

• Before the gag reflex is initiated, the following two reactions occur:– Cessation of respiration– Contraction of the muscles of the throat and

abdomen

• Precipitating factors for initiation of the gag reflex include:– Psychogenic Factors– Tactile Stimuli

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Patient Management

• Operator attitude• Patient and Equipment Preparations• Exposure Sequencing• Receptor Placement and Technique

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Operator Attitude

• Convey a confident attitude• Demonstrate:– Patience– Tolerance – Understanding

• EXPLAIN the imaging procedures, and then COMPLIMENT the patient as each exposure is completed.

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Patient and Equipment Preparations

• Limit the amount of time that the receptor stays in the mouth. (Move it, or they WILL lose it!)

• When patient and equipment preparations are completed before receptor placement, valuable time is saved, and the likelihood of stimulating the gag reflex is reduced.

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Exposure Sequencing

• Always begin with the anterior exposures, as you have been taught.

• With posterior exposures, always expose the premolar exposures before the molar exposures, as you have been taught.

• THE MAXILLARY MOLAR EXPOSURE IS THE MOST LIKELY EXPOSURE TO INITIATE THE GAG REFLEX.

• In a patient with a hypersensitive gag reflex, these two exposures should come last

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Receptor Placement and Technique

• To avoid stimulating the gag reflex, each receptor must be placed and exposed as quickly as possible.

• DO NOT SLIDE THE RECEPTOR ALONG THE PALATE.

• Demonstrate film placement• If a patient does gag, remove the film as

quickly as possible.

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Extreme Cases of Gag Reflex

• Occasionally the dental radiographer encounters a patient with a gag reflex that is uncontrollable.

• Here, we resort to EXTRAORAL images such as a Pan or a lateral jaw image.

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Patients With Disabilities

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Special Needs

• A disability can be defined as “a physical or mental impairment that substantially limits one or more of an individual’s major life activities”.

• The DA must be prepared to modify imaging techniques to accommodate persons with disabilities.

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Physical Disabilities

• Vision– Use clear verbal explanations– Explain each step before performing it

• Hearing– May ask caregiver to act as interpreter– Use gestures or sign language– Use written instructions– If patient can lip read

• Speak slowly, clearly and FACE THE PATIENT!

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Physical Disabilities

• Mobility Impairment– When there is a loss of use of the lower limbs

• Ask patient how they would like to be transferred to the dental chair

• DA may offer to assist• Caregiver may assist• Patient may do on their own

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Physical Disabilities

• Mobility Impairment– If there is a loss of use of the upper limbs, and

the use of a beam alignment device cannot be used, the DA may ask the caregiver to assist with holding the receptor.

– If so, the caregiver MUST wear a lead apron also.– Give caregiver specific instructions on how to

hold the receptor– DA must never hold a receptor for a patient

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Physical Disabilities

• Remember, extraoral images are always an option.

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Developmental Disabilities

• A developmental disability is “a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration”.

• Examples include:– Autism– Cerebral palsy– Epilepsy– Mental retardation

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Developmental Disabilities

• Here, there may be problems with coordination and comprehension of instructions.

• With coordination issues:– Mild sedation may be effective

• With comprehension issues:– Caregiver may be asked to assist

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Developmental Disabilities

• There are some situations where intraoral exposures cannot be tolerated by the patient.

• In such cases, no intraoral exposures should be performed because – They will only result in non-diagnostic images– This would result in needless exposure of

radiation to the patient.– Turn to page 293 of your texts for Helpful Hints

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The Pediatric Patient

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Pediatric Patient

• Pediatrics is the branch of dentistry dealing with the diagnosis and treatment of dental diseases in children.

• When treating the Pediatric Patient the dental radiographer must be aware of :– Prescribing of dental images– Patient and equipment preparations– Recommended techniques– Patient management

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Prescribing Dental Images

• Based on individual needs based on the age of the child and their ability to cooperate during the procedure

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Patient and Equipment Preparations

• Explanation of the procedure– tubehead = camera– Lead apron = winter coat– Image = picture of their teeth

• Lead apron– As with all patients, a lead apron with a thyroid

collar must be placed on all peds patients.

• Exposure factors• Receptor size

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Patient and Equipment Preparations

• Exposure factors– Reduction of mA, kVp and exposure time– Reduced exposure time is preferred because a

shorter exposure time will reduce the chance of a blurred image if the child moves

• Receptor size– Primary dentition – size 0– Transitional dentition – size 1 or 2– Use size 2 for occlusal exposures

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Bite-wings on a 6 ½ year old- Size 1 film

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Panoramic Film- How Old??

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Recommended Techniques

• Turn to page 294, Table 24 – 1 for recommendations on dental imaging examinations of the Pediatric Patient.

• Bisecting Angle technique is often preferred because of the small size of the mouth and hence no depth of palate.

• Turn to page 294 for Helpful Hints with the Pediatric Patient

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The Endodontic Patient

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Endodontic Patients

• Endodontics is the branch of dentistry concerned with the diagnosis and treatment of diseases of the pulpal tissues of the tooth.

• Challenges arise with the placement of the film during endodontic procedures because of the rubber dam, clamp, etc.

• Use of a special film holder (Endo-ray film holder) may be helpful.

• Hemostat may also be used.

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The Edentulous Patient

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Edentulous Patients

• The edentulous patient requires a dental imaging examination to :– Detect the presence of root tips, impacted teeth

and lesions (cysts and tumors)– Identify objects imbedded in the bone– To observe the quality and quantity of bone that

is present

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Edentulous Patients

• The panoramic image is the most common way of examining the edentulous jaw.

• If a panoramic machine is not available, 14 periapical projections (6 anterior and 8 posterior) can be used to examine the edentulous arches.

• Generally, the #2 size film is used• If the paralleling technique is used, cotton

rolls must be placed on the bite block in place of the missing teeth

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Edentulous Patients

• If the paralleling technique is used, cotton rolls must be placed on the bite block in place of the missing teeth

• If the bisecting angle technique is used the receptor should be positioned so that approximately 1/3 of it extends beyond the edentulous ridge.