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 Radiographic Techniques for Children Chapter 26

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 the key words.  State the basis for prescribing dental radiographs for children.  List the conditions that would indicate radiographs be taken on children.  Identify suggested exposure intervals for the child patient.

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  List the factors that determine the number and size of image receptors to be exposed on children.  List image receptor size and type suggested for use with primary dentition.  List image receptor size and type suggested for use with transitional (mixed primary and permanent) dentition.

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  Identify two types of extraoral radiographs that may be acceptable substitutes for children who cannot tolerate intraoral image receptor placement  Identify adaptations or modifications in standard paralleling and bisecting techniques that aid in radiographic procedures for children.

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 the role occlusal radiographs play in imaging children.  Appropriately adjust standard adult exposure settings to apply to children.

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 Objectives  Explain the roles that the patient management techniques show-tell-do and modeling play in assisting the radiographer with child patient management.  Interpret radiographs taken on children with primary and transitional (mixed primary and permanent) dentition.

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 Introduction  Children have the same basic needs for oral health care as do adults.  Radiographs play an important role in detecting disease and assessing growth and development for the child patient.

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 Introduction  Radiographic techniques and the types of projections used to image the oral cavity of the child patient do not differ significantly from those used for adult patients.  The child patient presents with unique characteristics such as a smaller oral cavity and behavioral considerations that often require adaptations to standard procedures.

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 Assessment of Radiographic Need  The indication to expose dental radiographs on a child patient is based on the individual needs of the patient.  Evidence-based selection criteria guidelines have categories for assessing children and adolescents as well as adults.

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 Suggested Exposure Intervals  American Academy of Pediatric Dentistry recommendation is that a child’s first professional oral examination be made within 12 months following the eruption of the first primary tooth, usually between 6 and 12 months of age.  Early prevention is key to preventing tooth loss and developing good oral self-care habits.

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 for Choosing the Number and Size of Image Receptor to Expose on the Child Patient

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 Image Receptor Sizes and Numbers and Types of Projections  Primary dentition  Transitional (mixed primary and permanent) dentition  Extraoral radiographs

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 26-1 Radiographic survey of primary dentition. One anterior occlusal radiograph in each arch and one posterior bitewing radiograph on each side. (Courtesy DP Gutz, DDS, University Nebraska Medical Center, College of Dentistry, Lincoln, NE.)

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 26-2 Radiographic survey of transitional dentition. Six anterior periapical radiographs (three on the maxilla and three on the mandible), one posterior periapical radiograph in each quadrant, and one posterior bitewing radiograph on each side.

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 Figure 26-3 Panoramic radiograph of a child with transitional dentition. Note the overall jaw development and eruption pattern of the teeth.

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 Figure 26-4 Lateral jaw extraoral radiograph being exposed on a child. The child holds the cassette that contains the extraoral film against the side to be imaged. The PID directs the x-ray beam under the chin up toward the cassette/film.

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 Figure 26-5 Modifying an image receptor holder biteblock for use with the child patient. (Thomson, E. M. (1993). Dental radiographs for the child patient. Dental Hygiene News, 6(4), 24, with permission from Procter & Gamble Company.)

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 Figure 26-6 Adaptation of film holders for use with the child patient. Using a bitewing bitetab as a periapical film holder. (Thomson, E. M. (1993). Dental radiographs for the child patient. Dental Hygiene News, 6(4), 24, with permission from Procter & Gamble Company.)

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 Figure 26-7 Slightly increasing the vertical angulation will image more of the unerupted developing permanent teeth and compensate for the child’s lower palatal vault.

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 26-8 Occlusal technique. Using a size #2 film to expose a maxillary occlusal radiograph.

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 TABLE 26-1 Recommended Techniques for the Child Patient if Radiographic Need Is Assessed

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 TABLE 26-1 (continued) Recommended Techniques for the Child Patient if Radiographic Need Is Assessed

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 TABLE 26-1 (continued) Recommended Techniques for the Child Patient if Radiographic Need Is Assessed

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 TABLE 26-1 (continued) Recommended Techniques for the Child Patient if Radiographic Need Is Assessed

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 ALARA Radiation Protection “As Low As Reasonably Achievable”

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 Patient Management  Show-tell-do  Modeling  Communication

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 Figure 26-9 Maxillary anterior occlusal radiograph of primary dentition exposed with size #2 film. (1) Primary canine. (2) Unerupted permanent lateral incisor. (3) Unerupted permanent central incisors—note that root formation has not started yet. (4) Thin radiolucent line indicating the median palatine suture. (5) Partially resorbed root of primary central incisor. (6) Primary central incisors. (7) Primary lateral incisor.

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 Figure 26-10 Mandibular anterior occlusal radiograph of primary dentition exposed with size #2 film. (1) Alveolar bone. (2) Partially erupted permanent central incisors. (3) Primary teeth. (4) Unerupted permanent lateral incisors.

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 Figure 26-11 Posterior bitewing radiograph of transitional (mixed primary and permanent) dentition (1) Primary maxillary canine, first and second molars. (2) Primary mandibular canine, first and second molars. (3) Permanent maxillary and mandibular molars. (4) Note that this small size film does not adequately image the area of the developing premolars.

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 Figure 26-12 Maxillary central-lateral incisors periapical radiograph of transitional (mixed primary and permanent) dentition (1) Primary lateral incisor. (2) Unerupted permanent central incisors. (3) Roots of primary central incisors showing signs of physiological resorption. (4) Primary central incisors.

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 Figure 26-13 Mandibular central-lateral incisors periapical radiograph of transitional (mixed primary and permanent) dentition (1) Unerupted permanent lateral incisor. (2) Caries on mesial surface of primary lateral incisor. (3) Permanent central incisors. (4) Large open apex on all permanent teeth, indicating that root formation is still in progress. Root formation is generally not complete until about two or three years following tooth eruption.

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 Figure 26-14 Maxillary canine periapical radiograph of transitional (mixed primary and permanent) dentition (1) Primary canine. (2) Unerupted first premolar. (3) Unerupted permanent canine still in a follicle as indicated by radiolucency surrounding the crown. (4) Permanent central incisor. (5) Permanent lateral incisor, which appears to be tipped distally and overlapping with deciduous canine.

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 Figure 26-15 Mandibular canine periapical radiograph of transitional (mixed primary and permanent) dentition (1) Primary lateral incisor. (2) Radiolucent areas on mesial and distal of primary canine. A visual examination is needed to determine if this indicates caries or restorative materials that mimic caries radiographically (see Chapter 21). (3) Primary first molar. (4) Unerupted first premolar. (5) Unerupted permanent canine. (6) Unerupted permanent lateral incisor.

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 Figure 26-16 Maxillary molar periapical radiograph of transitional (mixed primary and permanent) dentition (1) Permanent first molar. (2) Unerupted second premolar. (3) Unerupted first premolar. (4) Primary canine. (5) Primary first molar (note that the roots are almost completely resorbed). (6) Primary second molar.

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 Figure 26-17 Mandibular molar periapical radiograph of transitional (mixed primary and permanent) dentition (1) Unerupted first premolar. (2) Primary first molar with partial resorption of distal root. (3) Primary second molar. (4) Permanent first molar. (5) Unerupted second premolar.

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 Review: Chapter Summary  The child patient presents with unique characteristics such as a smaller oral cavity and special behavioral considerations that often require adaptations to standard procedures.

37. 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  Radiographs for the child patient may be indicated for the detection of congenital dental abnormalities, to assess growth and development, and to detect and diagnose diseases and the effect of trauma.  Most children react favorably to the authority of a confident, capable operator.

38. 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

39. 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 public health clinic where you have volunteered to work one day a week has just received funding to begin providing oral health care services to children. Currently the exposure times for radiographic projections posted near the x-ray unit control panels list only the following impulse times for adults.

40. 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  Based on what you learned in this chapter, design an exposure setting chart that lists the impulse timer settings that would be appropriate for children. Design your chart to include children of all ages: under age 10 and between the ages of 10 and 15. Current settings for adult patients are as follows:

41. 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

42. 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

43. 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