DENTAL RADIOLOGY RELATED TO PEDODONTICS

Dr Sunny PurohitDept. of PEDIATRIC & PREVENTIVE DENTISTRY

SDCH

Introduction

• Wilhelm Conrad Roentgen's - x-ray in 1895• Early diagnosis of caries- prevents dental pain,

extraction, and emotional stress, • eruptive or developmental problems may

reduce the need for prolonged orthodontic procedures

• Some restorative procedures require an accurate registration of the pulpal outline that only a radiograph can reveal

Interesting Fact!Bertha’s Hand

X rays- “x” algebraic designation of unknown

Dr Otto Walkhoff-1896-First X ray Radiograph

a

bc

a : enamel

B : dentin

C : pulp

Lamina dura:It is a thin radio-opaque Layer Of dense bone surrounding the Tooth socket.

It is thicker than the surrounding Trabecular bone and thickness Increases with increase in amount In the occlusal stress

Alveolar crest

The gingival margin of theAlveolar process that extendsBetween the teeth isApparant on radiographsAs radiopaque line calledAlveolar crest.

It is considered as normal If it is not > than 1.5 mm From cej of adjacent teeth.

Ideal technique

• should expose the patient to a minimum amount of radiation,

• few radiographs as possible,• Take as little time as possible, and • provide a diagnostically accurate examination

of the dentition and sup-porting structures

Intraoral film size

• Size 0 - Used for bite wing and IOPA of small children

• Size 1 - Used for anterior teeth in adults • Size 2 - Standard film, used for anterior

occlusal, IOPA and bite wing in mixed and permanent dentition

• Occlusal films - 57 x 76mm used for maxillary or mandibular occlusal radiographs

Intraoral Periapical (IOPA) Radiographs

Indications:• To evaluate the development of the root end and to

study the periapical tissue • To detect alterations in the integrity of the periodontal

membrane • To evaluate the prognosis of the pulp treatment by

observing the health of the periapical tissues • To identify the stage of development of unerupted teeth • To detect developmental abnormalities like

supernumerary, missing or malformed teeth

Contd.

Indications:• For early detection of pathologic changes

associated with teeth • For space analysis in the mixed dentition • To assess the path of eruption of permanent

teeth • To evaluate the extent of traumatic injuries to the

root and alveolus

Radiographic techniques commonly used in children

Intraoral • lOPA • Bite wing –Proximal Caries• Occlusal –Sialolith etc…

Extraoral • TMJ and lateral oblique view• Lateral cephalograms, PNS view • Orthopantomography

Bitewing Xray

Occlusal Radiograph

Panoramic Radiographs

• It is an extra oral radiograph in which the X-ray film and the X-ray source move in opposite directions.

• It can be used to visualize the entire dentition. • This reduces the total number of films and thus

reduces the radiation exposures. • This can also be used to introduce the child to

radiography as it is an extraoral radiograph.

Contd.

• It requires a total of 15 to 22 seconds to record. • Although it is considered as a supplement it

cannot substitute intraoral radiographs in the diagnosis of caries or for viewing the periapical region.

• This view can be useful in handicapped children and for viewing a wide area of the TMJ and associated region.

Panoramic Radiographs

Localization Technique(SLOB)

localizing embedded or unerupted teethuses the buccal object rule, which states that the imageof any buccally oriented object appears to move in theopposite direction from a moving x-ray source. On theother hand, the image of any lingually oriented objectappears to move in the same direction as a moving x-raysource

Horizontal angle of the x-ray tube isshifted posteriorly, the canine appears to move anteriorly. Thecanine lies buccal to the erupted teeth.

Radiographic examinations

Four film series: This series consists of a maxillary and mandibular occlusal radiographs and two posterior bitewing radiographs.

Radiographic examinations

Eight film survey: • This survey includes a maxillary and

mandibular anterior occlusal radiographs.• Four molar periapical radiographs.• Two posterior bitewings

Radiographic examinations

Twelve film survey: • This survey include maxillary and mandibular

permanent incisor periapical radiographs.• Four primary canine periapical radiographs.• Four molar periapical radiographs.• Two posterior bitewing radiographs

Twelve film survey

Radiographic examinations

Sixteen film survey: This examination consists of the twelve-film survey and the addition of four permanent molar radiographs.

Child's Cooperation

• Child's cooperation is as essential to radiographic examination as is the selection of correct radiographic technique. Both increase the probability of success and reduce additional radiographic exposure.

• Dental radiographic equipment can be threatening or can generate curiosity, depending on the child

What is this ?

Management of Pediatric Paient• Euphenisms-Camera• TSD-Tell Show Do• In the child less than three years of age it may be

necessary for the child to sit in the parent’s lap while the radiograph is exposed.

• Obtaining the least difficult radiograph first (such as an anterior occlusal) desensitizes the child to the procedure.

• Correct settings are made on the apparatus and the x-ray head is properly positioned before placing the film in the child’s mouth.

• Positioning the radiograph vertically in the mouth for both periapical and bitewing radiographs reduces the distal extension of the radiograph and may result in greater tolerance by patients, especially those with a mild gag reflex.

• The vertical bitewing radiograph provides greater detail of the periapical area.

Positioning the Radiograph

• The Snap-A-Ray is also useful for those patients that have a fear of swallowing the radiograph.

• By biting on the large positioning device and watching in a mirror they are assured they will not swallow the radiograph.

Contd.

• Desensitization is defined as gradually exposing the child to new stimuli or experiences of increasing intensity.

• An example of this is introducing the patient to x-rays by initially taking an anterior radiograph which is easier to tolerate than a posterior radiograph.

Desensitization Techniques

• Another example of desensitization is the “Lollipop Radiograph Technique.” The child is given a lollipop to lick (preferably sugarless).

• After a few licks, the lollipop is taken from the child and a radiograph is attached to the lollipop using an orthodontic rubber band. The lollipop with the attached film is returned to the child, who is told to lick the lollipop again.

• After a few licks, the child is told to hold the lollipop in his mouth while we take a tooth picture. The exposure is made.

Contd.

Modeling

Special technique for the handicapped child

• The physically handicapped child cannot usually hold a film in his\her mouth with fingers.

• In such a child radiograph can be taken by the parent holding the child or by the use of film holding devices.

• If the child is unable to open the mouth, extra oral radiographs such as oblique lateral radiograph should be preferred.

Radiation Effects

• x-radiation is its ability to impart some of its energy to the matter it traverses.

• If that matter is living tissue, then some biologic injury may occur

effects of low levels of x-radiation (as used in diagnostic radiology) on biologic systems are virtually unknown

• 3 primary biologic effects of low-level radiation: • (1) carcinogenesis,• (2) teratogenesis (malformations), and (3) mutagenesis.• Carcinogenesis and malformations are a response ofsomatic tissues and in most instances are believed tohave a threshold response; that is, a certain amount ofradiation is necessary before the response is seen.• Mutation may occur as a response of genetic tissue (gonads)

to x-radiation and is believed to have nothreshold. In general, younger tissues and organs aremore sensitive to radiation

Critical organs and theassociated adverse biologic effects

(1)The skin (cancer), (2) Red bone marrow (leukemia),(3) The gonads (mutation, infertility, and fetal

malformations),(4) The eyes (cataracts), (5) The thyroid (cancer), (6)The breasts (cancer), And (7) possibly the salivary glands (cancer

• Proper registration and maintenance of radiographic units

• Training of personnel who are associated with radiography

• Dosage monitoring

• Radiation protection of the child patients

by using lead apron with thyroid collar.

Radiation hygiene measures

• Use of long lead-lined cylinder and cone positioning devices

• Use of electronically controlled exposure timer

• Use of high speed films

• Use of automatic processing machines that give good consistent result

• Employing proper technique to avoid the chances of repeating exposure.

High Speed Films

• Faster film speeds have contributed most significantly

to the reduction in radiation to the patient. Film• speeds of the "D," "E," and "F" groups are

currently available for intraoral radiography. • Faster film also reduces error from patient

movement

Guideline on Prescribing Dental Radiographs for Infants, Children, Adolescents, and Persons with Special Health Care Needs• AAPD

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