A Moment in Dental Science

April 1, 2009
X-ray vision for dental hygienists

X-ray vision for dental hygienists

1. Review the 2004 Guidelines and Patient Selection from ADA and U.S. Dept. of Health and Human Services: Print and discuss.

2. Remember your goal: Operate under ALARA (as low as is reasonably achievable) with regard to exposure. Retakes should be only taken for a valid clinical reason and not for improving esthetics or because digital is easy to take. When a patient needs assistance/reassurance, then a third party (not the clinician), such as family member, may be allowed to stay to assist, provided the individual is issued appropriate protective devices and instructed to stay out of the path of the primary beam (should not be pregnant or under the age of 18). Thyro-cervical shield protects the neck.

3. Fix those errors: With digital, many have gone the way of the extinct dodo bird (our fav is static electricity!), since technical ones often can be corrected to provide an optimal radiograph without retakes. Still, operator-caused errors can lead to less diagnosis from X-rays, so it is important to perform a chart audit to ensure quality (the most common errors were placement and horizontal angulation). May want to review radiology textbook for hints.

4. Maintain infection control: Aprons should be sanitized by misting with disinfectant and wiping surface and should not be contaminated during procedure. Sensors cannot be sterilized, so care needs to be taken to properly prepare, cover, and ensure that the barrier is not damaged. To prevent cross-contamination avoid direct saliva contact with the receptor and electrical cable.
The latest:

• Patient shielding equivalent aprons: Non-lead alloy aprons (at least 0.25 mm) are lightweight, able to be folded without creasing, and does not present a problem with disposal.

• Cone-beam computed tomography: Computer-generated imaging of hard tissues of maxillofacial region, providing three-dimensional representation of skeleton with minimal distortion; high diagnostic quality of resolution with short scanning time; and radiation dosages lower than computed tomography scans. Highly recommended for implant placement as well as pre- and postoperative endodontic procedures with cracked teeth, missing canals, and apical surgery.

Source: From Review of Dental Hygiene, 2nd edition, Saunders/Elsevier, 2009 (Fehrenbach, Weiner), available Dec. 2008.