Guidelines for Prescribing Dental Radiographs - Essay Example

Radiology Dental Radiographic Examinations. Presentation of Guidelines for prescribing Dental Radiographs. Akram khan Radiology Introduction: The branch of medical science known as radiology was born in the year 1895 by a German physicist Wilhelm Roentgen, accidentally while working in his lab. The X-rays extraordinary benefit to the medical science was immediately recognized and, with the research of French scientist Marie and Pierre Curie that followed Roentgen’s discovery, scientific an technologies advances and have led to the important role radiology plays today in the diagnosis and treatment of diseases. X-rays define Radiology as the medical specialty dealing with imaging. It is a branch of medicine concerned with X-rays, ultrasounds and other imaging techniques. Radiology is the study of images of the human body. Radiology is both a diagnostic and therapeutic tool. Radiology includes a number of different modalities, such as plain radiography, CT Scanning, magnetic resonance imaging, ultrasound, and nuclear medicine, to identify disease and other conditions within the Human body. Although radiology began with the use of X- rays and large flat sheets of photographic films, the modern radiologist now has a variety of tools for taking pictures of patients. Radiology interpretation is dependent on the ability to make observations and interpret them within a framework of knowledge. Radiographs are two-dimensional, images generated by the interaction of X-rays and the tissues, which depict variation in the types and nature of structure (influenced by atomic number, density and thickness), permanently recorded in the emulsion that is been supported by a plastic base. The first part of this statement is fact: as a complete statement, its truth is dependent on as series of procedure carried out correctly. Radiographs are been used to provide information that is not usually available by other means. A radiologist is a physician who has become a specialist in radiology –a medical doctor who has taken additional training in the interpretation of medical images. The observer requires certain skills: perceptual, descriptive ability, knowledge, experience, and some common sense. Each of these is important in recognizing radiological feature, ascribing a level of importance to the various finding in a single radiograph, and interpreting them, in conjunction with other available information. Knowledge of the clinical reason for requiring the radiographic investigation will provide background information to link with the radiological finding, and will often pose specific questions that need to be answer. It is important to decide if the question is been adequately answered, and if not plan the next stage of the investigation. Radiology is not limited for some uses; it is used in approximately all the field of treatment of diseases. Radiology is been used in Cardiology, Endocrinology, Gastroenterology, Hematology, Neurology, Renal, Skeletal, and Respiratory Medicine. In these fields different types of radiograph is been used for different fields such as for the complete scanning of brain, CT-scan is used and for the complete bodies a different type. The type of radiology, which is been used in the field of dental surgery, is either plain radiology or a different type, as plain radiology, shows limited evidence of pathology and the signs are subtle. We have to discuss about the usage of radiography in the field of dental surgeries, this can solve the problems regarding the present use of radiography in the dental field. We have to consider the standard guidelines and methods given by the Government organizations for overcoming the problems with radiography used for dental surgeries. About the Dental profession: As we, all know that the dental profession is committed to delivering the highest quality of care to each of its individual patient and applying advancement in technology and Science to improve the oral health status of the United State’s population. Radiographs can help the dental practitioner evaluate and definitively diagnose many oral disease and condition. These guidelines were developed to severe as an adjunct to the dentist’s professional judgment of how to use diagnostic imaging for each patient. However, the dentist must weigh the benefits of taking dental radiograph against the risk of exposing a patient to X-rays, the effect of which accumulate from multiple sources over time. Patients with poor personal dental health care will often have a higher incidence of Dental disease; this is an important factor in planning appropriate radiographic investigation, in particular will influence the timing review of radiograph for regular patient under the ongoing care of a single practitioner Radiography and the dental profession: The use of X-rays is an integral part of clinical dentistry, with some radiographic examination necessary on the majority of patients. As a result, radiographs are often referred to as the clinician’s main diagnostic aid. Radiography is been used since many years in the dental field. The range of knowledge of dental radiology thus can be required can be divided conveniently into four main sections 1. Basic physics and equipments- The production of X-rays, in their properties and interactions which results in the formation of the radiographic image. 2. Radiation protection- The protection of patients and dental staff from the harmful effects of X-rays. 3. Radiography-The techniques involved in producing various radiographic images. 4.Radiology- The interpretation of these radiographic images. The problem started when people discovered problems and diseases with the upper part of the body, due to Radiation as they were been exposed to some radiation for taking x-rays, for their treatment. To conquer these problems guidelines were first developed in 1987 by a panel of dental experts convened by the center for devices and Radiological Health of the U.S. Food and Drug Administration (FDA). The developments of the guidelines at that time were spurred by concern about the U.S. population’s total exposure to radiation from all sources. Thus, the guidelines were developed to promote the appropriate use of X-rays. The guidelines have served dentists and other interested parties well during the subsequent 15 years. In the year 2002, the American dental association recognizing that dental technology and science continually advances, recommended to the FDA that the guidelines be reviewed for possible updating. The FDA welcomed organized dentistry’s interest in maintaining the guidelines, and so the American Dental Association undertook this review. After reviewing the guideline by many organizations, the final draft was then submitted to the FDA for its consideration and was accepted in November 2004. These guidelines described the methods and ways of using radiography more safely so that patients are not effected by radiation. Radiography and other imaging modalities are been used to diagnose and monitor oral diseases, as well as to monitor dent facial development and the progress of therapy. These examinations can be performing using digital imaging or conventional film. Digital imaging may offer reduce radiation and the advantage of image analysis that may enhance sensitivity and reduce error introduced by subjective analysis. In addition, new imaging technology offers the possibility of 3-D visualizing of skeletal and other condition. The development and progress of many oral conditions is associated with a patient’s age, stage of dental development, and vulnerability to known risk factors. If, not appropriate management techniques should have to use after consideration of the relative risks and benefits for the patients. The dentist, knowing the patient’s health history and vulnerability to oral diseases, is in the best position to take decision in the interest of the patient. These guidelines includes about the horizontal axis of the matrix, patient age categories are been described, each with its usual dental development stage, child with primary dentition and transitional dentition and adults with permanent dentition and who are edentulous. Next is along the vertical axis, the types of encounter with the dental system are being categorized. The guidelines also included about the accidents in which new teeth’s are to fixed, this is also done accordingly to the age of the patient. Once a decision to obtain radiograph is made, it is the dentist’s responsibility to follow the ALARA Principle (As Low as Reasonably Achievable) to minimize the patient’s exposure to radiation. The amount of radiation striking the patient’s abdomen during a properly conducted radiographic examination is negligible. However, there is some evidence that radiation exposure to the thyroid during pregnancy is associated with low birth weight. Protective thyroid collar substantially reduce exposure to the thyroid during dental radiographic procedure. As every precaution should have to taken to minimize radiation exposure, protective thyroid collar, and aprons have to be used whenever possible. These practices must been strongly recommended for children’s, women of childbearing age, and pregnant women. The Guidelines: Guidelines for prescribing dental radiographs are with respect to the patient’s age and medical history and may not apply to every patient. Dentist should follow them only after the patient’s health history and completing a clinical examination. These guidelines are for new patient, Recall patient with clinical caries, Recall patient with no clinical caries, recall patient with periodontal disease, patient for monitoring of growth and development and patient with other circumstances. The FDA jointly with OCER (Office of communication, Education and Radiation Programs) updated guidelines again, the recommendation in this updated document provide the dentist with a strategy for ordering X- rays examination for patients seeking treatment while at the same time minimizing radiation exposure. The revised recommendation update information on newer technologies, update the scientific literature and terminology, describe the use of radiographs when assessing various types of patients and discussing the use of protective aprons when taking Radiographs. These revised recommendations are been developed to serve as an adjunct to the dentist’s professional judgments of how to best use diagnostic imaging for each patient. The clinical situations for which radiography is been indicated include but are not limited to be: a) Positive historical Findings and b) Positive clinical signs. Positive Historical Finding includes previous treatments, history of pain, familial history of dental anomalies, demineralization monitoring, and presence of implants or evaluation for implant placement. Positive Clinical signs include clinical evidence of periodontal disease, large or deep restoration, deep carious lesions, clinically influenced teeth, swelling, evidence of Dental/facial trauma, clinical erosion, unexplained bleeding, eruption, spacing, sensitivity of teeth, absence of teeth, facial asymmetry and positive neurological finding in the head and neck. Other factors increasing risk for caries may include but are not limited to: high level of caries experience, history of recurrent caries, high titers of cryogenic caries, poor oral hygiene, irregular dental care, drug/alcohol abuse, eating disorder, genetic abnormality of teeth and xerostomia. General guidelines on patient care- For intra oral radiography the patient should be positioned comfortably in the dental chair, ideally with the occlusal plane horizontal and parallel to the floor. For most projections the head should be supported against the chair to minimize unwanted movements. This upright positioning is assumed in subsequent chapters when describing radiographic techniques. However, some clinicians elect to X-ray their patients in supine positions along with most other dental surgery procedures. 1- All techniques need to be modified accordingly, but it can sometimes be more difficult to assess angulations and achieve accurate alignment of film and tube head with the patient lying down. 2- For extra oral views the patients should be reassured about the large, possibly frightening or unfriendly looking equipment, before being positioned within the machine. This is particular importance with children. 3- The procedure should be explained to the patients in terms they can understand, including warning them not to move during the investigation. 4- Spectacles, dentures or orthodontic appliances should be removed. Jewellery including earrings may also need to be removed for certain projections. 5- A protective lead thyroid collar, if deemed appropriate for the investigation being carried put, should be place on the patient. 6- The exposure factor on the control panel should be selected before positioning the intra oral film packets and X-ray tube head, in order to reduce the time of any discomfort associated with a discomfort associated with the investigation. 7- Intra oral film packets should be positioned carefully to avoid trauma to the soft tissues taking curve, e.g. the anterior hard palate, lingual to the mandibular incisor teeth and distolingual to the mandibular molars. 8- The radiographic investigation should be carried out as accurately and as quickly as possible, to avoid having to retake the radiograph and to lessen the patients discomfort. 9- The patient should always be watched throughout the exposure to check that he/she has obeyed instructions and has not moved. An important point to note that if dental clinicians are requesting other HCW’s (health care workers) to take their radiographs, either in hospitals or in general dental practice, it is their responsibility to ensure that these workers are made aware of any known medical problems or risks, e.g. epilepsy or other infections. The guidelines are been meant to guide the dentist’s so that they should not be any problems after surgeries but some controversies rose, as some dentists were not comfortable with these guidelines. The problems with the guidelines were, when low radiation is used to take a x-ray the X-ray was not clear enough to understand the problem and it was difficult for a doctor to cure the dieses. This problem was solved by revising the guidelines again. The above guidelines are to follow by the entire dentist’s for surgeries they do, for better results these guidelines are to be followed so that the patient does not complain about the problems with radiation. These guidelines are not easy to follow but the dentists have to be followed strictly while doing the surgery or before doing the surgery to avoid problems after surgery. Main infections of concern: Though these guidelines are followed strictly and many precautions are taken by the doctors and the person’s conducting the tests, some infections do occur in some cases, to the patient or to the doctor or to the persons who is conducting the tests. - Infective hepatitis caused by hepatitis B (HBV) or hepatitis C (HCV) viruses. The WHO estimates that of the 2 billion people that have been infected with HBV, more than 350 million have chronic (lifelong) infections. In the developing world, 8% to 10% of people in the general population become chronically infected. HBV is thought to be 50 to 100 times more infectious than HIV. The WHO estimates that 3% of the world’s population has been infected with HCV. - Human immunodeficiency virus(HIV disease and AIDS caused by HIV). - Tuberculosis (TB). The incidence of all forms of TB is rising and now approximately one- third of the world’s population is infected. Many of the people with active TB are also infected with HIV. - Cold sores caused by herpes simplex virus(HSV). HCW’s are at risk for getting herpetic whitlow, a painful finger infection. - Rubella (German measles). - Syphilis. -Diphtheria - Mumps - Influenza - Transmissible spongiform encephalopathy (TSEs), e.g. creutzfeldt- Jakob disease (CJD). Control of infection: In most of the countries, the health and safety at work statistic’s states that every person working in hospital or general practice (referred to as HCW’s) has a legal duty to ensure that all necessary steps are taken to prevent cross-infection to protect themselves, their colleagues and the patients. In addition, the management of health and safety regulations 1992 requires that a risk assessment is carried out for all procedures to reduce the possibility of harm to staff and patients. Effective infection control measures are therefore required in dental radiography even though most investigations are regarded as non-invasive or non-exposure prone procedures, because they do not involve breaches of the mucosa or skin. The main risk of cross-infection is from one patient to another from salivary contamination of work areas and equipment. HCW’s themselves are not great risk during radiography but there are no grounds for complacency. A throughout medical history should therefore be obtained from all the patients. How ever, the medical history and examination may not identify asymptomatic carriers of infectious diseases. Conclusion: In my view, a dentist must know the patient’s health history and Vulnerability to oral disease, is in the best position to make this judgment in the interest of each patient. For this reason, the guidelines are intended to serve as a resource for the practitioner and are not intended to be a standard of care, requirement, or regulations. A Dentist must always understand the problem of the patient and as per the guidelines; a dentist must perform his operation, so that the patient do not complain of any kind of problem in future. Based on the premise, the guideline can be used by the dentist to optimize patient care, minimize the total diagnostic radiation burden and responsibilities allocate health care resources. The guidelines are subjected to clinical judgment and may not apply be applied to every patient; they are to be used by dentists only after reviewing the patient’s health history and completing a clinical examination. Because every precaution should be taken to minimize radiation exposure, protective thyroid collar and aprons should be used whenever possible. This practice must have to strongly recommend for children’s, women of childbearing and pregnant women’s. In my view, these guidelines must be followed strictly, so that they are no problems in future. Read More