Unit Four handout
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Unit Four
DIAGNOSTICS IN DENTISTRY
Objective One: Discuss various methods used in the dental office to diagnose oral conditions.
Examination and Diagnostic techniques
Visual evaluation
A visual examination allows the dentist to determine an overall assessment of the type of dental care the patient has previously received as well as the current conditions that have not been treated. Examined areas include: face, lymph nodes, temporomandibular joints, neck, lips , soft oral tissues, tongue, restorations and missing teeth. Palpation
The examiner uses his or her fingers to feel the texture, size and consistency of the hard and soft tissue.
Instrumentation Specialized instruments allow a dentist or dental hygienist to further evaluate areas that were first examined visually . These instruments include a mirror and explorer and a periodontal probe.
The mirror and explorer are used to help to detect carious lesions as well as evaluate existing restorations. Periodontal probing is a technique used to assess the gingival sulcus in an assessment for periodontal disease. Digital Imaging
Digital Imaging in dentistry is the use of computer controlled components such as digital photography and digital radiography to assess caries, periodontal disease, occlusion, provide patient education and assist with laboratory and clinical dentistry.
Objective two. Briefly describe: the dental record, examination and diagnostic techniques with a focus on Dental Imaging. (Orthodontic diagnostic records will be discussed in a future unit)
The dental record, whether paper or digital, contains a patient’s personal information, financial information such as billing and insurance and health information . The clinical examination and recall examination are detailed records showing the past restorations and procedures and all the current oral conditions. Extraoral and
intraoral Photography can be used in pre-treatment and post-treatment records. Records that can be used in patient education, progress notes and as an adjunct to insurance predeterminations.
Dental radiography and digital radiography
a) Diagnostic - radiographs and digital images can detect the conditions of the teeth and bones that cannot be identified clinically.
b) Preventive - radiographs can minimize and prevent problems from developing or progressing and lead to less invasive procedures. It is important that the prescription of radiographs be patient specific.
c) Administrative - images may need to be sent to insurance companies for a pre-determination of dental treatment to establish a patient's coverage.
d) Client/Patient - an intra-oral camera, for example, may be used to show a patient intraoral condition that they may not be aware such as the breakdown of a large restoration and the need for a crown. Digital images are helpful in educating our patients since these images can be seen on a computer screen and can be enlarged or enhanced for better viewing. Digital images are also useful in cosmetic dentistry to show examples of treatment outcomes ie. before and after photos
e) Treatment planning - for example, an orthodontist uses panoramic and cephalometric radiographs as
well as photographs as initial records to determine the course of treatment. Bitewing radiographs may be used to determine the extent of penetration of a carious lesion to establish whether treatment will be a restoration or
if a root canal is required.
f) Forensic Records - dental records, including radiographs are sometimes used for identification purposes.
Objective three. Outline the responsibility of the dental office administrator involving dental images.
As a Dental Office Administrator, it is important to have an understanding of radiation, quality assurance, infection control, government regulations and its biological effects. This will enable you to respond confidently to questions or concerns your clients have regarding radiation either prior to or following treatment.
Possessing the skills to competently process and mount x-rays, identify radiographs, or carry out quality assurance procedures enhances the value you bring to the dental office.
Responsibilities may include:
sending radiographs to insurance companies for estimates (called predeterminations) for proposed treatments
sending radiographs to other offices (specialists) for client treatment
ie. orthodontist, endodontist, or oral surgeon
obtaining patient consent for the transfer of such records
duplicating radiographs
mounting of radiographs
assist with processing procedures
maintenance of the automatic processor - cleaning and replenishing the solutions (if the office has analogue radiography)
carry out quality assurance procedures ie. step wedge tests, maintaining records regarding daily # of exposures, and temperatures of solutions
monitoring of regular maintenance checks of x-ray machines (yearly check)
responsible for operator dosimeter badges - measures amount of radiation that reaches the radiographer, checked 4x/year –shows occupational exposure
Objective four. Discuss HARP and how it relates to dental personnel and office procedures.
What is HARP?
Healing
Arts Radiation
Protection
To promote and ensure the safety of all persons (operator & client) involved in the use of x-rays and the healing arts.
HARP is an x-ray safety legislation that was passed in 1980 and implemented in 1985. It is responsible to legislate that every office carries out an effective quality assurance program; regulates the approval of training courses and outlines responsibilities of the owner, operator and radiation protection officer regarding the x-ray machine in the office.
Objective five. Define Dental imaging.
Define Imaging:
Imaging is the process of creating a picture or alikeness of an object. In dentistry, it can be a photograph or a radiograph.
The reproduction of a photo, radiograph or digital picture which is produced on a film or a computer screen.
An Image may be intra-oral or extra-oral
Intra-oral means: A film or sensor placed inside the Oral cavity. Examples include bitewings and periapical radiographs.
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Extra-oral means: The film or sensor is placed outside the Oral cavity. Examples include panoramic and cephalometric radiographs.
Other examples of imaging systems which are used in the medical field are MRI- Magnetic Resonance Imaging- uses strong magnetic fields and radio waves
CT scan uses xrays from different angles
Ultrasound uses high frequency sound.
Objective six. Differentiate between the following terms: radiograph, dental
image, radiography, and intra-oral / extra-oral photographs and intra-oral scanning.
Radiography: The art and science of making radiographs by the exposure of film to x-rays.
Radiograph: The visual image produced by the passage of x-rays through an object and striking a film or a sensor.
This photographic record is provided by the passage of x-rays through an object.
Examples of radiographs commonly used in the dental office include:
1.
Periapical exposure an intra-oral radiograph that shows: the entire tooth and surrounding bone tissue.
2.
Bitewing exposure an intraoral radiograph that shows only; the crowns of maxillary and mandibular teeth in a biting position. (Doesn’t show the apices)
3.
Occlusal exposure – radiographs produced by placing the film along the Incisal or Occlusal (biting surfaces) and having the patient bite down gently on the film or sensor.
4.
Panoramic – an extra oral radiographic technique used to examine the upper and lower jaws on a single film.
5. Cephalometric –lateral or side exposure or posterioanterior exposure. This is frequently used in orthodontic treatment.
Photographs in dentistry:
Pictures used in dentistry, either by conventional or digital cameras use film that is: Either exposed to light and processed as in film based or it can be digitally received and processed. These can be used in predeterminations , treatment planning, patient education or case presentation.
Intraoral optical scanners are used in dentistry to create a digital impression of the tooth's anatomy. They create digital impressions without requiring traditional impression materials. They can create colour maps to provide accurate determining the shades for cosmetic restorations.
A digital impression is a virtual scan that creates that map of your teeth. By using lasers and other optical scanning devices, dentists can create a computer generated model that can be translated into data that the dental lab can use.
Using CAD/CAM technology (computer assisted design/computer assisted manufacture) enables the Dental lab to produce of a wide range of dental restorations, such as crowns, veneers, bridges, and implants. Objective seven. Differentiate between digital and conventional or analogue radiography.
Digital Radiography
Is a method of capturing a radiographic image using a sensor breaking it into electronic pieces, and presenting and storing the image using a computer
image is displayed on a computer screen.
The image is displayed immediately (no waiting for processing)
Gives the operator the ability to manipulate the image by contrast enhancement or size.
There is also a reduction in patient’s radiation dose by 50-80% -sensors used in digital radiography are more sensitive to x-rays than conventional film.
Advantages of Digital Imaging
There is No need for: film, dark rooms, processors, chemicals, film mounts.
Less space is required, images can be transmitted electronically or stored, and it can be used for both intraoral and extraoral images
More environmentally friendly
Disadvantages of digital radiography -initial cost is high (One sensor can cost between $3,000 and $10,000, you need multiple sensors, computers and software)
-sensors are sometimes bulky and rigid
-need a computer
-no hard copy without additional equipment/ printer -need to use barriers, sensors cannot withstand heat sterilization
As technology advances the quality of the image improves with digital radiography
Conventional radiography
Both digital and conventional use the x-ray unit as the source of x-rays.
Conventional uses film packet instead of sensor
Higher dose of radiation with film based radiography
Film must undergo chemical processing
More waste- lead foil, chemicals
More time to produce the image (processing)
ADVANTAGE: You always have a hard copy and initial costs are lower.
Objective eight. Describe the uses of dental images.
Detect Lesions (carious lesions)
Lesions may include dental caries (decay) which is a demineralization of the enamel On a radiograph, decay appears darker than the healthy enamel and dentin. This means that there is an increase in density on the radiograph. (Density is the amount of blackness on a radiograph). This area on the film shows as being radiolucent. From this radiograph we can determine if carious lesion has progressed and invaded the pulp (nerve chamber)
Tumours, abscesses and cysts
An abscess is seen clinically as a swelling may show as a radiolucency at the root of the tooth involved.
Tumours or bone lesions can also be detected on a radiograph
Detect Suspected Disease (periodontal disease)
Periodontal disease (disease that involves the bony support of the teeth) may be assessed along with the conditions which may be contributing to its progression (calculus, poorly contoured restorations, open contacts).
The extent and location of bone loss seen radiographically is crucial in diagnosing and treating periodontal disease.
The build up of calculus (tartar), if very heavy, may be dense enough to be seen on a radiograph.
Overhanging restorations or open contacts may be determined as contributing to a periodontal condition.
Detect Conditions of the Teeth and Surrounding Structures
Several conditions of the teeth may be assessed or examined with the use of dental images, both radiographic and photographic.
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The shape of the roots of teeth (important for extractions or for root canal treatment) can be visualized by the use of radiographs.
Root resorption (diminished root structure) can be detected.
Supernumerary teeth (extra teeth), or congenitally missing teeth (teeth missing naturally) can be assessed.
Evaluating Growth and Development
The dentist is able to see eruption patterns and intervene if warranted. Orthodontics use Cephalometric and Panoramic radiographs to show relationship between upper and lower jaws, eruption patterns, spacing etc. This serves as a useful tool in treatment planning for timing and actual treatment modalities.
Radiographs must be prescribed by a DDS. and should always be based upon clients’ specific needs. (Not an office policy that every client has radiographs taken at a specified period of time). Once prescribed, radiographs can be exposed by both Dental Assistants and Dental Hygienists who have graduated from a HARP approved program.
Some radiographs are better suited for diagnosing certain conditions or lesions and will help to determine the treatment required. Examples:
Impacted wisdom teeth- Panoramic
Periodontal disease- Intraoral such as a bitewing or a periapical
Carious lesions between the teeth- Bitewing
Periapical (around the root) Abscess - Periapical
Jaw development for orthodontics- Panoramic and cephalometric