Management Techniques

One of the most challenging tasks for the clinical staff is to obtain diagnostic quality radiographs on a young patient (under three years of age) without psychological trauma.

The first step is to desensitize the child to the dental experience by explaining to the child what you plan to do in words easily comprehended by the child. Using a "tell, show, do" technique, the clinician explains to the child a tooth picture will be taken of the child's tooth with tooth film and a tooth camera. The child is allowed to touch and examine the radiographic film and camera. The child is positioned to gain maximum cooperation. 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.

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Such positioning reduces the child's anxiety to such a degree that minimal restraint may be needed to successfully take the radiograph. The child is seated in the parent's lap with the parent resting their arms around the child's upper body and their legs wrapped around the child's lower body. Not only does this provide additional emotional security for the child and, thus, increased cooperation but also enables the parent to adequately restrain the child should there be any unexpected sudden movements.

Obtaining the least difficult radiograph first (such as an anterior occlusal) desensitizes the child to the procedure. Since many children have difficulty keeping the film in their mouth for extended periods of time, be certain the correct settings are made on the apparatus and the x-ray head is properly positioned before placing the film in the child's mouth. A positioning device such as a Snap-A-Ray can be used to aid the parent in positioning and securing the film. Be sure to adequately protect the parent and child with lead aprons to reduce radiation exposure.

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If the child is uncooperative, then additional restraint by a second adult may be necessary to successfully obtain the radiograph. With the first adult restraining the child as described previously, a second adult stabilizes the child's head with one hand while the other hand positions the x-ray holder in the patient's mouth. Under no circumstances should staff be asked to perform this task.

If a second adult is not available, it may be necessary to place the child in a mechanical restraining device (Papoose Board) to adequately restrain the child. This frees the parent to stabilize the child's head and properly position the radiograph in the child's mouth.

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If the child is still too uncooperative, it may be necessary to manage the child pharmacologically with inhalation, oral, or parental sedatives.

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Older children may also be uncooperative for a variety of reasons. These can range from the jaw being too small to adequately accommodate the radiograph, fear of swallowing the radiograph, fear of the procedure itself, or the patient exhibits a severe gag reflex. There are numerous techniques to overcome these problems.

For the child with the small mouth, use the smallest size film available (size 0 film). Roll the film (do not place sharp bends) to allow the film to accommodate the shape of the jaw and not impinge on the soft tissues.

Figure 8.

Use of the Snap-A-Ray as a bitewing tab will reduce impingement on the soft tissue but unfortunately will reduce the amount of detectable tooth structure on the radiograph.

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