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Patients With Special Needs. Gagging. The term “gagging” refers to the strong involuntary need to vomit. The gag reflex can be defined as retching that is e licited by stimulation of the sensitive tissues of the soft palate area.

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gagging
Gagging
  • The term “gagging” refers to the strong involuntary need to vomit.
  • The gag reflex can be defined as retching that is elicited by stimulation of the sensitive tissues of the soft palate area.
  • The gag reflex is a protective mechanism which serves to clear the airway of obstruction.
gagging1
Gagging
  • ALL patients have a gag reflex.
  • It is important to remember that it is a more exaggerated reflex in some than in others.
  • But is IS a REFLEX, and not a fault of the patient.
how the gag reflex works
How the Gag Reflex works
  • Before the gag reflex is initiated, the following two reactions occur:
    • Cessation of respiration
    • Contraction of the muscles of the throat and abdomen
  • Precipitating factors for initiation of the gag reflex include:
    • Psychogenic Factors
    • Tactile Stimuli
patient management
Patient Management
  • Operator attitude
  • Patient and Equipment Preparations
  • Exposure Sequencing
  • Receptor Placement and Technique
operator attitude
Operator Attitude
  • Convey a confident attitude
  • Demonstrate:
    • Patience
    • Tolerance
    • Understanding
  • EXPLAIN the imaging procedures, and then COMPLIMENT the patient as each exposure is completed.
patient and equipment preparations
Patient and Equipment Preparations
  • Limit the amount of time that the receptor stays in the mouth. (Move it, or they WILL lose it!)
  • When patient and equipment preparations are completed before receptor placement, valuable time is saved, and the likelihood of stimulating the gag reflex is reduced.
exposure sequencing
Exposure Sequencing
  • Always begin with the anterior exposures, as you have been taught.
  • With posterior exposures, always expose the premolar exposures before the molar exposures, as you have been taught.
  • THE MAXILLARY MOLAR EXPOSURE IS THE MOST LIKELY EXPOSURE TO INITIATE THE GAG REFLEX.
  • In a patient with a hypersensitive gag reflex, these two exposures should come last
receptor placement and t echnique
Receptor Placement and Technique
  • To avoid stimulating the gag reflex, each receptor must be placed and exposed as quickly as possible.
  • DO NOT SLIDE THE RECEPTOR ALONG THE PALATE.
  • Demonstrate film placement
  • If a patient does gag, remove the film as quickly as possible.
extreme cases of gag reflex
Extreme Cases of Gag Reflex
  • Occasionally the dental radiographer encounters a patient with a gag reflex that is uncontrollable.
  • Here, we resort to EXTRAORAL images such as a Pan or a lateral jaw image.
special needs
Special Needs
  • A disability can be defined as “a physical or mental impairment that substantially limits one or more of an individual’s major life activities”.
  • The DA must be prepared to modify imaging techniques to accommodate persons with disabilities.
physical disabilities
Physical Disabilities
  • Vision
    • Use clear verbal explanations
    • Explain each step before performing it
  • Hearing
    • May ask caregiver to act as interpreter
    • Use gestures or sign language
    • Use written instructions
    • If patient can lip read
      • Speak slowly, clearly and FACE THE PATIENT!
physical disabilities1
Physical Disabilities
  • Mobility Impairment
    • When there is a loss of use of the lower limbs
      • Ask patient how they would like to be transferred to the dental chair
      • DA may offer to assist
      • Caregiver may assist
      • Patient may do on their own
physical disabilities2
Physical Disabilities
  • Mobility Impairment
    • If there is a loss of use of the upper limbs, and the use of a beam alignment device cannot be used, the DA may ask the caregiver to assist with holding the receptor.
    • If so, the caregiver MUST wear a lead apron also.
    • Give caregiver specific instructions on how to hold the receptor
    • DA must never hold a receptor for a patient
physical disabilities3
Physical Disabilities
  • Remember, extraoral images are always an option.
developmental disabilities
Developmental Disabilities
  • A developmental disability is “a substantial impairment of mental or physical functioning that occurs before the age of 22 and is of indefinite duration”.
  • Examples include:
    • Autism
    • Cerebral palsy
    • Epilepsy
    • Mental retardation
developmental disabilities1
Developmental Disabilities
  • Here, there may be problems with coordination and comprehension of instructions.
  • With coordination issues:
    • Mild sedation may be effective
  • With comprehension issues:
    • Caregiver may be asked to assist
developmental disabilities2
Developmental Disabilities
  • There are some situations where intraoral exposures cannot be tolerated by the patient.
  • In such cases, no intraoral exposures should be performed because
    • They will only result in non-diagnostic images
    • This would result in needless exposure of radiation to the patient.
    • Turn to page 293 of your texts for Helpful Hints
pediatric patient
Pediatric Patient
  • Pediatrics is the branch of dentistry dealing with the diagnosis and treatment of dental diseases in children.
  • When treating the Pediatric Patient the dental radiographer must be aware of :
    • Prescribing of dental images
    • Patient and equipment preparations
    • Recommended techniques
    • Patient management
prescribing dental images
Prescribing Dental Images
  • Based on individual needs based on the age of the child and their ability to cooperate during the procedure
patient and equipment preparations1
Patient and Equipment Preparations
  • Explanation of the procedure
    • tubehead = camera
    • Lead apron = winter coat
    • Image = picture of their teeth
  • Lead apron
    • As with all patients, a lead apron with a thyroid collar must be placed on all peds patients.
  • Exposure factors
  • Receptor size
patient and equipment preparations2
Patient and Equipment Preparations
  • Exposure factors
    • Reduction of mA, kVp and exposure time
    • Reduced exposure time is preferred because a shorter exposure time will reduce the chance of a blurred image if the child moves
  • Receptor size
    • Primary dentition – size 0
    • Transitional dentition – size 1 or 2
    • Use size 2 for occlusal exposures
recommended techniques
Recommended Techniques
  • Turn to page 294, Table 24 – 1 for recommendations on dental imaging examinations of the Pediatric Patient.
  • Bisecting Angle technique is often preferred because of the small size of the mouth and hence no depth of palate.
  • Turn to page 294 for Helpful Hints with the Pediatric Patient
endodontic patients
Endodontic Patients
  • Endodontics is the branch of dentistry concerned with the diagnosis and treatment of diseases of the pulpal tissues of the tooth.
  • Challenges arise with the placement of the film during endodontic procedures because of the rubber dam, clamp, etc.
  • Use of a special film holder (Endo-ray film holder) may be helpful.
  • Hemostat may also be used.
edentulous patients
Edentulous Patients
  • The edentulous patient requires a dental imaging examination to :
    • Detect the presence of root tips, impacted teeth and lesions (cysts and tumors)
    • Identify objects imbedded in the bone
    • To observe the quality and quantity of bone that is present
edentulous patients1
Edentulous Patients
  • The panoramic image is the most common way of examining the edentulous jaw.
  • If a panoramic machine is not available, 14 periapical projections (6 anterior and 8 posterior) can be used to examine the edentulous arches.
  • Generally, the #2 size film is used
  • If the paralleling technique is used, cotton rolls must be placed on the bite block in place of the missing teeth
edentulous patients2
Edentulous Patients
  • If the paralleling technique is used, cotton rolls must be placed on the bite block in place of the missing teeth
  • If the bisecting angle technique is used the receptor should be positioned so that approximately 1/3 of it extends beyond the edentulous ridge.