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Patients often view x-ray procedures with
disdain. They may have had previous bad experiences and children are sometimes
overwhelmed by the technology. Confidence and compassion on the part of the
operator can do wonders for patient compliance.
The key to controlling gagging is breathing
through the nose, or holding the breath. No one gags while they are eating,
even though food fills the entire oral cavity.
The reason is that one does not breath through
the mouth while it is filled with food. The position of the tongue in the mouth
is all-important because as long as the throat is blocked by the posterior
portion of the tongue, gagging does not take place. In order to properly position the tongue,
ask the patient to open the mouth as wide as possible and then hum through the
nose. If any noise comes out of the mouth (you can usually tell by
listening) ask the patient to block the throat with the back of the tongue and
try again.
Once the patient is clearly humming through the nose with the mouth wide open,
tell them to be sure to inhale with the tongue in the same position forcing the
breath to enter through the nose.
With the breathing controlled in this manner, patients are less likely to have
gagging problems. It sometimes helps to lighten the mood by having the
patient hum a tune for a few moments while you congratulate him or her on a fine
singing voice. As long as the patient remembers to continue to breath
through the nose and open very wide while you are inserting the film,
the gag reflex is fairly easy to control.
Gagging has a very large psychological component even though
it is a physical reaction. While the order of film exposure is of little
consequence with most patients, it takes on more significance with gaggers.
It is generally best to start the series with anterior or premolar films which,
being placed further forward in the mouth are less likely to stimulate gagging.
This shows the patient they can be successful in spite of their fears. It
also helps to establish you as the
authority. Don't leave the film in the patient's mouth for any longer than
absolutely necessary. Set up the machine and do everything else necessary before
putting the film in the patient's mouth. Always instruct the patient to breathe through
his or her nose while placing the film. Set the film in place with confidence
and don't move it around. If the patient gags anyway, try to reassure them that
it is a common survival instinct and that you know just what to do to help them
control it.
There are mouth washes and throat lozenges
available to anesthetize the mouth. Some practitioners swear by salt on the
tongue. Others instruct the patient to concentrate on an object or picture in
the room. Probably the best thing to concentrate on is breathing through
the nose. The common thread running through these techniques is that the
operator insists that this technique has worked for many other
patients. Since the reflex is triggered by psychological factors, any way that
occupies the concentration skills of the patient is helpful. Try different
techniques when the opportunity presents itself.
Patients will sometimes refuse x-rays for a
variety of reasons. Many will say they do not want to be exposed to the
radiation. Explain to the patient that the doses of radiation are small in
comparison to the benefit of the diagnostic importance of the x-ray. "The doctor
cannot give you a full examination without these." Also explain to the patient
that every effort is made to expose them to the least amount of radiation
possible to gain a good x-ray. If the patient has recently had x-rays for
medical purposes, they may not want to be exposed again. Each case will be
different, depending on the reason for the oral x-ray (routine or because of a
problem). If the patient still refuses the x-rays, have the dentist speak to the
patient. Every effort should be made on your part to explain the situation to
the patient to establish your credibility.
The safety issue is often best resolved by
explaining to the patient that the amount of radiation received from dental
x-rays is so small that it would take 20 full series surveys (360 films in all)
to equal the amount of radiation the patient normally receives from normal
environmental background sources over the course of one year. It may be
helpful to maintain a printed handout containing some of the information from
The practical aspects of radiation
safety section in this study course.
The one exception is in the case of a pregnant patient.
In an emergency, it is probably best to consult with the patient's physician before any x-rays are taken, especially in the first trimester. If the
patient has a suspicion that they may be pregnant, it is wise to postpone
routine x-rays until she is sure she is not pregnant. The lead apron should
protect the reproductive area if the x-rays must be taken, but if the patient's
physician recommends against it, postpone any x-rays until after the baby is
born.
Informed Consent/Informed Refusals
The patient should give documented informed
consent. The patient should have a full explanation of the benefits and the
risks of exposure to radiation and they must specifically express his or her
permission to have them taken. A written, signed consent form is the easiest way
to document the patient's approval.
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Dentists and allied dental professionals often
seek CE courses from ADA CERP recognized providers to fulfill their
CE requirements for re-licensure. Most state and
provincial licensing boards will accept CE credits issued by ADA
CERP recognized providers. In the spring of 2003, the FDI World
Dental Federation became the first internationally based CE provider
to be granted ADA CERP recognition.
Please contact your state board directly for their specific rules
and regulations. Most states approve supervised self-study courses
that are ADA CERP accredited.
Those dentists, hygienists, dental assistants
and radiographers interested in receiving 3 continuing
education credits for this course may take a 10 question test at a
cost of $35 and receive their certificate immediately by clicking
here.
Those dentists, hygienists, dental assistants
and radiographers interested in receiving 8 continuing
education credits for this course may take a 25 question test at a
cost of $66 and receive their certificate immediately by clicking
here.
Note: There are no questions on tables or
Glossary. |
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