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Pediatric Restorative Dentistry with Radiographs
Dr. Ha T. Jacklynn ThaiBoard Certified Pediatric Dentist
Associate Professor, University of California, San FranciscoDepartment of Pediatric Dentistry
HRSA Program: Pediatric Dentistry in Hygiene Dentistry
24700 Calaroga Ave. Suite 104 ~ Hayward, CA 94545 ~ 510.785.9295
Pediatric Radiography
SignificanceDiagnostic AidProper diagnosis Areas to be evaluated
SafetyReimbursement of servicesQuantity
DevelopmentAgeNeed
Significance
The risk of under diagnosing vs. the radiation exposureNot all surfaces are visible to the naked eyeIt’s not just the teeth that need to assessed
Periapical films BW filmsPanoramic filmCephalometric film
SafetyRadiation Exposure
Adherence of radiation safety protocolsDental x-rays are one of the lowest exposure of radiation dose
Absorbed radiation is measured in units of millirem(mrem)– In the United States, the average accumulated background radiation
dose to an individual in a 1 year period is 620mrem Radiation itself is measured in units of millisieverts (mSv)
Perspective4 bitewings 0.4 mremChest xray 10 mrem CT scan of head 200 mremCT scan of chest 700 mrem5 hours transcontinental flight 2-5 mremBanana 0.01 mrem1 cup of Brazil nuts 0.016 mrem Living at high altitude for 1 year i.e. Denver, CO 50 mrem per year
Source: National Council on Radiation Protection and Measurements (NCRP)
Other Common Day-To-Day Sources of Radiation
Televisions with cathode ray tubesFlat screens do not have tube (1 mrem per year)
Drinking water Sourced from rivers and lakes which pick up radiation from natural sources like the soil and rocks (5 mrem per year)
Natural gas stoves (9 mrem per year)Cigarette smoking – quarter of a pack per day (1,300 mrem per year)
Reimbursement
Access to care barriers
Quantity of RadiographsAll primary dentition (baseline)
Upper and lower anterior 2 BWs (size 0)
Early mixed dentition (~6-8 years)Upper and lower anterior*2 BWs (attempt size 2)
Late mixed dentition (~8-12 years)Upper and lower anterior* 2 BWs (size 2)Panoramic
Full permanent dentition (~13+ years)Upper and lower anterior*4 BWsPanoramic
Isolated/focused areasTrauma areas
Film placement
Ectopic Eruption #3
6 years old
INVESTIGATE further when something looks suspicious
Cavity Control – Treatment Options
Sealant Filling
AmalgamComposite
Pulpotomy/pulpectomyCrowns
SSCResin Zirconia
Extraction With space maintainerWithout space maintainer
Sealant
IsolationEtchTo bond or not to bondSealant
Various options
Sealant Placement
Pumice/clean tooth – no fluoride products & rinseIsolationAir dry toothApply etch
Explore Bond (?) Sealant application
Explore vs. microbrushCureAssessment/self-critiqueCheck occlusion
Total Working Time: 3-5 min per tooth
Clinical presentation
Broken, Defective, Displaced