COURSE OUTLINE. Prerequisites: Course Description:

Transcription

1 Revised: Fall/ TDNH TOral Radiography for the Dental Hygienist Admission in to the Dental Hygiene Program COURSE OUTLINE Prerequisites: Course Description: Introduces the practical study and application of dental radiology. Presents aspects of chemistry, biology, and anatomy that correlate to dental radiography. Encompasses knowledge of technique, treatment, diagnosis and prognosis. Studies radiation physics, biology, safety, and exposure techniques for intra- and extra-oral radiographic surveys. Laboratory provides practice in exposure, processing methods, mounting, and interpretation of normal findings. COURSE INFORMATION A study of the nature, physical properties, biological effects, methods of control, safety, and the techniques for exposing, processing, and mounting x-rays; identification of anatomical landmarks, and interpretation of radiographic findings is also included. Laboratory procedures will include the application of these techniques. Lecture one hour, laboratory three hours per week. The lecture portion of this class will be distanced from LFCC. (The lab portion will be at the home campus of the student.) The graded assignments for this course are going to be found on the corresponding Blackboard site. These will be timed and are to be taken UbeforeU the lecture/lab. The tests/exams will be given on your campus during the lecture time except for the lab final which will be done online.

2 COURSE PURPOSE To instruct the dental hygiene student in exposing, processing, mounting, and interpretation of dental radiographs. Semester Credits: 2 Lecture Hours: 1 Lab/Recitation Hours: 3 22TOral Radiography for the Dental Hygienist-DNH 130 UCourse Outcomes Upon completion of this course, the student will be able to accomplish the following objectives with at least 77% competency: List the uses of radiographs in dentistry and discuss techniques for exposing intraoral and extraoral dental films including advantages and disadvantages. Discuss the physics of fabricating x-ray energy and relate that to how it affects the radiographic image and radiation exposure to the patient. List the types and effects of radiation to humans and different types of tissues and explain how it occurs on a cellular level List the steps to take before, during and after exposure to reduce the amount of radiation to patients. Identify normal anatomy and interpret specific pathological conditions on radiographs of the oral cavity. UDENTAL HYGIENE COMPETENCIES/STUDENT LEARNING OUTCOMES DOMAIN: ETHICAL VALUES & PROFESSIONALISM 1. Apply the ADHA Code of Ethics as a guide for ethical consciousness, decisionmaking, and practice. 2. Adhere to state & federal laws, regulations, & recommendations in the provision of dental hygiene care. 3. Assume responsibility and accountability for dental hygiene actions and services, according to protocols.

3 4. Serve all clients without discrimination, appreciating population diversity. 5. Communicate effectively using verbal, non-verbal, written & electronic communication skills. DOMAIN: DENTAL HYGIENE PROCESS OF CARE 1. Apply the general, biomedical, dental and dental hygiene sciences to the delivery of educational, therapeutic, and preventive services to diverse populations. 2. Provide accurate, consistent & complete documentation for assessment, diagnosis, planning, implementation & evaluation of dental hygiene services. 3. Use principles of risk management to assess & manage risk, and prevent liability. 4. Evaluate the safety and efficacy of oral health products, interventions, and treatments. 5. Utilize critical thinking and problem solving skills.

4 Oral Radiography for the Dental Hygienist-DNH 130 Required Materials: Rinn XCP Film holders and Beam Alignment Devices Textbook: Iannucci, Joen M. and Howerton, Laura Jansen. Dental Radiography Principles and Techniques. 4th Edition. Elsevier, ISBN# ; Langlais, Robert. Exercises In Oral Radiography, Elsevier, 2004, ISBN# ; Virginia Western Community College Dental Hygiene Student Guidelines & Procedures Manual; Wilkins, Esther M. Clinical Practice of the Dental Hygienist.10th Edition.Lippincott, Williams, & Wilkins, 2009 ISBN# The following supplementary materials are available: 1. Evolve website for Dental Radiography Principles and Techniques. 4th Edition. 32TUhttps://evolve.elsevier.com/staticPages/index.htmlU32T

5 Oral Radiography for the Dental Hygienist-DNH UModule 1 ULearning Objectives: Summarize the importance of dental radiographs. List the uses of dental radiographs. Summarize the discovery of x-radiation. Recognize the pioneers in dental x-radiation and their contributions and discoveries. List the highlights in the history of x-ray equipment and film. List the highlights in the history of dental radiographic techniques. Define the key words associated with dental x-ray equipment. Discuss the regulation of dental x-ray machines in the federal, state, and local levels. Recognize dental x-ray machines used for intraoral and extraoral films. Identify the component parts of the dental x-ray machine. Describe the purpose and use of dental x-ray film holders and devices. Identify commonly used dental x-ray film holders and devices. Define the key words associated with dental x-ray film. Describe in detail film composition and latent image formation. List and describe the different types of x-ray film used in dentistry. Define intraoral film and describe intraoral film packaging. Identify the types and sizes of intraoral film available. Discuss film speed. Define the key words associated with processing of dental x-ray film. Describe in detail how a latent image becomes a visible image. List and discuss the five steps of film processing. List and describe the four basic ingredients of the developer solution. List and describe the four basic ingredients fo the fixer solution. Discuss the parts of the processing tank: insert tanks, master tank, and lid.

6 List and describe the equipment needed for manual film processing. List and discuss the procedural steps for manual film processing. Describe the care and maintenance of the processing solutions, equipment, and equipment accessories used in manual film processing. Define the key terms associated with digital imaging. Describe the purpose and use of digital imaging. Discuss the fundamentals of digital imaging. List and describe the equipment used in digital imaging. List and describe the two types of digital imaging. Describe the patient and equipment preparations required for digital imaging. List and discuss the advantages and disadvantages of digital imaging. 1. Radiation History a. Dentistry and x-radiation; discovery and pioneers b. History of dental x-ray equipment, dental x-ray film and dental radiographic technique 2. Introduction to Radiographic Exams a. Intraoral examinations b. Extraoral examinations c. Prescription of dental radiographs 3. Dental X-Ray Equipment a. Dental x-ray machines b. Dental x-ray film holders and beam alignment devices 4. Dental X-Ray Film a. Dental X-ray film composition and latent image b. Types of dental film c. Film storage and protection 5. Dental X-Ray Film Processing a. Film processing b. Manual film processing c. Automatic film processing d. Darkroom e. Film duplication

7 U f. Processing problems and solution 6. Digital Radiography a. Basic concepts i. Terminology ii. Purpose and use iii. Fundamentals iv. Radiation exposure v. Equipment b. Types of digital imaging i. Direct digital imaging ii. Indirect digital imaging c. Step-by step procedures i. Sensor preparation ii. Sensor placement d. Advantages and disadvantages U UModule 2U Learning Objectives Define the key words associated with radiation protection Describe in detail the basics of patient protection before x-ray exposure. Discuss the different types of filtration, and state the recommended total filtration for dental x-rays operating above and below 70 kvp. Describe the collimator used in dental x-ray machines, and state the recommended diameter of the useful beam at the patient s skin. List six ways to protect the patient from excess radiation during x-ray exposure. Describe the importance of receptor handling and processing after patient exposure to x-radiation. Discuss operator protection in terms of adequate distance, shielding, and avoidance of the useful beam. Describe personnel equipment monitoring devices used to detect radiation. Discuss radiation exposure guidelines, including radiation safety legislation, maximum permissible (MPD), maximum accumulated dose (MAD), and the ALARA concept.

8 Discuss with the dental patient what radiation protection steps will be used before, during, and after x-ray exposure. Define the key words associated with radiation injury. List the determining factors for radiation injury. Describe the mechanisms, theories, and sequences or radiation injury. Define and discuss the dose-response curve and radiation injury. Discuss the short-term and long-term effects as well as the somatic and genetic effects of radiation exposure. Describe the effects of radiation exposure on cells, tissues, and organs. Identify the relative sensitivity of a given tissue to x- radiation. Define the key terms associated with infection control. Describe the rationale for infection control. Describe three possible routes of disease transmission. Describe the conditions that must be present for disease transmission to occur. Discuss personal protective equipment (PPE), hand hygiene, sterilization and disinfection of instruments, and the cleaning and disinfection of the dental unit and environmental surfaces. 1. Radiation Protection a. Radiation Injury i. Mechanisms of Injury ii. Theories of Injury iii. Dose Response-curve iv. Stochastics and non-stochastic effects v. Sequence of radiation injury vi. Determining factors for radiation injury b. Radiation effects i. Short and long term effects ii. Somatic and genetic effects iii. Radiation effects on cells iv. Radiation effects on tissues and organs c. Radiation measurements i. Units of measurements ii. Exposure measurements

9 iii. Dose measurements iv. Dose equivalent measurement v. Measurements used in dentistry d. Radiation risks i. Sources of exposure ii. Risk estimates iii. Dental radiation and exposure risks iv. Patient exposure and dose v. Risk versus benefit of dental radiographs 2. Infection Control and Protection a. Infection control basics i. Rationale for infection control ii. Terminology b. Guidelines for infection control practice i. Personal protective equipment ii. Hand hygiene iii. Sterilization of dental instruments iv. Cleaning and disinfecting the dental unit and environmental surfaces c. Infection control in dental radiography i. Infection control procedures used before, during and after exposure U UModule 3 ULearning Objectives Define the key terms associated with bite-wing technique. Describe the purpose and use of the bite-wing image. Describe the appearance of opened and overlapped contact areas on a bite-wing image. State the basic principles of the bite-wing technique. List the two ways a receptor can be stabilized in the bite-wing technique, and identify which film size is recommended for exposures in the adult patient. List the three receptor sizes that can be used in the bite-wing technique, and identify which one is recommended for bite-wing exposure.

10 Define the key terms associated with film mounting and viewing. List the individuals who are qualified to mount and view dental radiographs. Describe when and where films are mounted. List five reasons to use a film mount. Describe what information is placed on a film mount. Discuss the importance of normal anatomy in film mounting. Describe how the identification dot is used to determine film orientation. List and describe two methods of film mounting and identify the preferred method. Define the key words associated with radiation injury. List the determining factors for radiation injury. Describe the mechanisms, theories, and sequences or radiation injury. Define and discuss the dose-response curve and radiation injury. Discuss the short-term and long-term effects as well as the somatic and genetic effects of radiation exposure. Describe the effects of radiation exposure on cells, tissues, and organs. Identify the relative sensitivity of a given tissue to x- radiation. 1. Bite Wing Technique a. Basic concepts i. Terminology ii. Principles iii. Beam alignment device and bite-wing tabs iv. Receptors v. PID vi. Rules b. Step-by step procedure i. Preparation of patient and equipment ii. Exposure sequence iii. Receptor placement c. Vertical Bitewings d. Bitewing technique modification i. Edentulous spaces

11 ii. Bony growths 2. Film mounting and viewing a. Basic concepts of mounting b. Mounting methods c. Step-by-step procedure to mounting d. Film viewing basic concepts and step-by-step procedure 3. Radiation Biology a. Patient protection i. Before, during and after exposure b. Operator protection i. Guidelines ii. Monitoring c. Radiation exposure guidelines i. Radiation safety legislation ii. Maximum permissible dose iii. Maximum accumulated dose iv. ALARA concept d. Radiation protection and patient education UModule 4U ULearning Objectives Define the key words associated with radiation physics Identify the structure of the atom. Describe the process of ionization. Discuss the difference between radiation and radioactivity. List the two types of ionizing radiation, and give examples of each. List the characteristics of electromagnetic radiation. Describe the different sizes of receptor used with paralleling technique and how each receptor is place in the bite-block. State the five basic rules of the paralleling technique. Describe the patient and equipment preparations that are necessary before using the paralleling technique. Discuss the exposure sequence for 15 periapical receptor placements using the paralleling technique.

12 Describe each of the 15 periapical receptor placements recommended for use with the XCP instruments. Summarize the guidelines for periapical receptor positioning. Explain the modifications in the paralleling technique that are used for a patient with a shallow palate, bony growths, or a sensitive premolar region. List the advantages and disadvantages of the paralleling technique. 1. Radiation Physics a. Fundamental Concepts of Matter i. Atoms and molecules ii. Ionization, radiation and radioactivity iii. Ionizing radiation b. Components of x-ray machine c. Production of x-radiation i. Types of x-rays produced ii. Definitions of x-radiation d. Possible interactions of x-radiation in patients i. None ii. Absorption and photoelectric effect iii. Compton scatter iv. Coherent Scatter 2. Paralleling Technique a. Basic concepts i. Terminology ii. Principles iii. Beam alignment devices iv. Receptors used v. Rules b. Step-by step procedure i. Patient and equipment preparation ii. Exposure sequence iii. Receptor placement c. Modifications in paralleling technique i. Shallow palate ii. Bony growths

13 iii. Mandibular premolar region d. Advantages and disadvantages UModule 5 ULearning Objectives Define the key terms associated with exposure and technique errors. Identify and describe the appearance of the following film exposure errors: unexposed receptor, film exposed to light, underexposed receptor, and overexposed receptor. Describe horizontal and vertical angulation. Identify and describe the appearance of the following periapical technique errors: incorrect horizontal angulation, incorrect vertical angulation (foreshortened images and elongated images), and incorrect beam alignment (cone-cut images). Describe and identify proper receptor placement for bite-wing radiographs. Identify and describe the appearance of the following bite-wing technique errors: incorrect horizontal angulation, incorrect vertical angulation, and incorrect position-indicating device (PID) alignment (cone-cut images). Identify and describe the appearance of the following miscellaneous technique errors: film bending, film creasing, phalangioma, double exposure, movement, and reversed film. Define the key words associated with radiation characteristics. Describe the effect that the kilovoltage peak has on the quality of the x-ray beam. Describe how milliamperage influences the quanity of the x-ray beam Identify the range of kilovoltage and milliamperage required for dental radiography. Describe how increasing and decreasing exposure factors affect the density and contrast of the image 1. Exposure and Technique errors a. Receptor exposure errors i. Time factors b. Periapical technique errors i. Placement problems ii. Angulation problems

14 iii. PID alignment problems c. Bite-wing technique errors i. Placement problems ii. Angulation problems iii. PID alignment problems d. Miscellaneous technique errors i. Film bending ii. Film creasing iii. Phalangioma iv. Double Exposure v. Movement vi. Reversed film 2. Radiation Characteristics a. X-ray beam quality i. Voltage and kvp ii. Relationship of kvp, density, contrast and exposure time b. X-ray beam quantity i. Relationship of ampere, time, density, and exposure time c. X-ray beam intensity i. kvp ii. mas iii. Exposure time iv. Distance and Inverse Square Law v. Half value layer vi. U UModule 6 ULearning Objectives Define key words associated with quality assurance in the dental office. List quality control tests and quality administration procedures that should be includeded in the quality assurance plan. Discuss the purpose and frequency of testing dental x-ray machines.

15 Describe the tests used to check for fresh film and adequate film-screen contact; discuss the frequency of testing and the interpretation of test results. Describe the test used to check for darkroom leaks and proper safelighting; discuss the frequency of testing and the interpretation of test results. Define the key terms associated with the bisecting technique. State the rule of isometry. State the basic principles of the bisecting technique, and illustrate the location of the receptor, tooth, imaginary bisector, central ray, and position-indicating device (PID). List the beam alignment devices that can be used with the bisecting technique. Describe the receptor size used with the bisecting technique. Describe correct and incorrect horizontal angulation. Define the key words associated with dental x-ray image characteristics. Differentiate between radiolucent and radiopaque areas on a dental radiograph. Describe a diagnostic dental radiograph. List the two visual characteristics of the radiographic image. List the factors that influence film density and contrast. Discuss the difference between high and low contrast. 1. Quality Assurance in the Dental Office a. Quality control tests i. Equipment and supplies ii. Film processing iii. Digital imaging b. Quality administration procedures c. Operator competence 2. Dental X-ray Image Characteristics a. Visual characteristics i. Density ii. Contrast b. Geometric characteristic i. Sharpness ii. Magnification

16 iii. Distortion 3. Bisecting Technique a. Basic concepts i. Terminology ii. Principles iii. Beam alignment devices iv. Receptors used v. Rules b. Step-by step procedure i. Patient and equipment preparation ii. Exposure sequence i. Receptor placement c. Advantages and disadvantages UModule 7 ULearning Objectives Define the key terms associated with normal anatomy on intraoral images. State the difference between cortical and cancellous bone. Define the general terms that describe prominences, spaces, and depressions in bone. Identify and describe the normal anatomic landmarks of the maxilla on a human skull. Identify and describe the normal anatomic landmarks of the maxilla as viewed on dental images. Define the key terms associated with patients who have special needs. List the areas of the oral cavity that are most likely to elicit the gag reflex when stimulated. List two precipitating factors responsible for initiating the gag reflex. Describe how to control the gag reflex using operator attitude, patient and equipment preparations, exposure sequencing, and receptor placement and technique. Describe common physical disabilites and what modifications in technique may be necessary during the imaging examination. Describe common developmental disabilites and what modifications in technique may be necessary during the imaging examination.

17 1. Normal Anatomy: Intraoral Images a. Definitions of general terms i. Types of bone ii. Boney prominences iii. Spaces and depressions in bone b. Normal anatomic landmarks i. Maxilla ii. Mandible c. Normal tooth anatomy i. Tooth structure ii. Supporting structures 2. Imaging of Patients with Special Needs a. Patients with a gag reflex i. Patient management b. Patients with disabilities i. Physical disabilities ii. Developmental disabilities c. Patients with specific dental needs i. Pediatric patients ii. Endodontic patients iii. Edentulous patients UModule 8U ULearning Objectives Define the key terms associated with interpreting images. Summarize the importance of interpretation of images. Define the roles of the dentist and dental auxiliary in the interpretation of dental images. Discuss the difference between interpretation and diagnosis. Describe who is able to interpret dental images. Describe when and where dental images are interpreted. Describe how radiographic interpretation can be used to educate the dental patient about the importance and use of dental images. Define the key terms associated with identifying restorations, materials, and foreign objects on dental images.

18 Discuss the importance of interpreting dental images while the patient is present. On dental images, identify and describe the radiographic appearance of the following restorations: amalgam, gold, stainless steel and chrome, post and core, porcelain, porcelainfused-to-metal, composite, and acrylic. On dental images, identify and describe the radiographic appearance of the following dental materials and devices: base materials, metallic pins, gutta percha, silver points, removable partial dentures, complete dentures, orthodontic bands, brackets, and wires, fixed retainers, implants, suture wires, splints, and stabilizing arches and wires. On dental images, identify and describe the radiographic appearance of the following miscellaneous objects: jewelry, eyeglasses, and patient napkin chains. 1. Introduction to Image Interpretation a. Basic concepts i. Interpretation terminology ii. Importance of interpretation b. Guidelines i. Who interprets ii. Interpretation versus diagnosis iii. Ideal place and time for interpretation iv. Interpretation and patient education 2. Identification of Restorations, Dental Materials and Foreign Objects a. Restorations i. Amalgam restoration ii. Gold restoration iii. Stainless steel and chrome restoration iv. Post and core restoration v. Porcelain restoration vi. Composite restoration vii. Acrylic restoration b. Materials used in dentistry i. Restorative dentistry ii. Endodontics

19 iii. Prosthodontics iv. Orthodontics v. Oral surgery c. Miscellaneous objects i. Jewelry ii. eyeglasses UModule 9U ULearning Objectives Define the key terms associated with the interpretation of dental caries. Describe dental caries. Explain why caries appears radiolucent on a dental image. Discuss interpretation tips for evaluating caries on a dental image. Discuss the factors that may influence the image interpretation of dental caries. Define the key terms associated with panoramic imaging. Describe the purpose and uses of panoramic imaging. Describe the fundamentals of panoramic imaging. Describe the equipment used in panoramic imaging. Identify and describe the patient preparations, equipment preparations, and patient positioning procedures needed before exposing a panoramic film. Identify the patient preparation and positioning errors seen on panoramic radiographs. Discuss the causes of patient preparation and positioning errors and the necessary measures needed to correct such errors. Define the key terms associated with normal anatomy on panoramic images. Identify and describe the bony landmarks of the maxilla and surrounding structures as viewed on the panoramic image. Identify and describe the bony landmarks of the mandible and surrounding structures as viewed on the panoramic image. Identify air space images as viewed on the panoramic image. Identify soft tissue images as viewed on the panoramic image. 1. Interpretation of Dental Caries

20 a. Description of caries i. Clinical examination ii. Dental Image examination b. Interpretation of caries on dental images i. Interpretation tips ii. Factors influencing caries interpretation c. Classification of caries on dental images i. Interproximal caries ii. Occlusal caries iii. Buccal and lingual caries iv. Root surface caries v. Recurrent caries vi. Rampant caries vii. 2. Panoramic Technique a. Basic concepts i. Purpose and use ii. Fundamentals iii. Equipment b. Step-by-step procedures i. Equipment preparation ii. Patient preparation iii. Positioning c. Common errors i. Preparation errors ii. Positioning errors d. Advantages and disadvantages 3. Normal Anatomy: Panoramic Images a. Panoramic normal anatomic landmarks i. Boney landmarks of maxilla and surrounding structures ii. Boney landmarks of the mandible and surrounding structures b. Airspace on panoramic radiographs c. Soft tissue seen on panoramic images

21 UModule 10 ULearning Objectives Define the key terms associated with occlusal and localization techniques. Describe the purpose of the occlusal examination. List the uses of the occlusal examination. Describe the patient and equipment preparations necessary before using the occlusal technique. State the recommended vertical angulations for the following maxillary occlusal projections: topographic, lateral (right or left), and pediatric. State the recommended vertical angulations for the following mandibular occlusal projections: topographic, cross-sectional, and pediatric. Define the key terms associated with interpreting periodontal disease. Describe the healthy periodontium. Briefly describe periodontal disease. Discuss the importance of the clinical and examination and interpretation of dental images in the diagnosis of periodontal disease. Describe the limitations of dental images in the detection of periodontal disease. Describe the type of dental images that should be used to document periodontal disease and the preferred exposure technique. 1. Occlusal and Localization Techniques a. Occlusal technique concepts and step-by-step procedures b. Localization techniques concepts and step-by-step procedures 2. Interpretation of Periodontal Disease a. Description of the periodontium b. Description of periodontal disease i. Clinical examination ii. Dental image examination

22 c. Detection of periodontal disease i. Bone loss ii. Classification of periodontal disease d. Predisposing factors U UModule 11 ULearning Objectives Define the key terms associated with the interpretation of trauma, pulpal lesions, and periapical lesions as viewed on a dental image. Describe and identify the appearance of crown, root, and jaw fractures as viewed on a dental image. Describe and identify the appearance of an avulsion as viewed on a dental image. Describe and identify the appearance of internal and external resorption as viewed on a dental image. Describe and identify the appearance of pulpal sclerosis, pulpal obliteration, and pulp stonesas viewed on a dental image. Describe and identify the appearance of a periapical granuloma, cyst, and abscess as viewed on a dental image. Describe and identify the appearance of condensing osteitis, sclerotic bone, and hyper cementosis as viewed on a dental image. Identify the categories of information that should be documented for all lesions viewed on dental images. Define descriptive terminology and describe why the dental professional should use descriptive terms. Define the terms dental image, x-ray, radiolucent, and radiopaque. Distinguish between dental image and x-ray. Distinguish the terms radiolucent and radiopaque. 1. Interpretation of Trauma and Pulpal and Periapical Lesions a. Trauma viewed on dental images i. Fractures ii. Injuries 2. Descriptive Terminology

23 a. Definition and uses i. Descriptive terminology versus diagnosis b. Review of basic Terms i. Radiograph versus x-ray ii. Radiolucent versus radiopaque iii. Terms to describe radiolucent lesions iv. Terms to describe radiopaque lesions U UModule 12 ULearning ObjectivesU Define the key terms associated with the extraoral imaging. Describe the purpose and uses of extraoral imaging. Describe the equipment used in extraoral imaging. Detail the equipment and patient preparations necessary before exposing an extraoral projection. Identify the specific purpose of each of the extraoral film projections. Describe the head position, the receptor placement, and beam alignment for each of the following extraoral films: lateral jaw projection- body of the mandible, lateral jaw projection- ramus of the mandible, lateral cephalometric projection, posteroanterior projection, Waters projection, submentovertex projection, reverse Towne projection, and transcranial projection. Define the key terms associated with three-dimensional digital imaging. Describe the purpose and uses of three-dimensional digital imaging. Describe the equipment used in three-dimensional digital imaging. Detail the equipment and patient preparation necessary before exposure to x-radiation using three-dimensional digital imaging. Identify advantages and disadvantages of three-dimensional digital imaging. 1. Extraoral Radiography a. Basic concepts

24 i. Purpose and use ii. Equipment b. Step-by step procedures i. Equipment preparation ii. Patient preparation iii. Positioning c. Extraoral projection techniques i. Lateral jaw imaging ii. Skull imaging iii. TMJ imaging 2. Three- Dimensional Digital Imaging a. Basic concepts i. Terminology ii. Fundamentals iii. Equipment iv. Common uses b. Step-by step procedures i. Patient preparation ii. Positioning c. Advantages and Disadvantages UModule 13 ULearning Objectives Discuss the importance of dental radiographs. List the uses of dental radiographs. Discuss the benefits of dental radiographs. List examples of common dental conditions that may be evident on a dental radiograph. Discuss the knowledge and skill requirements of the dental radiographer. List the responsibilities that may be assigned to the dental radiographer. Discuss the professional goals of the dental radiographer. Define the key words associated with patient relations. Discuss verbal, nonverbal, and listening skills and explain how each can be used to enhance communicaiton.

25 Discuss how facilitative skills can be used to enhance patient trust. Define a relationship of trust between the dental professional and the patient. Discuss the importance of first impressions, chairside manner, and attitude, and explain how each can enhance patient relations. Summarize the importance of educating patients about dental radiographs. List the three methods that can be used by the dental radiographer to educate patients about dental radiographs. Answer common patient questions about the need for dental radiographs, x-ray exposure, the safety of dental x-rays, and other miscellaneous concerns. Define the key words associated with legal issues. List the federal and state regulations affecting the use of dental x-ray equipment. Describe the general application of federal and state regulations as they affect the dental auxiliary. Describe the licensure requirements for exposing dental radiographs. Define the legal concept of informed consent. Describe ways to obtain informed consent from a patient. 1. Dental Radiographs and the Dental Radiographer a. Importance of radiographs b. Uses of dental radiographs c. Benefits of dental radiographs d. Information found on radiographs e. Knowledge and skill needed by the radiographer f. Duties and responsibilities g. Professional goals 2. Patient Relations and the Dental Radiographer a. Interpersonal skills i. Communication skills ii. Facilitation skills b. Patient relations i. First impressions

26 ii. Chairside manner and patient relations iii. Attitude and patient relations 3. Patient Education and the Dental Radiographer a. Importance of patient education b. Methods of patient education c. Common questions and answers i. Necessity question ii. Exposure questions iii. Safety questions iv. Digital imaging questions v. Miscellaneous questions 4. Legal Issues & the Dental Radiographer a. Legal issues federal and State b. Legal issues and the dental patient i. Risk Management ii. Malpractice issues iii. Patient records iv. Patients who refuse dental radiographs U

27 Oral Radiography for the Dental Hygienist-DNH 130 Notes to Instructors U****All Radiology Faculty will need to be knowledgeable Uin the interpretation of radiographs. UGuide and Guidelines for Radiology Faculty Review packet. Notice pg. 3 E - x-ray Uretake rulesu are different on DXTRR compared to Uclient retake rulesu in the clinic manual. Establish a faculty member(s) that will be responsible for calculating and recording the Ulab competenciesu on each student s Master Tally Sheet. Establish a faculty member(s) that will be responsible for calculating and recording the Uradiograph gradesu for each student s Master Tally Sheet. In an effort to ensure faculty calibration, please critique/ interpret/ and fill out a landmark form the FMX on the CD (found in the back of the text) for case #5. (This is online for the new edition (Evolve) too as they stopped giving out the CD.) Look at these images as if they were handed in to you by a student. Use the provided interpretation sheets to accomplish this. I will send the answers in a few days for you to compare. Please let me know of any questions/concerns. See clinic manual to aid in interpretation and the Syllabus for DNH 130 for grading the films General Information for Laboratory Faculty A. Each student has an individual Ufile folderu. 1. These are for FACULTY USE ONLY!

28 2. Faculty may let students review grades/scores/radiographs and recollect. B. Each individual Ufile folderu contains and will hold: 1. 1 Master Tally Sheet (see sample) a. faculty record grades for radiographs and competencies C. Competencies D. Radiographs 2. All 6 Competency Forms (see samples) a. Automatic Processor b. Timed HBWX Process c. BWX Comp. on Lab partner d. Timed FMX Competency (Part I & II) e. Panoramic Competency on Lab Partner (Part I & II) f. Duplication Competency 3. All radiographs with critique forms that were taken on DXTRR. 1. FACULTY use AS GUIDE for preparing students for competency. 2. Try to have all competencies performed during Uassigned Uweek. There is wiggle room if you run out of time but that doesn t mean that a student can refuse to do competency that is assigned for that week. 3. Students may view these competencies prior to taking them they will also be up on Blackboard under Course Documents. 4. Once faculty document scores in each student s individual master tally sheet, students may review their competency scores. 5. Students may UnotU keep these graded competencies, master tally sheet or individual file folder. 6. Students may UnotU progress to another competency until current competency is met SATISFACTORILY. 7. Radiographs produced in Competencies may count toward Radiograph Requirements. 1. All radiograph requirements are listed in the tally sheet.

29 G. Student Lab Duties 2. All radiographs must be reviewed with lab instructor prior to exposing more radiographs. After practicing technique is successful, student will have UonlyU 2 opportunities to retake radiographs for successful radiograph requirements on DXTRR. Use clinical manual for retake policy on clients. 3. Students must process, mount, and complete critique form prior to turning in DXTRR radiographs for grade evaluation. **Allowed 2 retakes / film** 4. Students may UnotU progress to other DXTRR radiographs until they have met at least 86% on current radiographs. First attempt is graded and that grade stands but student will need to get to competency (85%). 5. Students must process, mount, and complete critique/interpretation/landmark forms prior to turning in client radiographs for grade evaluation. 6. Once faculty document scores in each student s individual master tally sheet, students may review their radiograph grades. 7. Students may UnotU keep these graded radiographs or envelopes. 1. Please assign each student to one Lab Duty day. 2. Failure to perform Lab Duties satisfactorily will result in a 2 point deduction from the Total calculated Lab grade. 3. Please record if unsatisfactory on Master Tally sheet. H. Student Tardiness / Unexcused Absence 1. UNO Personal Days Ufor lab. 2. Tardiness or unexcused absences will result in a 2 point deduction. 2. Record each occurrence on Master Tally sheet. 3. Deductions will be taken from the Total Lab grade. J.Student participation I. Assignments/homework 1. Students may work on Radiology Assignments & Radiology homework during lab. (Example: while waiting on x-rays, DXTR availability, etc.)

30 P week a. Students may use their books and extra resources (UnotU faculty assistance when involving homework). b. Please discourage group answer sessions for these assignments (i.e. copying each other s assignment). 2. Do UnotU collect homework from students. Most graded assignments are on the Blackboard site and students may be allowed to go do them on the computer lab if time permits and all lab exercises and competencies are up to date. Others are hard copy and the students are permitted to work on these as an individual effort. 3. Encourage the use of studnt resources on the Evolve site that accompanies the text if computer and time are available. 4. Students may go to the testing center to take the final lab exam during the 14 th and 15P if all competencies/exercises are done. 5. Have students bring in UExercises In Oral Radiography, Uby Robert Langlais and using small study groups review the questions in the texts-especially the ones that have the pictures with them as that is where most of their lab final will come from. J. Lab Grading 1. Faculty are responsible for interpreting, calculating and documenting each student s radiographs and competencies. Nothing will be mailed or sent for interpretation or grading. 2. Use each students individual Master Tally Sheet. 3. When UallU requirements are complete, mail master tally sheets for each student to Lord Fairfax Community College, attn: Linda Gill, 173 Skirmisher Lane, Middletown, Virginia, (I will be sending electronic workbooks for the lab grades and you can enter the grades there and them to me but if you are not comfortable with using Excel, please feel free to just use the hard copy of the master tally sheet for lab and mail the grades.) Flexible Lab schedule UWeek 1- Lab Reception duties reviewed and schedule handed out Orientation to x-ray machines demo parts and operation Orientation to automatic processor/ Manual processor (Site specific-see clinic manual)

31 Introduction to film packets/digital receptors/phosphor plates- Each student is to open a film and verbalize the details about the components (what they are used for, made up of and the reason they are in the packet ). Review protocols for exposing radiographs on clients- Electronic Chart must be made Fill out appropriate forms- Med. Hx., Informed consent, Perio. and Caries Risk Assessment, Dental History, HIPAA,Client Rights and Radiation History Sheet Client is to sign in the appropriate areas No exposure without instructor confirmation- Use guidelines found in The Selection of Patients for Dental Radiographic Examinations found on Blackboard under Course Documents and on Page 47 of the Iannucci text Need instructor signature in 3 places 1. -Green IE/OE sheet 2. -Informed consent 3. -Radiation History sheet Films/sensors are to be gotten by the instructors and are to be kept in a locked cabinet All films need to be seen by DDS to look for caries and pathology-have him sign on grade sheet critique sheet that he has reviewed films All films need to be graded and all grades count. Retakes are to be kept to a minimum. See clinic manual. Films should be turned in for grading within 1 week of date of exposure. Films on clients go to fulfill requirements in dnh 130 only Have student process 2 films- one exposed to light (use the one they opened) and one unexposed using the automatic processor Sterilize XCP Review Automatic processor competency UWeek 2- Demo/ infection control and glove usage for radiographic exposure Demo XCP and how to place it in the mouth comfortably Have student practice placing film on each other using aseptic technique Demonstrate duplication process ****Automatic Processor Competency- all students UWeek 3-

32 Student take horizontal (4) and vertical (7)bwx on Dxtrr. (these are to be critiqued by the student first then with instructor. (All films should be kept in the students file folder.)these films are to be graded as part of the lab grade. Refer to guidelines for retakes. ****Duplicating Competency-(use the horizontal bwx taken this week) UWeek 4- Student take and develop FMS paralleling technique on DXTRR right side mount and critique with instructor ****Timed HBWX Competency UWeek 5- Students continue taking radiographs Take FMS left side on DXTRR paralleling technique-mount and critique-these films (both right and left side)are to be graded (one grade) Complete Vertical Bitewing series (if needed)-mount and critique- These films are to be graded ****BWX on lab partner Competency USubmit client info for your FMS client- **UFaculty are to evaluate (approve/ disapprove) the rationale and need for that client UWeek 6 Take ½ FMX using snap- a- ray these are to be critiqued (non- graded exercise; films and critique sheet should be kept in the students file Take 4 horizontal bwx using tabs-these are to be critiqued by student then graded Take pedo bwx- These are to be critiqued by student then graded ****Finish all competencies to date Faculty should have FMS schedule available for students to sign up Allow 45 minutes for each student Students to present a chart with filled out (and signed) Med. Hx., Informed consent, Perio. and Caries Risk Assessment, Dental History, HIPPA,Client Rights and Radiation History Sheet get confirmation for radiographs on client. UWeek 7 Week 7, 8 & 9 are devoted to taking a FMX on a patient. This client/student must have filled out a Med. Hx., Informed consent, Perio. and Caries Risk Assessment, Dental

33 History, HIPAA,Client Rights prior to radiograph exposure. The student is to present this information along with a rationale for taking radiographs to their instructor *****UBY WeekU 6 ***** to get confirmation that radiographs are needed. If the student is not scheduled to take the radiographs and they are complete to date with competencies and radiographs, they do not have to attend the lab unless they are scheduled to take films but they will need to let their instructor know that you will not be there. Failure to let instructor know will result in a 5 point deduction from total lab grade. Student taking the radiographs on the client/classmate must: 1. Check-in with faculty, present treatment plan, consent, vitals, etc. 2. Treatment notes must be complete/signed by faculty, etc. 3. (Use guidelines found in The Selection of Patients for Dental Radiographic Examinations found on Blackboard under Course Documents and on Page 47 of the Iannucci text) Take develop and interpret FMS on patient (use double films/sensors)- At their scheduled time, the student should have 45 minutes to expose films on their client. Do not let the patient leave until the student develops the films and you determine if retakes are necessary. The student will need to complete the technique form, the interpretation form and the landmark form for the FMX taken on a client within one week of exposure. All these forms will be graded. Each form is worth 100 points. Please use the grading rubric found in the syllabus for technique critique and the retake rule from the clinic manual for FMX. The instructor will grade the interpretation form and deduct appropriate points for each error (see form). The landmark sheet is also graded by the instructor. Directions for grading will be found on that form. (The DDS. will need to review the films too and indicate in electronic chart that he/she has done so.) Finish radiographic requirements on DXTRR (as needed) Critique FMS and review with an instructor UWeek 8 Take develop and interpret FMS on patient (use double films/sensors)- At their scheduled time, the student should have 45 minutes to expose films on their client. Do not let the patient leave until the student develops the films and you determine if retakes are necessary. The student will need to complete the technique form, the interpretation form and the landmark form for the FMX taken on a client within one week of exposure. All these forms will be graded. Each form is worth 100 points. Please use the grading rubric found in the syllabus for technique critique and the retake rule from the clinic

34 manual for FMX. The instructor will grade the interpretation form and deduct appropriate points for each error (see form). The landmark sheet is also graded by the instructor. Directions for grading will be found on that form. (The DDS. will need to review the films too and indicate in chart that he/she has done so.) Student taking the radiographs on the client/classmate must: Check-in with faculty, present treatment plan, consent, vitals, etc.; Treatment notes must be complete/signed by faculty, etc. Critique FMS and review with an instructor Finish radiographic requirements on Dxtrr UWeek 9 Student taking the radiographs on the client/classmate must: Check-in with faculty, present treatment plan, consent, vitals, etc.; Treatment notes must be complete/signed by faculty, etc. Take develop and interpret FMS on patient (use double films)- At their scheduled time, the student should have 45 minutes to expose films on their client. Do not let the patient leave until the student develops the films and you determine if retakes are necessary. The student will need to complete the technique form, the interpretation form and the landmark form for the FMX taken on a client within one week of exposure. All these forms will be graded. Each form is worth 100 points. Please use the grading rubric found in the syllabus for technique critique and the retake rule from the clinic manual for FMX. The instructor will grade the interpretation form and deduct appropriate points for each error (see form). The landmark sheet is also graded by the instructor. Directions for grading will be found on that form. (The DDS. Will need to review the films too.) Critique FMS and review with an instructor Finish radiographic requirements on dxtrr. UWeek 10 Activity-Evaluation of FMS on patient-already taken; Review procedure for taking Pan

35 Digital radiographs- take 4 HBWX using digital equipment. (If already done using digital then do 4 HBWX using traditional films USubmit client info (chart) for your Pan client**ufaculty are to evaluate the rationale and need for that client. Use guidelines found in The Selection of Patients for Dental Radiographic Examinations found on Blackboard under Course Documents and on Page 47 of the Iannucci text UWeek 11 Take occlusal maxillary and mandibular projection (DXTRR) Expose two films to demonstrate localization technique (tape a metal object [ for example- bur or paper clip] ****Panoramic competency on partner Confirmation of need for panoramic radiograph on client Schedule for exposing panorex - allow minutes per student. USubmit client info (chart) for your Pan client**ufaculty are to evaluate the rationale and need for that client, if not already done. Use guidelines found in The Selection of Patients for Dental Radiographic Examinations found on Blackboard under Course Documents and on Page 47 of the Iannucci text. Week 12 & 13 are devoted to taking a Pan on a patient. This client must have filled out a medical history form along with a dental history form, HIPAA, Informed Consent, and risk assessment forms prior to radiograph exposure. The student is to present this information along with a rationale for taking radiographs to instructor. Use guidelines found in The Selection of Patients for Dental Radiographic Examinations found on Blackboard under Course Documents and on Page 47 of the Iannucci text *****UBY WeekU 11 to get confirmation that radiographs are needed. If the student is not scheduled to take the radiographs and is complete to date with competencies and radiographs, they do not have to attend the lab but will need to let instructor know that they will not be there. Failure to let your instructor know will result in a 5 point deduction from total lab grade. Please make note on tally sheet. UWeek 12 Take develop and evaluate pan on Client Critique/Grade with instructor Have DDS review film UWeek 13

36 Take develop and evaluate pan on Client- Critique/Grade with instructor Have DDS review films UWeek 14 Lab Finish Radiographic requirements/ review pans Individualized instruction Lab Final TBA UWeek 15U Lab Finish Radiographic requirements/ review pans Individualized instruction Lab Final TBA Grading of radiographs A. FMX 2 total sets graded for class (one DXTRR/ one Client) total points possible /set 2. Points to be taken off for each error: UPacket Placement 1 point UBitewings Premolar view -should see the distal of both max. and mand. canines Molar view- -Should see the distal of both max. and mand. second premolars Anterior views o Centrals- midline should be centered on the film o Canines- Lateral should be centered UPeriapicals Premolar view -should see the distal of the canine but not any of lateral