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Pediatric dentistry & Children Orthodontics

AAPD recommendation

About radiographs in pediatric dentistry...

Many parents refuse to make radiographic examinations on their children because they think that this is carcinogenic radiation, i.e., it may trigger the growth of cancer cells in children. However, this fear is unfounded and should not exist because the radiation used in the pediatric dental office is minimal. It is only performed the x-rays that patients need. In everyday life, without realizing it, we expose ourselves to a specific lot of radiation such as solar radiation, radio waves, microwave oven, cell phones, television, laser beams, among others.

Did you know that dental radiographs are only equivalent to one hour of sun exposure in the environment?

The dental radiographic exposure represents only 1% compared with other radiological exposures in other fields of health sciences. At a federal and state level, the government health offices establish a set of regulations for the operation of radiographic equipment, proper use of this equipment, its maintenance, and the dosage that it can emit.

In our office, the pediatric dentist is very careful. First, the radiographic digitalized film in use is not only highly sensitive, and also minimum radiation exposure is applied.  Second, we have "lead protective aprons" for the patient's body as well as for the neck and thyroid of children.  If the cooperation of parents is required to fasten the child while radiographs are being taken, we use "lead protective aprons" for an adult. In cases where parents want to be present while we take x-rays, we place them 2 meters away from the device and radiological exposure and behind the cone or 45 degrees behind it.  We also use digitized rapid and sensitive receptors to reduce the exposure to a factor of two. We provide to dental assistants with dosimeters for monitoring and protection in the event of pregnancy.

Types of Dental X-rays:

  1. A child with Primary Dentition: before the eruption of the first permanent tooth, an individualized radiographic exam consisting of selected periapical/occlusal views and posterior bitewings if proximal surfaces cannot be easily visualized.  Patients with no indication of a disease and with what is called open proximal contacts (diastema) may not require a radiographic exam at this time unless a tooth development disorder is suspected.
  2. A child with Transitional Dentition: When the first incisors and permanent molars already have erupted, the radiographs would be periapical proximal views, and panoramic.
  3. A child with Permanent Dentition: In the early puberty stage and during adolescence, we make single proximal and panoramic radiographs in case of suspected periodontal diseases or other injuries that require treatment.

The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children aged 3-6 years and for those children with high-risk caries. In many cases, children between the ages of 3-6 years are not cooperative when we try to take radiographs; therefore, it is better to delay radiographs until the patient improves their behavior and understands that it is only a radiograph. Moreover, If the child becomes more cooperative, then we begin by taking an intraoral radiograph; therefore, they will gradually become more used to routine dental checkups.

Pediatric dentists use behavior modification techniques to take these valuable dental images, including the following:

  • Tell-Show-Do: Familiarize the child with the radiographic camera, let him touch it, and see how it works.
  • Using the mirror to permit him to visualize the plate or film while is in his mouth.
  • Starting by taking the easiest radiographs, which are those of the anterior teeth.
  • Using the size of the film or plate according to the size of the child's mouth and bend a little edge or angle of the plate or film not to injure or irritate your gums and also to prevent nausea.
  • Putting the cone or chamber at first in the area we want to get the image, so that when we shoot, or we press the button to get the image, we can do it well quickly, and we can avoid the discomfort that can cause taking radiographs on children-patients.  Let's not forget that children have short er attention spans and even less when they have some anxiety.
  • Ultimately, if these techniques do not serve for radiographic evaluation, then we resort to advanced behavior management techniques with the use of relaxing gas (nitrous oxide), oral conscious sedation, physical subjection by their parents, and always their consent.

In our office, we try to take the minimum of radiographs needed. Just the essentials every six months for follow-up evaluations after trauma or other pulp treatment, to assess the injury and to monitor the dental development of children and adolescents. Remember that the pediatric dentistry today is purely preventive!

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