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114 Cards in this Set
- Front
- Back
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What is the purpose of infection control?
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to prevent the transmission of infectious diseases from dental personnel to patient, patient to dental personnel, or from patient to patient |
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What are the routes of transmission? |
- direct contact w/ pathogens (open lesions, blood, saliva, etc.)
- direct contact w/ airborne contaminants (aerosoles) - indirect contact with contaminated objects or instruments |
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What are 4 examples of personal protective equipments (PPE)? |
- gloves - masks - gowns - protective eyewear |
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Which equipment needs to have a barrier on it in the x-ray room? |
- x-ray tube head and supporting arms - x-ray chair headrest - control panel - patient bib on counter top |
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What do you place on the patient bib that is on the counter top? |
clean films, film positioning instruments, and a new plastic cup |
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How often should the counter tops be disinfected? |
at least after every clinic |
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When do you disinfect the lead apron/thyroid collar? |
when necessary |
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Which equipment will you NEVER disinfect? |
the x-ray tube head or control panel |
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How often do you sterilize positioning instruments? |
between uses |
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Where do you place ALL contaminated films after they have been exposed? |
in the plastic cup |
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What infection control steps do you take after all films have been exposed? |
1. place films in the plastic cup 2. remove gloves 3. disinfect hands 4. pick up the plastic cup w/ bare hands 5. transport to the darkroom |
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The object of the infection control steps taken after films have been exposed is to do what? |
get the films into the darkroom without contaminating the darkroom revolving door |
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What infection control steps do you take to handle the films once you are in the darkroom? |
1. place 2 paper towels on the counter 2. strip the films & place on "clean" towel 3. place contaminated debris in the trash can 4. remove gloves 5. disinfect hands 6. place films in processor with clean, bare hands |
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Radiographic instruments and equipment are classified according to what? |
their risk of transmitting infection and to the need to sterilize them between uses |
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In general, what are examples of critical dental instruments or equipment? |
needles, forceps, and scalers (used to penetrate soft tissue or bone) |
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How do you clean critical dental instruments or equipment and how often? |
sterilize after each use |
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Are there any critical instruments or equipment used in dental radiology? If so, what are they? |
No |
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In general, what are examples of semi-critical dental instruments or equipment? |
intraoral dental mirrors and burrs (they contact but do not penetrate soft tissue or bone) |
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How do you clean semi-critical dental instruments or equipment and how often? |
sterilize after each use |
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Are there any semi-critical instruments or equipment used in dental radiology? If so, what are they? |
image receptor holders, digital sensor/phosphor plate, panoramic biteblocks |
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In general, what are examples of non-critical dental instruments or equipment? |
lead apron, the PID, and the exposure button (they do not come in contact w/ the mucous membrane) |
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How do you clean non-critical dental instruments or equipment and how often? |
disinfect using an EPA-registered chemical classified as an intermediate-level disinfectant ( Cavicide) when necessary. |
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In general, what is an example if a clinical contact surface? |
head positioned guides of a panoramic x-ray machine (do not contact the patient or contact is with the skin only) |
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How do you clean clinical contact surfaces and how often? |
disinfect using an EPA-registered chemical classified as an intermediate-level disinfectant ( Cavicide) when necessary. |
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Are there any non-critical instruments or equipment/clinical contact surfaces used in dental radiology? If so, what are they? |
X-ray tube head, PID, support arms, exposure controls**, lead/lead-equivalent apron & thyroid collar, countertop in operatory and darkroom, extraoral radiographic machine parts (chin/forehead rest, side head positioner guides; cephalostat) |
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What does the CDC state about PPE? |
"Wear gloves when exposing radiographs and handling contaminated film packets. Use other PPE as appropriate if spattering of blood or other body fluids is likely" |
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What are the licensure requirements for dentists and hygienists to take x-rays? |
automatic by the state board |
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What are the licensure requirements for dental assistants to take x-rays? |
they must pass a certification exam within 6 months of employment (training period) |
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Informed consent |
(notes) we have a standard consent form that covers all aspects of TX (book) the consent that patient gives for treatment after being informed of the nature & purpose of all treatment procedures |
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What should the patient be informed of prior to taking x-rays? |
1. the purpose of taking radiographs 2. the benefits the radiographs will supply 3. the possible risks of radiation exposure 4. the possible risks of refusing radiographs 5. the person preforming the procedure |
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What should you avoid in the office when taking x-rays? |
any negative comment about the equipment, competence of yourself or anyone else in the office |
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What should you NEVER say when taking radiographs? |
"OOPS" |
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Documentation |
"findings" form is critical and is a permanent part of the patient's record |
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What must be documented into the patient's record following radiographs? |
informed consent, number and type of radiographs (including retakes), date the radiographs were taken, name of the radiographer, reason for radiograph, and the results |
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State laws have always governed confidentiality to do what? |
protect the patient's privacy |
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HIPPA - 1996 - (Health Insurance Portability and Accountability Act) was designed to do what? |
to provide patients with control over how their personal health information is used and disclosed |
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Radiographs should NEVER be shown to anyone outside the oral health care practice without obtaining _______. |
a current signed release from the patient |
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In 2003, HIPPA was amended to include what? |
privacy standards to protect the patients' medical records and other health information, including radiographs |
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Who owns the radiographs? |
the dentist |
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When are patient's allowed to request copies of their radiographs? |
if they decide to change dental offices or for a consultation with a specialist for a second opinion, etc. |
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Should a patient's original radiographs ever leave the office? |
NO!! NEVER!! |
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How long should radiographs be kept? |
7 years but it is recommended to keep them forever because of legal action that could be brought against the dentist |
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Statute of limitations |
places a time limit on pursuing a legal remedy after an injury occurs |
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When does the statute of limitations for adults start? |
starts at the time of injury of when the injury should have been discovered |
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When does the statute of limitations for children start? |
does not begin to run until the child reaches the age of majority (18 or 21 depending on the state) |
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Statute of limitations vary depending on what? |
the state |
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In Texas, when does the statute of limitations for children start? |
2 years |
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Insurance companies have the right to do what? |
request pretreatment radiographs to evaluate the dental treatment plan for services that they will be paying for to avoid fraudulent claims |
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What kind of images may some insurance companies accept? |
digital images |
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Negligence |
the failure to use a reasonable amount of care when failure results in injury or damage to another |
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If a patient discovers negligence years later after treatment, when does the statute of limitations begin? |
years after the negligent dental treatment occured |
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What is a common example of negligence? |
an irreversible periodontal condition that could have been prevented if detected (with appropriate radiographs) and treated earlier |
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Why do patients often refuse radiographs? |
the cost or they believe that the x-ray exposure will be hazardous to their health |
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If the patient STILL refuses x-rays, after explaining that radiographs are essential for diagnosis, prognosis, and treatment planning, what must the dentist do? |
decide whither treatment can be provided |
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Can a patient legally consent to negligent care? |
NO!! |
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Ethics |
a sense of moral obligation regarding right and wrong behavior |
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What are the goals of the dental radiographer? |
- achieve perfection w/ each radiograph - perform confidently & w/ authority - take pride in services rendered & professional advancement - keep radiation exposure as low as possible - avoid retakes - develop integrity, dedication & competence |
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Intraoral radiography consists of what? |
methods of exposing dental x-ray film, phosphor plates, or digital sensors within the oral cavity |
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What is the purpose of a bitewing examination? |
to image the coronal portions of the teeth and alveolar crests of the bone of both the maxilla and mandible on one film |
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What are bitewings mainly used for? |
detecting interproximal caries and to examine the crestal bone |
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What is the purpose of a periapical examination? |
to image the apices of the teeth and surrounding bone |
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What is the purpose of an occlusal examination? |
to image the entire maxilla or mandible on one film |
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What can you see with an occlusal examination? |
the midline of the maxilla and soft tissue under the tongue |
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What are the 2 basic techniques used for intraoral radiography? |
1. Bisecting (oldest 1907) 2. Paralleling (1920) |
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Which technique used in radiography is considered the best and why? |
Paralleling technique because is minimizes distortion better than bisecting |
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What are the 5 rules for casting a shadow image? |
1. small focal spot 2. long focal (source of radiation) - film distance 3. short object (tooth) - film distance 4. object (tooth) & film parallel 5. central ray perpendicular to object and film |
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What are the 3 important things that image receptor positioners accomplish? |
1. sets the horizontal angle (open contacts) 2. sets the vertical angle (sets central ray perpendicular to object & film) 3. centers the beam on the film (avoids cone cuts) |
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What should you be sure to do when using a film-holding device (rinn xcp positioners)? |
be sure that the dot is in the slot facing away from the apices of the teeth, so it won't interfere with diagnosis |
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How should the patient be seated when radiographs are being taken? |
chair back in an upright position with their head straight (headrest) |
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If image receptor positioners are not being used, what head position is necessary? |
head straight with occlusal plane parallel to the floor |
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How is correct horizontal angulation achieved? |
by directing the x-ray beam directly through the interproximal spaces perpendicularly to the mean tangent of the teeth |
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Errors in horizontal angulation will result in? |
overlapped contacts |
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How is correct vertical angulation achieved? |
by directing the central ray at a right angle to the surface of the image receptor |
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Errors in vertical angulation will result in? |
foreshortening or elongation of the radiographic image |
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What causes foreshortening of the radiographic image? |
if the vertical angle is too steep |
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What causes elongation of the radiographic image? |
if the vertical angle is too shallow |
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What is the suggested sequence of receptor placement when making a full mouth radiographic survey? |
1. maxillary anterior periapical 2. mandibular anterior periapical 3. maxillary posterior periapical 4. mandibular posterior periapical 5. anterior bitewings ???? 6. posterior bitewings |
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What do periapical films show? |
the entire tooth from occlusal or incisal edge to 2mm (minimum) past root apex |
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What do bitewing films show? |
all of the crowns and part of the roots |
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What can bitewing films detect? |
caries, alveolar bone height, recurrent decay, fit of metallic restorations |
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What is the criteria for intraoral periapical radiographs? |
1. show proper definition & detail & degree of density and contrast 2. no distortion 3. show entire tooth & root apices 4. show entire alveolar process 5. all contacts open @ least once 6. no cone cuts 7. no cracks, bends, etc. 8. processed properly |
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The periapical examination paralleling technique: |
1. film is held parallel to the long axis of the tooth 2. central ray perpendicular to the film 3. film must be placed away from the teeth |
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What are the advantages of the periapical paralleling technique? |
- less dimensional distortion - more valid for diagnosis - easier to standardize - head position not as critical |
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What are the disadvantages of the periapical paralleling technique? |
- cost of equipment - infection control - "long" cone - more difficult to place - discomfort from positioning devices - longer exposure time |
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The periapical examination bisecting technique: |
1. film placement & number of films the same 2. films held by patient's finger or devices |
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What are the advantages of the periapical bisecting technique? |
- easier to learn - easier on patient - infection control ** - short PID |
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What are the disadvantages of the periapical bisecting technique? |
films are NEVER as accurate |
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What degree variation in the vertical angle is acceptable with the endodontic technique? |
20 degree variation |
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What is necessary which the endodontic technique to separate canals in multirooted teeth? |
variations in the horizontal angle |
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What can be very difficult to place correctly with the endodontic technique? |
"working" films (taken during the procedure) |
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During a bitewing examination, what film size do you use on an adult? |
#2 film depending on the arch size and teeth present |
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During a bitewing examination, what film size would you use on a patient with mixed dentition? |
#2 premolar, but for a small or uncooperative mouth use a #1 with sticks on the tabs w/ 1 premolar film on each side |
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During a bitewing examination, what film size would you use on a patient with deciduous dentition? |
#0 with sticks on the tabs (one for each side) |
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What areas are covered with posterior bitewings? |
all crowns, superior part of roots, alveolar bone height, open contacts, premolar position, molar position, and vertical bone loss |
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What are 2 examples of film hold devices? |
1. positioning devices with aiming ring 2. tabs - loop or stick-on tabs |
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During a bitewing examination, when is the vertical angle automatic? |
when positioning devices are being used |
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During a bitewing examination, what is the vertical angle when using tabs? |
+10 degrees |
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During a bitewing examination, what is the horizontal angle when using tabs? |
when the central ray is at a right angle to the film |
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What should a premolar bitewing image cover? |
the distal half of the mandibular canine anteriorly and the crowns of the maxillary and mandibular premolars |
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What should a molar bitewing image show? |
the distal half of the 2nd premolar and the crowns of the maxillary and mandibular molars |
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What are vertical bitewings used for? |
to show more of the alveolar bone |
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Quality assurance |
the planning and carrying out of procedures to assure high-quality radiographs with maximum diagnostic information (yield) while minimizing radiation exposure |
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What are the objectives of quality control? |
1. maintain a high standard of image quality 2. identify problems before image quality is compromised 3. keep patient and occupational exposures to a minimum 4. reduce the occurrence of retake radiographs |
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What are the requirements for an acceptable radiograph? |
1. show an anatomic area of interest without distortion 2. have proper density adjusting mA or time 3. exhibit sufficient definition (sharpness) 4. have sufficient contrast b/w adjacent ares |
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What determines contrast? |
kVp |
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What are the quality control guidelines? |
1. film quality should be monitored against a standard reference film 2. processing chemicals should be checked daily 3. a daily log of all retakes 4. check darkroom (light leaks, safelight) viewboxes, cassettes, & screens 5. comprehensive testing of equipment 6. annual check w/ a radiographic monitoring device |
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How often does Texas require comprehensive testing of x-ray equipment? |
every 4 years by a licensed technician |
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Step-wedge test for developer: |
- reference film is made with each new bath of developer & fixer - reference film is compared w/ another step-wedge film daily before any patient films |
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The developer is weak and must be changed if the step-wedge film is off by ________. |
2 or more steps |
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Clearing test for fixer: |
- clearing time should be 2-3 minutes - place fresh film in the fixer for 4 minutes |
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When is the fixer considered weak and needs to be changed? |
if the film has not been cleared by 4 minutes |
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How do you test the safelight? |
with a coin test // place coin on film and then place it under a safelight |
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When do you know the safelight is not good? |
if there is fog on the film surrounding the coin |
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When should you set the exposure time? |
BEFORE you place the film |
