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