Paediatric dentistry requires an abundance of extra qualities from the clinician on top of the typical clinical skills needed to treat adults. Patients can be half the size and twice as difficult to manage in the dental chair, meaning delivering care can sometimes be a challenge.
There are many aspects that will be similar to general dental care. Oral hygiene advice will need to be given, periodontal health will need to be assessed, and radiographs may be required.
What is obvious, however, is each aspect will need to be amended slightly for the patient in question. Communication is an obvious example; there are a variety of approaches that can be taken for typical dental procedures in children. These include the tell-show-do method to make patients comfortable with the practice, or the ask-tell-ask approach which can give better insights on the paediatric patient’s anxieties.
Radiography, however, creates new questions for practitioners and the carers of paediatric patients alike. Understanding how radiographic approaches may need to change is essential to ensure patients are safe and treated to a high standard.
Radiographic exposure for the paediatric patient
Radiography has been refined to a safe art in modern healthcare, and offers professionals insights into the health of bones and organs at the cost of minimal radiation exposure. The average person in the UK is estimated to be subjected to about 2.7mSv (millisieverts) of background radiation a year. The average radiation dose for a panoramic radiograph is just 0.007mSv, equating to around a day’s extra exposure. For paediatric patients, this means that a typical exam will be safe, and not present a great risk of adverse outcomes.
However, do not take this to mean that professionals can become complacent and request a young patient undergoes a radiograph without good measure. Over time, repeated exposure to radiation increases the probability of stochastic damage, and so the development of an adverse outcome – for example, a tumour – is possible with frequent radiograph use. Note that children have an increased radiosensitivity when compared to adults.
The European Academy of Paediatric Dentistry recognises this, and reinforces the need to optimise radiographs that limit exposure whilst obtaining the minimum quality image necessary to inform treatment. This is, in effect, the same as the ALARP principle, meaning ‘as low as reasonably possible’, that is also laid out in the guidance issued by UK regulatory bodies.
Justifying exposures
Two key aspects of the ALARP principle include the justification and optimisation of a radiographic exposure.
Firstly, one must ask if it is necessary – could the information displayed change a treatment plan and help find a new solution to an oral health problem? And secondly, what is the best way to take the radiograph in each instance, with the minimum possible radiation exposure, whilst ensuring the clinician has all of the information needed to make a confident assessment?
A paediatric patient may require a radiograph for a variety of justifiable reasons. The WHO Global Oral Health Status Report from 2022 estimated that 514m children have caries in their deciduous teeth, and a further 2bn people have caries in their permanent teeth – the latter will likely include paediatric patients. Assessing the extent of a carious lesion is vital when choosing the best care for a patient, and may justify a radiograph. This can minimise overtreatment, essential particularly in the primary dentition.
Dental trauma is a problem that mostly affects younger patients – 80 per cent of cases occur in those under 20 years old – and also may require a radiograph to judge the extent of an injury. This can ensure any problems caused by the trauma are recognised and treated before they develop further.
Improving results
Optimising a radiograph for a paediatric patient is a challenge in itself. Children are much more likely to move during a CBCT examination, which may indicate the need for radiographs with a single exposure where at all possible. If a patient does move, but the scan is still diagnostically acceptable, it should not be retaken.
Choosing a solution that is comfortable for the patient, and reliably provides a high-quality diagnostic image is key to delivering a successful result. The CS 7200 Neo Edition imaging plate system from Carestream Dental delivers high-resolution images in just eight seconds. The three plate sizes available mean you can choose the optimal solution for your patient, whether they are a child, adult, or somewhere in between, and can help create high quality periapical, bitewing and paediatric images.
Radiography is an essential element of paediatric dentistry that must be managed safely to protect patients and deliver high quality results. In turn, clinicians can support young individuals get the care they need in a timely and appropriate manner.
For more information visit www.carestreamdental.co.uk