The printed quality of a digital image is sometimes inferior to that of traditional radiographs, although digital images are usually viewed on-screen. Digital x-ray images must be stored Intensifying screens Film and digital receptors can be used in combination with intensifying screens to minimize a patient’s exposure to radiation. The coatings on intensifying screens fluoresce when exposed to radiation, further exposing the x-ray film. This decreases the amount of radiation needed for a correct exposure. Screens coated with rare-earth elements are much more sensitive compared to calcium tungstate-coated screens as the former is faster with an increased absorption and conversion efficiency (Goel and Jones, 2021). Rare-earth phosphors used Common radiographic mistakes Several common mistakes affect the quality of intraoral and extraoral dental x-ray images. Improper angulation or positioning of the tube head can cause foreshortening, elongation, or cone- cuts. Improper positioning of film in the film-positioning device (i.e., reversing the intraoral film so that the lead foil is closer to the beam) may cause a waffle-weave or herringbone effect on the image. Patient, film, or tube-head movement may cause blurred images or cone-cuts. Improper film handling may result in scratches or bends in the film, static charges on the film, and/ or double exposures. Incorrect pairing of intensifying screen type with film type can result in improper exposure. Problems with processing may cause spotting on the film, overlapping films, lost film, dark film (overdeveloped or overexposed), or light film. Light film may be caused by underdeveloping (e.g., insufficient developing time, cold developing solutions, or old solutions), as well as by unexposed or underexposed film. Before increasing exposure time or the kilovoltage, the operator should check that the processing solutions are fresh, because old processing solution is more likely to be the cause of light film. This is especially true of developer Gag reflex One common complication in radiographic technique is the patient’s gag reflex. A study that focused on understanding the etiology and effective management of gag reflexes reported that gagging in the dental setting is usually caused by psychological or physiological factors, or both (Eachempati, et.al., 2019). The patient may have a physical condition or may have previously experienced a trauma that influences his or her susceptibility to gagging; even fear of gagging can increase susceptibility. The gag reflex is a natural part of the body’s self-defense mechanism, usually triggered by irritation of the soft palate or the posterior part of the tongue. Other predisposing physiological factors include inability to breathe through the nose properly, sinusitis, nasal polyps, dry mouth, mucus in the upper respiratory tract, and medications with nausea-inducing side effects (Gupta, et al., 2018). Patients with mild to moderate gag reflexes can be managed in the dental office; those with severe reactions may require management by specialists or clinicians. One option to combat an exaggerated gag reflex is the use of topical anesthetics (Lineberry, 2018). Several brands of anesthetic sprays or liquid rinses containing lidocaine are available without a prescription. Over-the-counter sprays containing benzocaine may numb the back of the throat long enough for an intraoral x-ray film to be exposed. Lozenges may also be effective. Lineberry (2018) reported that rubbing salt on the sides of the tongue a few minutes before an intraoral procedure was effective in suppressing gag reflex. Centrally-acting pharmacological agents such as antihistamines and anxiolytic medications may be of benefit to some patients (Eachempati, et. al., 2019). The dose- related response to these medications is variable and the use of an anxiolytic medication requires a responsible adult to drive the patient to and from the appointment. The authors also reported
on computers or other storage media to prevent loss of patient information.
in intensifying screens include gadolinium, lanthanum, terbium, thulium, and yttrium. When rare-earth screens fluoresce, they emit green, blue, or ultraviolet light depending on the impurities (i.e., other rare-earth phosphors) added to the screen coating. The additional exposure provided by the fluorescence varies depending on the coating used on the intensifying screen. The operator must be careful to pair the proper intensifying screen with the film speed used to achieve the intended exposure (Goel and Jones, 2021).
RADIOGRAPHIC TECHNIQUES AND CHALLENGES
solutions because they often oxidize and need replacement more frequently than fixer solution. Poor-quality radiographs may also be the result of film fog, which can interfere with the clarity of images. Fog can result from use of old film, improper safelighting, contaminated or old developing solution, or film stored at high ambient temperatures; exposure of the film to white light; and scatter radiation from x-ray sources. Bite wing tabs or loops, locking hemostats, patient finger pressure, and specialized film holders and film positioning devices have been used to enhance radiographic techniques and decrease the chance of radiographic errors. In their study, incorrect positioning of intraoral film and collimators was the most common cause of repeat exposures and that film holders and properly aimed collimators substantially reduced retakes (Bhatti, et. al., 2020). Although new film holders have facilitated the technique of taking dental radiographs, other challenges still must be faced. that desensitization techniques practiced by the patient at home – such as having him or her carefully introduce a dental mirror in the mouth or digitally massaging the palate – helped reduce the gag reflex during a subsequent dental procedure (Lineberry, 2018). Other distraction techniques involve having the patient wiggle his or her toes or lift a leg. Another approach that is effective in reducing a patient’s gag reflex is acupuncture. An acupuncture needle is inserted into the Anti-gagging point of both ears just above the tragus and rotated clockwise and counterclockwise and remain in place during the dental procedure that can stimulate the gag reflex in susceptible patients. Although the exact mechanism by which acupuncture can diminish the gag reflex is not clearly understood, this technique may decrease the influence of the Vagus and Trigeminal nerves on the gag reflex (Hashim, et. al., 2017). Acupuncture is not a technique taught in dental school so clinicians who opt to use this technique must receive additional training in this treatment modality. Conscious sedation is also an option but should be a method of last resort. When sedation is used, the gag reflex is eliminated but other reflexes that protect the patient’s airway remain intact (Gupta, et al., 2018). When all else fails, the patient may need a panoramic x-ray with supplemental bite wings. In general, x-ray film is much softer today, but patients may still complain about the sharp edge of film packets, especially when a mandibular periapical film is positioned between the tooth and the tongue. Coating the edge of the film with a small amount of topical anesthetic, carefully swabbing the floor of the mouth with topical anesthetic, and/ or placing a piece of cotton gauze around the film may alleviate this problem.
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