Lecture 20 - Pediatric Radiographs & Teeth Disturbances

what is the primary goal of the alliance for radiation safety in pediatric imaging?

to raise awareness in the imaging community

of the need to adjust radiation dose when imaging children

what is an x-ray?

electromagnetic radiation of great penetrating power, produced by the bombardment of a

substance by a stream of high velocity electrons, usually in a vacuum tube

what cells are the most radiosensitive?

cells with a high mitotic rate, cells who undergo many future mitosis, cells with very primitive differentiation

what are deterministic effects?

response proportional to the magnitude of a dose

what are stochastic effects?

response proportional to the frequency of a dose

what shape of the collimator best reduces patient exposure?

rectangular

what can clinical evaluation and specific selection of periapical radiographs allow for?

43% reduction in number of radiographs

where are radiographs limited to?

areas required for adequate diagnosis and treatment

should radiographs be prescribed at present intervals for all patients?

no

should radiographs be prescribed before or after clinical evaluation?

after

how far from the patient should the provider stand while taking a radiograph?

6 feet

what should be considered in selection criteria for radiographs

exposing radiographs in asymptomatic children, development of dentition, risk of caries

what radiographs are indicated for a child with primary dentition only?

individualized radiographic exam with selected periapicals / occlusal views or posterior bitewings

what radiographs are indicated for a child with transitional dentition?

individualized radiographic exam consisting of posterior bitewings with

panoramic exam or posterior bitewings and selected periapical images; if low risk, retake BWs every 24 months

individualized radiographic exam consisting of posterior bitewings with panoramic exam or

posterior bitewings and selected periapicals; FMX when the patient has clinical evidence of

generalized dental disease or a history of extensive dental treatment

what is the preferred periapical radiograph technique?

paralleling

1 multiple choice option

what is the placement for a mandibular anterior occlusal radiograph?

film placed on the occlusal surfaces; long axis is AP direction; film extends ¼ inch labial; beam just above the chin point; 60 degrees

what are the advantages of panoramic radiographs?

broad coverage of the facial bones and teeth; low patient radiation dose; ability to use in patients unable to open their mouths; short time required to make the panoramic image

what are the disadvantages of panoramic radiographs?

images do not display the fine anatomic detail; unequal magnification; geometric distortion across the image; overlapping structures

what is fusion?

single large tooth from two separate tooth germs with independent pulp chambers and root canals; absence of one of the corresponding permanent teeth

what teeth commonly experience fusion?

maxillary central and lateral incisors

what is concescence?

fusion only at the root level by cementum with two pulp chambers one root

what teeth commonly experience concrescence?

maxillary molars

what is gemination?

attempted but incomplete division of a single tooth germ; bifid crown with one root and a single, enlarged pulp chamber

what is twinning?

increased tooth number with complete division of a single tooth germ, leading to two separate teeth; extra tooth

what is coronal dens in dente?

enamel organ infoldings into the dental papilla

what is radicular dens in dente?

invagination of HERS, lined with cementum

what tooth commonly experiences dens in dente?

permanent lateral incisor (80-90%)

what is a dens evaginatus?

accessory cusp on occlusal of a posterior tooth

what is a talon cusp?

accessory cusp on occlusal/lingual of an anterior tooth

what causes enamel hypoplasia?

disturbance in enamel development; quantitative defect on the enamel matrix, qualitative defect on the enamel

what is a turner's tooth?

enamel hypoplasia ocal hypomineralized defect in the crown of a permanent tooth with extension of a periapical infection or mechanical trauma from a deciduous predecessor

what teeth most commonly experience turner's tooth?

mandibular premolars

what can enamel hypoplasia cause?

high caries

what is the treatment for enamel hypoplasia?

resin/GI restorations, SSCs, fluoride varnish

what is amelogenesis imperfecta?

developmental defect with a complex etiology that affects the enamel of BOTH primary and permanent dentition

what are the clinical findings of hypoplastic AI?

thin enamel with pitted, rough, or smooth & glossy surface; yellowish to brown; undersized, squared crown, lack of contact; flat occlusal surface & low cusps, attrition

what are the clinical findings of hypomaturation AI?

normal thickness of enamel, but mottled surface; cloudy white, yellow or brown,

opaque in color; softer than normal; same density as dentin

what are the clinical findings of hypocalcified AI?

normal thickness of enamel, density less than dentin; normal size & shape when erupting, abrade, or fracturing away rapidly; permeability increase, darkened & stained

what are the radiographic features of dentinogenesis imperfecta?

bulbous crown, normal size, constriction

of the cervical area; short & slender roots, occlusal attrition; partial or complete obliteration of the

pulp chambers, root canals absent or

threadlike

what is DI usually associated with?

osteogenesis imperfecta

what is taurodontism?

longitudinal enlarged pulp chamber and increased distance between CEJ to the bifurcation; normal crown size & tooth length, shortened roots, not recognizable clinically

where is taurodontism most common?

molars

what is transposition?

two teeth exchanged position

what is ectopic eruption?

tooth erupting in an abnormal position