Top 10 Tips when taking Dental Radiographs in Children

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Dentists in Goregao
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Top 10 Tips when taking Dental Radiographs in
Children
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• Since starting working in a community setting,
  I've had much more experience treating children.
  One aspect I felt less confident in when I was in
  general practice was taking X-rays in children. I
  feel like this is echoed throughout the world of
  general practice as many of the referrals I see
  for children, GDPs have not attempted to take
  them. So here are my top tips when taking X-rays
  in children.
• 1.Try!
• So many referrals I see do not include x rays. In
  some cases this is due to the child not being
  co-operative or not having an OPG machine but in
  many cases when I take bitewings I can manage
  them quite easily! Just because they are a child
  doesn't mean you shouldn't take x rays.
• You should start to take bitewings from children
  around 6 years of age onwards if possible to
  assess for interproximal caries and the position
  of the first permanent molars.

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• 2. Use a small film
• It seems obvious but children's mouth are smaller
  than adults, so a regular sized film is way too
  big and uncomfortable for the patient. You can
  even get XS films! So when should you try to
  switch to the regular size? This depends on the
  size of the patient, but I would usually
  recommend once the 7s are starting to erupt.
• 3. Explain!
• Children are commonly afraid of the unknown (as
  are adults a lot of the time!) so taking them
  through the process step by step in a
  child-friendly way is important. It's easy on
  adults where they've probably had multiple x-rays
  taken over the years and know what's happening,
  but often it will be the first time this child
  has had any form of x-ray!
• I like to show them the film and tab/bitewing
  holder and I call the x ray tube my camera, often
  practicing placing in the correct position before
  attempting for real.

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• A good analogy for helping them remain still I
  use on smaller children is pretending we are
  playing musical statues and the music has gone
  off until I press the exposure button that starts
  the music again, so they need to stay still.
• 4. Tabs/foam
• Bitewing holders are bulky and cumbersome and
  actually for children they can limit your view on
  bitewings as the plastic bite plate is too thick.
  
• Instead in children aged 6-10 I would recommend
  the use of cardboard tabs or even little
  rectangles of foam for them to bite on instead.
  It's more comfortable for the patient and the
  quality of your radiograph can be improved.
• 5. Vertical Bitewings
• I was never taught as an undergraduate what
  vertical bitewings were and how useful they can
  be! Imagine on a 6 year old child where you have
  a carious LLE and you want to assess if there is
  pathology or where it's successor is. You can't
  really take a PA, an OPG could be useful but it
  may not be available or the quality may not be
  sufficient enough to be diagnostic.

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• This is where vertical bitewings come into their
  own. Essentially you turn the tab vertically so
  the film is portrait in the patient's mouth. This
  allows you to see more apically on both upper and
  lower arches and is very handy both in children,
  but you could also take it to assess bone loss in
  periodontal disease in adults.
• A useful video on how to take vertical bitewings
  can be found here.
• 6. Practice
• Let them practice! Whether that be in the chair
  on that day or what I've found quite successful
  is giving the patient a film to take home to
  practice with. This may not be possible in a
  practice where things are digital but if you're
  still on film or can give them the protective
  slips with the card in if you're using phosphor
  plates, this could be a great way to increase
  compliance.
• 7. Demonstrate on their Parent
• Again to help the patient with the fear on the
  unknown, a good tip is to demonstrate on their
  parent (obviously don't take the x ray but
  position everything as you would). This is a
  basically tell, show, do technique.

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• 8. Bimolars
• Bimolars can be very useful in patients with poor
  compliance e.g. learning difficulties, autism
  etc. If you're looking into providing these views
  I would recommend some hands on training, but
  these are useful views where the patient holds a
  film/cassette to the outside of their face to
  visualize the molars on one side. You need
  special sized films for this.
• To see more about bimolars see here.
• 9. Patience
• Take your time, keep your patience and keep
  persevering! Young children need lots of
  encouragement but in the majority of cases, a bit
  of practice and patience you'll get there in the
  end! Even if you don't manage to take the
  radiograph that visit, keep trying. Children can
  surprise you. I gave him the film to practice at
  home with and a few days later I saw him again
  and the first thing I did was to try again and
  guess what, I managed to take the film. Don't be
  disheartened and don't lose your patience.

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• 10. Standard Occlusals
• Again, I wasn't really taught how to take these
  as an undergraduate. They are much simpler than I
  thought they would be and in a lot of cases
  taking an USO is much simpler than taking a PA.
• Dentists in Goregao In young children you can use
  a standard sized film and ask them to bite in
  between their teeth as far back as you can take
  it. In older children you will need to order the
  larger size in order to get all the teeth on. A
  tip is to keep the occlusal plane parallel and
  the x ray tube bisects it (around 60 degrees).

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