Management of Radiographic Needs

Imaging Procedures in Dentomaxillofacial Radiology Dentists are using imaging procedures of den- tomaxillofacial radiology for diagnostic imag- ing, some of which have been developed specifically for dentistry. These are all intraoral radiographs (periapical radiographs of various sizes, bitewings and occlusal views) and all extraoral radiographs (panoramic radiographs, cranial and partial cranial views, especially cephalometric radiographs, hand radiographs, conventional tomography (used very rarely today) and cone‐beam computed tomography (CBCT)). Other imaging techniques used in medicine are also used in dentistry, such as computed tomography (in particular Dantascan; Schwarz et al., 1987a,b), magnetic resonance imaging and ultrasound. It takes a lot of training to choose from these numerous imaging procedures those that are right for the indication of the individual patient. Imaging Procedures in Children and Adolescents In dental medicine, similar emergency situa- tions can generally be experienced by children, adolescents and adults. Almost always, these emergencies are caused by pain or by situa- tions in some way associated with pain. In the age group of children and adolescents, the cause of pain is usually tooth decay, accident or discomfort caused by wisdom teeth. Dental traumatology is discussed in Chapter 5.2. This chapter will therefore focus on other emergency situations, including tooth decay and discomfort from wisdom teeth, as well as a wide range of pain caused by tooth eruption and inflammation. Often, therapy differs with regard to the dentition: treatment must be done differently in deciduous teeth than in permanent ones. In deciduous teeth, patient compliance is often poor or absent, making therapy difficult and sometimes impossible. The duration of treatment also plays an important role: espe- cially in children, a longer treatment is often not tolerated – they tire, become restless and react with uncontrolled movements. Most important is patient fear, which sometimes cannot be overcome. Fortunately, with decid- uous teeth, a less accurate x‐ray examination may often be acceptable, due to their different composition, structure and shape. Obtaining the information necessary for proper treat- ment is far more important than fulfilling the requirements for good image quality. In some situations, it may be necessary to prescribe a premedication or to ask the family 44 1.5 Management of Radiographic Needs doctor to sedate the young patient. Any therapy involving sedation or even general anaesthesia should be discussed with the anaesthesiologist in advance (see Chapter 1.4).