Go digital in paediatric radiography

The need for paediatric radiographs

Radiographs for paediatric patients are useful when managing dental injuries or examining pathological conditions, such as caries.[i] Traumatic dental injuries (TDIs) are especially prominent in children and young adults, making up 5% of all injuries suffered at this time in life;[ii] around one in four school children will experience dental trauma at some point.[iii] TDIs could be a result of accidents, brought on by sporting activities or regular life. Children learning to crawl, walk and run are particularly susceptible to losing control of their balance, prompting potential TDIs.[iv]

Similarly, dental caries is extremely prevalent in paediatric patients. More than half of four- and five-year olds could have caries (55% and 63% respectively), commonly brought on by a high-sugar-containing diet overseen by parents and guardians with poor oral health knowledge.[v]

In the case of TDIs, radiographs can be a helpful reactive measure, helping to establish immediate and future treatment actions. For caries, they can act as a preventative measure. The use of radiographs in paediatric check-ups can help to identify issues before they manifest further; recommendations of image capture regularity range anywhere between every 12-36 months,[vi] with considerations for the increased risks that radiographs pose to paediatric patients.

Risk management

Helping a parent/guardian understand the need for a digital radiograph, whilst being open about the associated risks and the steps taken to mitigate them, could alleviate any concerns. Guardians should know that children have an increased radiosensitivity when compared to adults,[vii] but that the procedure is made safe with various precautions in technology and workflow. For example, using digital radiography can produce less radiation than conventional film methods, whilst obtaining images of the same quality.[viii]

Another advantage that a patient’s guardian may appreciate is the speed of a digital process. A conventional radiograph on film would require extensive developing time, prolonging the treatment workflow. A digital production could be read immediately, creating an image that can be used for diagnosis during the same appointment. It could also improve the communication of diagnosis and the recommended treatment plan. Minimising the wait for information could put parents and children at ease throughout the process – especially useful in TDI cases, which may present as dental emergencies.

Calming young patients

The first, and largest, challenge a dental professional faces with paediatric imaging is patient anxiety and cooperation.[ix] Fidgeting, crying and resulting movement could lead to radiograph failure, with one study seeing this 44% of the time.[x] A digital radiograph is beneficial in these instances, as not only can it produce consistent quality, reducing the chance for clinician error, but its shortened processing speed requires patients to sit still for a smaller period of time.

Involving the parent/guardian in a role that actively encourages the patient to listen to a practitioner could increase co-operation.[xi] This does rely on the patient and guardian relationship which extends past the practice doors, and so cannot necessarily guarantee success. As patients reach an age where they gain a sense of autonomy, speaking to them independently could yield greater results.[xii] This could begin as patients reach around 6-8 years old, but individualised judgement is important.[xiii]

Verbally communicating and directly addressing the paediatric patient is also important for success.[xiv] Using a “tell-show-do” technique is favoured by many and can be especially effective.[xv] By introducing the child to the entire process in age-suitable language, they could feel adequately prepared, reducing anxiety. Walking them through the treatment before it takes place could aid in retaining attention. This is effective at most ages, but especially so for preschool (3 to 4-year-old) children.[xvi]

Performing digital radiographs with paediatric patients can be difficult, but incredibly useful. For leading quality, safety and comfort, consider the CS 7200 Neo Edition from Carestream Dental for your practice. As an ultra-compact image plate system, the CS 7200 Neo works as a chair-side unit or a hub for practice-wide imaging, processing quality and communicable images in as little as 8 seconds – whilst exposing patients to less radiation than film.

Radiographic imaging is an important part of care for paediatric patients, and the benefits of digital methods are significant. Communicating the strengths of a digital procedure to parents could ease some nerves, and provide some additional back-up for anxiety management in younger patients.

Nimisha Nariapara Bio

Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.

For more information on Carestream Dental visit www.carestreamdental.co.uk

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[i] Madan, K., Baliga, S., Thosar, N., & Rathi, N. (2015). Recent advances in dental radiography for pediatric patients: A review. Journal of Medicine, Radiology, Pathology and Surgery, 1(2), 21-25.

[ii] Levin, L., Day, P. F., Hicks, L., O’Connell, A., Fouad, A. F., Bourguignon, C., & Abbott, P. V. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dental Traumatology, 36(4), 309-313.

[iii] Levin, L., Day, P. F., Hicks, L., O’Connell, A., Fouad, A. F., Bourguignon, C., & Abbott, P. V. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dental Traumatology, 36(4), 309-313.

[iv] Anderson, M., Duran Sahin, D., & Tsilingaridis, G. (2021). Dental trauma in toddlers 1–3 years of age living in multicultural areas of Stockholm, Sweden: A retrospective cohort study. Dental traumatology, 37(4), 639-646.

[v] Tinanoff, N., Baez, R. J., Diaz Guillory, C., Donly, K. J., Feldens, C. A., McGrath, C., … & Twetman, S. (2019). Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. International journal of paediatric dentistry, 29(3), 238-248.

[vi] Goodwin, T. L., Devlin, H., Glenny, A. M., O’Malley, L., & Horner, K. (2017). Guidelines on the timing and frequency of bitewing radiography: a systematic review. British Dental Journal, 222(7), 519-526.

[vii] Public Health England, Faculty of General Dental Practice. (2020) Guidance Notes for Dental Practitioners on the Safe Use of X-Ray Equipment, 2^nd Edition.

[viii] Göstemeyer, G., & Schwendicke, F. (2019). Digital Bitewing Radiographs. Detection and Assessment of Dental Caries: A Clinical Guide, 119-126.

[ix] Pak, F., Estaji, M., Rezaei, B., & Vaezzadeh, V. (2021). Radiographers’ knowledge versus practice about methods of attracting pediatric corporation in medical imaging departments. Frontiers in Biomedical Technologies, 8(2), 87-93.

[x] Tyagi, P., Mali, S., Rathi, S. V., Agrawal, N., Kumar, A., & Abraham, J. M. (2022). Comparative Evaluation of Visual and Taste Distraction Techniques using RMS Pictorial Scale in making of Periapical Radiographs. Journal of South Asian Association of Pediatric Dentistry, 5(1), 32-37.

[xi] Roberts, J. F., Curzon, M. E. J., Koch, G., & Martens, L. C. (2010). Behaviour management techniques in paediatric dentistry. European Archives of Paediatric Dentistry, 11, 166-174.

[xii] Roberts, J. F., Curzon, M. E. J., Koch, G., & Martens, L. C. (2010). Behaviour management techniques in paediatric dentistry. European Archives of Paediatric Dentistry, 11, 166-174.

[xiii] Widmer, R. P., McNeil, D. W., McNeil, C. B., & Hayes-Cameron, L. (2013). Child development, relationships and behaviour management. In Handbook of Pediatric Dentistry (pp. 9-24). Mosby.

[xiv] Pak, F., Estaji, M., Rezaei, B., & Vaezzadeh, V. (2021). Radiographers’ knowledge versus practice about methods of attracting pediatric corporation in medical imaging departments. Frontiers in Biomedical Technologies, 8(2), 87-93.

[xv] Hintze, H., & Espelid, I. (2017). Radiographic examination and diagnosis. Koch G, Poulsen S, Espelid I, Haubek D, eritors. Pediatric dentistry, a clinical approach. 3rd Ed. Wiley Blackwell, 75-86.

[xvi] Sharma, A., & Tyagi, R. (2011). Behavior assessment of children in dental settings: A retrospective study. International Journal of Clinical Pediatric Dentistry, 4(1), 35.