5rad are not associated with increased congenital

malformations; therefore, dental X-ray scans

should not be cause for concern. A UK epidemiologic study of a cohort of 7375 mo
thers did not find
a significant association between use of dental
X-ray scans and low birth weight or preterm delivery. In addition, a case-contro
l study found no
overall increased risk of childhood brain tumors
after exposure to prenatal abdominal X-ray scan,
which produces many times higher radiation exposure than dental X-ray scans. (Mi
chalowicz et al.,
2008)
Radiation therapy
Patients with a malignancy in the oral cavity or
perioral region often receive radiation therapy for
the treatment of their disease. Although such
patients are often apprehensive about receiving
additional exposure, dental exposure is insignificant when compared with what th
ey have already
received.
In addition to the clinical examination, a thorough radiographic examination is
crucial to
determine the presence of inflammatory periapical abnormalities, periodontal sta
tus, other dental
disease, and tumor invasion of mandibular or
http://dentalebooks.com
40 General Principles and Techniques
the gag reflex, a number of cranial nerves as well
as sympathetic and parasympathetic nerves participate. Gag reflexes may be initi
ated by psychological factors as well as by tactile stimulation.
Anxiety and awareness of a previous gagging
problem may heavily influence the severity of the
condition.
Recommendations for suppressing and reducing gag reflexes during intraoral radio
graphic
examination
1. Gain confidence of the patient by demonstrating a professional and confident
behavior and
by demonstrating technical competence.
2. The operator explains the procedure.
3. The patient rinses the mouth with ice-cold
water.
4. Salt is placed on the patient s tongue.
5. The patient is requested to initiate deep and
audible respiration.
6. The patient holds his/her breath
7. Film placement is done quickly and in a
gentle and nonirritating manner, with exposure follows immediately to film place
ment
8. The attention of the patient is distracted by
a. Biting vigorously on the bite block
b. Looking fixedly at a point in the room
c. Concentrating on breathing control (e.g.,
by counting seconds)
Pregnancy
Oral radiography is safe for pregnant patients provided that protective measures
such as high-speed
film and lead apron and a thyroid collar are used.
No increase in congenital anomalies or intrauterine
growth retardation has been reported for X-ray

radiation exposure during pregnancy totaling less

than 5 10cGy, and a full-mouth series of dental
radiographs results in only 8 10 4cGy (National
Council on Radiation Protection and Measurements, 2003). A bitewing and panorami
c radiographic study generates about one-third the
radiation exposure associated with a full-mouth
series with E-speed film and a rectangular collimated beam (Freeman and Brand, 1
994). Patients
who are concerned about radiography during
pregnancy should be reassured that in all cases
requiring such imaging, the dental staff will practice the ALARA (As Low as Reas
onably Achievable) principle and that only radiographs necessary
for diagnosis will be obtained (Carlton et al., 2000).
The estimated fetal dose in a single dental exposure is 0.01mrad. It is known th
at doses less than
d. Performing slow muscular activities
requiring concentration (e.g., alternately
raising legs to a horizontal position)
9. Fingers in the mouth are avoided
10. Film holders are used
11. Tissue edge of the film packet is moistened by
holding it in a stream of cold water
12. The patient is asked to swallow immediately
prior to film insertion
13. Surface anesthesi