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Radiography Technique

Laura Jansen Howerton, RDH, MS, is a clinical associate professor at the University of North Carolina School of Dentistry, Chapel Hill. To read her most recent column on radiography and the ALARA Principle, visit our September 2006 issue archive online.

QUESTION: My dentist complains that the staff uses too many film retakes when taking radiographs. Is digital film a more effective way to go or should we be using that metal contraption we were taught to use in school?

ANSWER: Both of your issues—retakes and switching to digital radiography—relate somewhat to the ALARA Principle, in that our goal is to keep radiation exposures as low as reasonably achievable (ALARA). Exposing additional radiographs on our patients due to poor operator technique is not acceptable because it exposes patients to unnecessary radiation. The staff members in your office may need a refresher course in correct radiographic techniques, including how to avoid horizontal overlap, vertical angulation errors, cone-cuts, and proper film placements. The dental radiographer must be committed to producing high quality diagnostic images and consistently make every effort to achieve a perfect result. I suggest attending a continuing education course or rereading about technique in the literature. If your office can make the appropriate accommodations, I recommend the switch to digital radiography due to its lower dose of radiation exposure. However, correct operator technique is still required to produce diagnostic radiographs with digital imaging. And definitely leave that metal contraption in the closet!

Stannous Fluoride

Durinda J. Mattana, RDH, MS, is an associate professor in the Department of Periodontology and Dental Hygiene at the University of Detroit Mercy School of Dentistry, Detroit.

QUESTION: A dental hygiene consultant recently told me that all scaling and root planing patients should be placed on stannous fluoride immediately following treatment. Is this correct?

ANSWER: Stannous fluoride can be effective for post-scaling and root planing patients, but I do not understand the rationale for its use on every patient. Of the three types of fluoride (acidulated phosphate, neutral sodium, and stannous), stannous fluoride shows the best results in addressing dentin hypersensitivity and providing an antimicrobial effect but other products do address these two clinical problems. Whenever recommending a self-care product or a professional service, such as a fluoride application, the clinician must consider a variety of factors, such as patient compliance issues, interactions with other products, and the clinical problem. Many post-scaling and root planing patients present with a number of clinical issues, ranging from poor oral hygiene to exposed root surfaces, that may put them at risk for dentin hypersensitivity and dental caries. Instead of having an automated approach to all patients, recommendations should be customized to the individual patient’s needs. The good news is that we have many interventions available. Here is a short list of clinical issues and possible evidence-based interventions to consider.

Dentin hypersensitivity: Fluoride varnish application postscaling, use of 5% potassium nitrate dentifrice with fluoride.

Poor oral hygiene: Oral hygiene instruction with various mechanical aids, prescription chlorhexidine mouthrinse (shortterm, now available without alcohol, must be used at least 30 minutes from the use of fluoridated toothpaste), and over-thecounter essential oil rinses.

Moderate to high caries risk: In addition to drinking fluoridated water and using fluoridated toothpaste twice a day, the hygienist may choose a professional fluoride application (5% NaF varnish provides the best coverage on exposed root surfaces), high concentration prescription 1.1% neutral sodium home toothpastes or gels (these products contain 5,000 ppm fluoride versus 1,000 ppm fluoride found in over-the-counter toothpastes) or a 0.4% stannous fluoride gel (contains 1,000 ppm fluoride, which is the same concentration as toothpaste, but is applied separately from toothbrushing).

From Dimensions of Dental Hygiene. November 2006;4(11): 42.

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