dental appointment, which can make the completion of treatment and obtaining diagnostic dental radiographs difficult. Some indi- viduals have a strong gag reflex, anatomical limitations, tactile sen- sation when biting on image receptor holders, and difficulty following directions for radiographic exposures.8 Table 1 pro- vides some simple strategies to help patients with special needs experience a successful dental appointment.9 PERIAPICAL DENTAL TECHNIQUES Dental radiographs can be exposed using different types of techniques, images, and equipment. When exposing a periapical image, the paralleling technique provides a superior diagnostic image.8 An external aiming device, consisting of a rod, ring, and bite block, is used to hold the image receptor in place to expose in a specific area. The difficulty with using the external aiming device is that it can be bulky and challenging to place for cer- tain individuals.10 The bisecting angle technique is done with a universal sensor holder designed to take anterior and posterior periapical radi- ographs. It is often used for patients with small oral cavities and anatomical limitations. It may also be used for individuals with special needs who have difficulty biting and may have a hyper- sensitive gag reflex.11 OCCLUSAL TECHNIQUE The occlusal technique is a radiographic examination that allows the dental provider to examine anatomical areas of the maxilla and the mandible on a larger scale, exposing one image on the maxilla and/or the mandible.10 The occlusal technique helps with modifications using an image receptor holder, which in turn, allows the patient with special needs to tolerate the radiographic examination.8 Two types of occlusal projections may be exposed: • Cross-sectional • Topographical Maintaining oral health can be extremely difficult for patients with special needs. This population faces significant barriers to care such as low socioeconomic status, low levels of education, lack of health/dental insurance coverage, high levels of anxiety, and physical barriers (eg, patient who uses a wheelchair is unsure of whether he or she will be able to easily enter the office entrance, dental operatory, and dental chair).3 Patients with special needs and their caregivers may be con- cerned regarding dental providers’ lack of training in this area as well as their ability to communicate their needs to providers.4 Oral health professionals often don’t have much knowledge and/or hands-on training in treating patients with special needs in a dental setting.4 This lack of knowledge is changing as dental schools in the US are now required to educate oral health providers on how to treat patients with special needs. Students are taught how to assess, treat, and manage patients with special needs.5 A diagnostic radiographic exam is an integral part of a com- plete dental appointment. However, capturing radiographs among patients with special needs may present some challenges.6 SENSORY SYSTEM OVERLOAD When patients with special needs present to the dental office, it can be an overwhelming sensory experience.5 Humans have eight sensory systems:7 1. Visual 2. Gustatory 3. Tactile 4. Hearing 5. Olfactory 6. Vestibular 7. Proprioceptive 8. Interoceptive All eight of theses sensory systems come into play during a TABLE 1. Strategies for Treating Patients With Special Needs9 TAMARA J. FAURE, EdD, RDH, has been a practicing dental hygienist for more than 15 years. Specializing in pediatrics and patients with special needs, she is an assistant professor and radiology coordinator in the Department of Dental Hygiene at Farmingdale State College in New York. Faure is also the secretary for the Long Island Dental Hygienists’ Association. 16 Dimensions OF DENTAL HYGIENE • July/August 2023 dimensionsofdentalhygiene.com 1. Approach the patient gently, progressing from easier to more difficult treatment. 2. Progress slowly, using the “tell, show, do” approach for those with cognitive disabilities. 3. Introduce familiar objects (toothbrush, mirror) before instruments. 4. Ask permission with words/body language before starting treatment. 5. Keep appointments short and positive. 6. Gain cooperation in the least restrictive manner. 7. Consider protective stabilization or other advanced behavior management techniques only if necessary. When exposing a periapical image, the paralleling technique provides a superior diagnostic image
