As the prevalence of dementia in the UK increases, and researchers struggle to find concrete evidence for the possible causes of the disease, controversial studies have emerged hypothesising that dental X-rays could be the source of the infamous disorder. With no evidence to support this claim, however, and no indication that research can actually be conducted to prove such a theory, it would, perhaps, be more pertinent for professionals to reverse their concerns and focus instead on the effects diagnostic imaging can have on people currently living with dementia.
Presently, there is next to no research on how the experience of undergoing an X-ray can affect dementia patients both emotionally and psychologically, apart from one study funded by the Clinical Research Fellowship titled “Exploring the experiences of diagnostic imaging for people with dementia”, which has not yet published its findings.[i] The project hopes to improve understanding through interviews with patients and their carers as well as develop recommendations for practice change.
As it stands, there are advice pathways in place to steer professionals in the right direction – including Nice guidelines (CG42)[ii] and recommendations from the Society of Radiographers –[iii] with some consideration placed on support and intervention methods. However, it is also important to examine ways in which distress, confusion and discomfort can be minimised within the dental practice.
To do so, it is necessary to consider how the patient might feel before, during and after the process. Before the X-ray is taken, for instance, the patient is required to remove all jewellery, dentures, eyewear and any other metal objects or clothing that might interfere with the images, which can be an ordeal in itself for someone living with dementia. Indeed, depending on the level of their understanding, they might not be able to comprehend why you are removing their wedding ring, or why they aren’t allowed to have their glasses, without which, they cannot see.
That’s not to mention the confusion the patient might feel when the machine is positioned close to the body. Plus, if the equipment is big, bulky or intimidating in appearance, there is a possibility that the experience could induce anxiety or fear.
Emotional and psychological distress could occur during the process too, especially if the patient is unable to keep still and the images need to be retaken. Not only could this induce further feelings of anxiety in a situation that is already stressful for the patient, but it also puts the patient at risk of increased radiation exposure.
It is important to take into consideration the waiting time that is required after the examination is complete to check if all the necessary images have been obtained. If the equipment does not enable the user to view the images immediately, there is a chance that the patient could become impatient or agitated, which could lead to challenging behaviour.
To minimise such risks and create an experience that is as positive and comfortable as possible, there are several measures that could be implemented within the dental practice. One potential strategy could be to alter protocol and develop a specialist system specifically for patients with dementia – a service that is already being developed within innovative hospitals and clinical commissioning groups (CCGs). The Mid Essex CCG, for instance, funds a service affiliated with the national charity Carers Trust, which has developed a pathway that enables patients with dementia who require an X-ray to have direct access to radiology services.[iv] If practices were to implement a similar protocol and allow patients to bypass the waiting room, it could help the patient to feel more relaxed and minimise the likelihood of agitation and distress from occurring.
A clinician’s understanding and attitude towards the disease could also affect patients’ overall X-ray experience. Indeed, one study found that the approach of participating radiographers towards people with dementia was largely of a negative nature, especially from staff with fewer than 10 years’ work experience.[v] With better training, and an increased awareness of the affects of dementia, clinicians could help minimise agitation and behavioural symptoms during the X-ray process.[vi]
Lastly, the machine itself can have a huge impact on the outcome of the appointment and the patient’s experience. By using an X-ray unit such as the RXDC Hypersphere+ from RPA Dental, that provides a larger source-to-skin distance, generates consistently sharp images and reduces the irradiated surface area – and therefore exposure – practices could improve negative elements of the experience.
While it is clear that evidence is needed to discover more on how an X-ray could affect patients with dementia both emotionally and psychologically, there are practical solutions that practices can implement that could help make a difference. Nobody can know for sure what the cause of dementia is, nor can they reverse its effects, but it’s not too late to change the way patients live with it.
For more information, contact RPA Dental on 08000 933 975 or visit the website www.dental-equipment.co.uk
[i] Alzheimer’s Society: Research. Exploring the experiences of diagnostic imaging for people with dementia. Accessed online May 2016 at https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=2510
[ii] National Institute for Health and Care Excellence. Nice Guidelines. Dementia: supporting people with dementia and their carers in health and social care. Accessed online May 2016 at https://www.nice.org.uk/guidance/cg42/chapter/1-guidance
[iii] Society of Radiographers. Caring for People with Dementia: a clinical practice guideline for the radiography workforce (imaging and radiography). Published 2015. Accessed online May 2016 at file:///Users/officeone/Downloads/society_of_radiographers_-_-_.pdf
[iv] Mid Essex Hospital Services NHS Trust. Dementia Action Alliance 2013 Update. Accessed online May 2016 at http://www.meht.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=4146
[v] Kada S. Radiographers’ attitudes towards persons with dementia. European Journal of Radiography. 2009; 1 (4): 163-168. Accessed online May 2016 at http://www.sciencedirect.com/science/article/pii/S1756117510000236
[vi] Magai C, Cohen CI, Gomberg D. Impact of Training Dementia Caregivers in Sensitivity to Nonverbal Emotional Signals. International Psychogeriatrics. 2002; 14 (1): 25-38. Accessed online May 2016 at http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=273702&fileId=S1041610202008256
The ORTHOPHOS SL 2D is capable of capturing incomparably sharp 2D panoramic images. This is possible thanks to the powerful DCS sensor, which significantly reduces conversion signal loss, and the unique Sharp Layer Technology. Not only this, but the 2D system can be upgraded to full 3D and can include an optional Ceph arm for greater diagnostic flexibility.
The ORTHOPHOS SL 3D is available in two main volume sizes: 8x8cm or 11x10cm. Both of these devices have flexibility in volume, starting from 5x5.5cm upwards, for use with endodontic issues and single implant planning. With this expansive scope you will be able to adapt your diagnostic range to the specific needs of every patient and produce excellent 3D images every time.
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A century later, cone-beam computed tomography (CBCT) radiography was launched in Italy by Attilio Tacconi and Pero Mozzo[ii]. The algorithm for reconstructing a three-dimensional image from a set of two-dimensional projections had been devised by L.A.Feldkamp et al in 1984[iii]. However, CBCT units specifically dedicated to dento-maxillofacial radiology experienced a fifteen-year waiting gap whilst the cost of X-ray tubes, the quality of detector systems and strength of the personal computers developed enough to catch up with the science behind them.
Since that time there has been a global explosion of digital technologies in many spheres of life. We use digital TV, radio and imaging every day, so logically, digital dentistry is fast becoming the norm. More than 50% of dentists using digital technologies report an increase in earnings, and 93% claim they have significantly improved patient experience[iv].
It is only in recent times that CBCT clinical systems affording 3D data have been relatively inexpensive and small enough to be used in dental practices[v]. The advantages of this are infinite, especially within the fields of periodontology, endodontics and implantology. In these disciplines, CBCT 3D scanning is indispensable; the view of the teeth in context, with the surrounding bone and tissue is crucial to release full diagnostic potential and provide greater precision in the selection and placing of implants. Additionally, the cone beam technique uses a single scan capturing the entire area, vastly reducing the amount of exposure time to the patient.
The CBCT digital system allows for clinicians to explain treatment options and provide a virtual presentation of these processes in advance. Implants can be placed on an accurate and high resolution CBCT scans and the digital guides ordered. This guides then help in the precise positioning of the implant. Some practices even have the necessary equipment to take X-rays and mill guides in one sitting.
Carestream Dental, a leader in the arena of digital imaging, offers an exceptionally user-friendly CBCT solution in the CS 9000 3D extraoral imaging system. 3D technology combines panoramic imaging in one, affordable unit. The cone beam limits radiation to a specific oral site, offering the lowest possible radiation dose. Provided with innovative CS 3D imaging software, the unit aids with treatment planning and patient communication using visuals in slice by slice, axial, coronal, cross-sectional and oblique views. What’s more, the integration of the CS 3500 Intraoral Scanner with the Dicom volumes from the CBCT, provides all the information required for guided surgical stents.
For concise, efficient and safe radiography practices, discover the latest innovations available to you today.
For more information, contact Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk
[i] The Scientist: The First X-ray, 1895, Hannah Waters, 2011. http://www.the-scientist.com/?articles.view/articleNo/30693/title/The-First-X-ray--1895/. (Accessed 20/10/2015)
[ii] World Journal of Radiology: Use Of Dentomazillofacial Cone Beam Computed Tomography In Dentistry, Kivanç Kamburo?lu, 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473305/ (Accessed 2010/2015)
[iii] The Optical Society of America: Practical Cone-Beam Algorithm, L.A.Feldkamp, L.C.Davis and J.W.Kress, Research Staff, Ford Motor Company, Dearborn, Michigan 4812. https://www.osapublishing.org/view_article.cfm?gotourl=https%3A%2F%2Fwww%2Eosapublishing%2Eorg%2FDirectPDFAccess%2F2FE6D9C8-C1B8-B2E6-A47A3F9DE903FEE9_996%2Fjosaa-1-6-612%2Epdf%3Fda%3D1%26id%3D996%26seq%3D0%26mobile%3Dno&org= (Accessed 20/10/2015)
[iv] Independent Carestream Dental Study, November 2014, conducted by Kunde & Co. http://www.carestreamdental.com/ImagesFileShare/.sitecore.media_library.Files.Company.Independent-CSD-Study.pdf (Accessed 20/10/2015)
[v] Journal of Indian Society Of Periodontology: Three-Dimensional Imaging In Periodontal Diagnosis – Utilization of Cone Beam Computed Tomography. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134038/ (Accessed 20/10/2015)