Be quick with your xrays
I did mention this tip a very long time ago (while still a dental student) but watching my colleagues has reminded me of several pet peeves that I used to be guilty of. Xrays are uncomfortable, we want to therefore do them as quickly but without compromising diagnostic quality. I am not talking about minimising exposure time because there really isn't any difference in comfort between 0.125ms and 0.250ms.What I am referring to is having everything prepared in advance i.e your DA setting up the film holder and film and most importantly positioning the xray tube before you place the film. Most patients find it incredibly uncomfortable to bite down on xray films and it is nerve wracking watching my colleagues place the film and waste an extra ten seconds pulling the xray tube from the wall with the patient writing in front of them Knowing that at any point the patient will give up and open and the xray will be ruined.
There are a few things you must do to prepare the patient for the xray exposure:
-You have to tell them that it won't take long. Some patients are surprised at how fast dental xrays take which implies that they think the film will be in their mouth for an extended period of time. This kind of thinking may make them give up early. You have to emphasise the importance of a good xray the first time around to avoid retakes. Tell them it will only be in their mouth for a few seconds
-Tell them that they have to bite down until their "teeth touch". If they don't bite firmly the film will not be displaced to sit alongside the teeth and you will miss the apex. The film will also not sit still and there may be distortion, cone cut or a non parallel xray. I find it useful to tell the patient to close until the teeth touch. I say this before every xray. If you don't specify this then they will do a half arsed lip stretch without moving their mandible and the film will be in completely the wrong place. Don't feel bad, you're just doing your job well.
-Grab the xray tube and put it pretty much where you need it to expose the film. You can put it at the right angle but slightly away from the patient's face as it may get in the way of placing the film holder with aiming ring. Place the film in the correct position then get the patient to close their jaw pushing the film into the right place. Then it is a simple matter of pushing the tube slightly closer to the patient's face in the correct position, moving otf of the way and exposing the film.
This technique will save clinical time by avoiding unnecessary retakes and extra explanation time. Importantly it will also avoid unnecessarily excessive xray exposure to patients. Aim to do things correctly the first time. If you see that the patient is not closing enough tell them to open, reexplain things and don't exposure the xray until they have done it right. If you accept anything less than ideal you will find that you will process the xray and debate with yourself if the quality is good enough. From there you will either retake the film (wasting time and xray exposures) or proceed with substandard films and mess up along the line.
There are a few things you must do to prepare the patient for the xray exposure:
-You have to tell them that it won't take long. Some patients are surprised at how fast dental xrays take which implies that they think the film will be in their mouth for an extended period of time. This kind of thinking may make them give up early. You have to emphasise the importance of a good xray the first time around to avoid retakes. Tell them it will only be in their mouth for a few seconds
-Tell them that they have to bite down until their "teeth touch". If they don't bite firmly the film will not be displaced to sit alongside the teeth and you will miss the apex. The film will also not sit still and there may be distortion, cone cut or a non parallel xray. I find it useful to tell the patient to close until the teeth touch. I say this before every xray. If you don't specify this then they will do a half arsed lip stretch without moving their mandible and the film will be in completely the wrong place. Don't feel bad, you're just doing your job well.
-Grab the xray tube and put it pretty much where you need it to expose the film. You can put it at the right angle but slightly away from the patient's face as it may get in the way of placing the film holder with aiming ring. Place the film in the correct position then get the patient to close their jaw pushing the film into the right place. Then it is a simple matter of pushing the tube slightly closer to the patient's face in the correct position, moving otf of the way and exposing the film.
This technique will save clinical time by avoiding unnecessary retakes and extra explanation time. Importantly it will also avoid unnecessarily excessive xray exposure to patients. Aim to do things correctly the first time. If you see that the patient is not closing enough tell them to open, reexplain things and don't exposure the xray until they have done it right. If you accept anything less than ideal you will find that you will process the xray and debate with yourself if the quality is good enough. From there you will either retake the film (wasting time and xray exposures) or proceed with substandard films and mess up along the line.
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