Volume 6 • 2019 • Issue 8

35 Issue 8 | 2019 | S upporting Y our P ractice Anterior Periapical Radiographs Anterior periapicals should be considered in the following clinical situations: the child’s anterior teeth have closed contacts, making them prone to interproximal caries; pathologies or anomalies are noted; or the child has experienced trauma to anterior teeth. With pediatric patients, the tooth often won’t appear unusual even when periapical lesions develop, so taking an anterior periapical radiograph shows you what’s going on inside the bony structure.  Establishing a reference after trauma. A child (age 3) fell and intruded tooth 51 and subluxated tooth 61 ( Image 1a ). In cases of trauma to anterior teeth, periapical radiographs ( Image 1b ) will be used as your reference for a follow-up assessment, particularly if you elect to watch and observe over the next couple of months to see if tooth 51 self-erupts. Immediately following trauma, it is important to focus on bringing down the internal inflammation of the tooth structure as much as possible; you might recommend that the patient stay on anti- inflammatories and to keep the tooth as cold as possible for 48 hours. It’s also important to tell the parents to keep an eye out for the formation of an abscess by lifting the lip once a week and checking the area above the gum line. Children do not necessarily complain about an abscess so it’s important for parents to be vigilant. Theviewsexpressedarethoseofthe authoranddonotnecessarilyreflect theopinionsorofficialpoliciesofthe CanadianDentalAssociation. Questions about when to take a child’s first radiographic examination are common, says Dr. Reza Nouri, a certified specialist in pediatric dentistry in the Greater Vancouver Area. Timing a child’s first radiograph depends on the patient’s individual circumstances, and not their age, according to the American Academy of Pediatric Dentistry (AAPD) 1 guidelines on prescribing dental radiographs for infants, children, adolescents, and persons with special health care needs. The AAPD guideline states, “Because each patient is unique, the need for dental radiographs can be determined only after reviewing the patient’s medical and dental histories, completing a clinical examination, and assessing the patient’s vulnerability to environmental factors that affect oral health.” Here, Dr. Nouri shares examples from his practice that illustrate the individual factors he considers when deciding when to take a child’s first radiograph. When Should You Take Radiographs for Children? rezanouri@telus.net Dr. Reza Nouri Dr. Nouri is a certified specialist in pediatric dentistry practising at PDG Pediatric Dental Group in the Greater Vancouver area. This article is based on Dr. Nouri’s presentation on CDA Oasis: oasisdiscussions.ca/ 2016/09/14/fr-2 1a 1b