Marianne Martinez
Panoramic radiography is a dental X-ray that captures all of a patient's teeth and jaws in a single image. A common error in this procedure is nasopharyngeal airspace, which is caused by the patient's failure to hold their tongue to the roof of their mouth. This error can be avoided by using a simple breathing technique that instructs the patient to breathe in, breathe out, swallow, close their lips, and hold still. This technique is suitable for all patients, including those with intellectual disabilities, and does not require mentioning the tongue, which can be confusing for some patients. This technique helps to reduce the intensity of the nasopharyngeal airspace on panoramic radiographs, improving the accuracy of the procedure.
| Characteristics | Values |
|---|---|
| Traditional patient instruction | Holding the tongue to the roof of the mouth |
| Simple breathing technique instruction | Breathe in, breathe out, swallow, lips closed and hold still |
| Patient groups | All patients, including young patients and those with intellectual disabilities |
| Benefits | Reduces the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs |
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What You'll Learn
Tell the patient they are going to have a dental X-ray
It is important to inform your patients that they are going to have a dental X-ray. Dental X-rays are a form of radiation that can help dentists diagnose and treat oral health issues. They are an essential part of oral health maintenance and can help detect problems such as cavities, gum disease, bone loss, infections, and even some types of oral cancer. While the risk from a single dental X-ray is very small, it is important to understand the potential risks and benefits.
Before the procedure, it is crucial to inform the dentist if the patient is pregnant or trying to become pregnant. Although dental X-rays are generally considered safe during pregnancy, most dentists avoid them unless absolutely necessary. In such cases, precautions will be taken to minimize radiation exposure to the fetus. Additionally, patients may be asked to remove any metal objects, jewelry, or eyeglasses that could interfere with the X-ray images.
During the procedure, the patient will be positioned in front of an X-ray machine, either sitting or standing. A lead apron will be placed over the patient's chest, and a thyroid collar may be wrapped around the neck to protect against excess radiation exposure. The patient's head will be positioned with chin, forehead, and side rests, and a bite blocker may be provided to open the mouth slightly for a clearer picture.
The X-ray tube will rotate in a semicircle around the patient's head, capturing images of the teeth and jaws. These images are then used by the dentist to diagnose and plan appropriate treatment. It is important to note that dental X-rays are not the only method of diagnosis, and dentists will also rely on clinical exams and risk factors to determine the patient's treatment plan.
In conclusion, informing patients about the dental X-ray procedure is crucial for their understanding and comfort. By explaining the purpose of the X-rays, addressing any concerns about radiation exposure, and guiding them through the process, dentists can ensure that patients are well-informed and actively involved in their oral health care.
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Use a 'tell-show-do' approach
Tell-Show-Do Approach to Preventing Nasopharyngeal Airspace on Pan
Tell: Inform the patient that you will be inserting a nasopharyngeal airway (NPA) to help them breathe better. Explain that the NPA is a soft, flexible tube that will be inserted through their nose and into the back of their throat, clearing their airway and improving oxygenation.
Show: Demonstrate the NPA device to the patient, showing them how it is a hollow plastic or soft rubber tube with one end flared and the other end beveled. Explain that the beveled end will be inserted gently through their nose, ensuring comfort and minimal discomfort.
Do:
- Prepare the NPA device by selecting the appropriate size for the patient. The length should be slightly less than the distance from the tip of their nose to the earlobe. Choose a diameter slightly smaller than the patient's nares.
- Position the patient comfortably, ensuring their head is tilted back slightly to facilitate insertion.
- Gently insert the NPA, beveled end first, through one nostril, directing it towards the back of the throat. Avoid forcing the NPA and stop if resistance is felt, trying the other nostril instead.
- Ensure the NPA is positioned correctly by checking that the distal tip is beyond the tongue base but not touching the epiglottis.
- Monitor the patient's breathing and comfort, making any necessary adjustments to ensure effective ventilation and oxygenation.
- Reassure the patient throughout the process, providing updates and answering any questions they may have.
Remember to collaborate with an interprofessional team and develop short- and long-term plans to ensure optimal outcomes for the patient. This technique can be a valuable tool for quickly establishing and maintaining a patent airway, especially in emergency situations.
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Instruct the patient to breathe in, breathe out, swallow, close their lips, and hold still
Instructing the patient to breathe in, breathe out, swallow, close their lips, and hold still is a simple breathing technique used in panoramic radiography to reduce common errors caused by patient positioning. This technique is suitable for all patients, including young patients and those with intellectual disabilities who may struggle with traditional tongue position instructions.
The "breathe-in, breathe-out, swallow, lips closed, and hold still" instruction sequence is designed to reduce the intensity of the palatoglossal and pharyngeal airspaces on panoramic radiographs. The "breathe-in" cue commences the mechanical deformation of the tongue, while "breathe out" reduces the air in the pharyngeal space and initiates the posterior movement of the genioglossus muscle. The “swallow” cue completes the reflex tongue movement associated with respiration and swallowing, resulting in the desired tongue position, flattened against the hard palate.
Instructing the patient to “close their lips" is essential to preventing the oral orifice airspace, which appears as an oval radiolucency overlying the incisor teeth crowns. This airspace can mimic caries and lead to missed pathologies or unnecessary further radiation. The "hold still" cue is crucial for obtaining clear panoramic images and ensuring the tongue remains in the desired position.
This simple breathing technique uses a “tell-show-do" communication approach, demonstrating the known tongue positions during breathing and swallowing without explicitly mentioning the tongue. This method effectively guides patients into the correct tongue position, reducing errors and improving the accuracy of panoramic radiographs.
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Ensure the tongue is flattened against the hard palate
To prevent nasopharyngeal airspace on a pan, it is important to ensure that the tongue is flattened against the hard palate. This can be achieved by instructing the patient to follow a simple breathing technique, which involves the following steps: "breathe in, breathe out, swallow, and close lips".
This technique is designed to reduce the occurrence of common patient position errors, such as failing to hold the tongue to the roof of the mouth, which can lead to missed pathology or the need for further radiation. By utilising the natural tongue positions during breathing and swallowing, this method simplifies the process for the patient and minimises potential errors.
The "breathe-in" step initiates the mechanical deformation of the tongue, while "breathe out" reduces the air volume in the pharyngeal space, triggering the posterior movement of the genioglossus muscle. The "swallow" instruction completes the reflex tongue movement, resulting in the desired tongue position, with the tongue flattened against the hard palate. Finally, "close lips" prevents the oral orifice airspace from forming.
This technique is suitable for all patients, including those with intellectual disabilities, as it does not explicitly mention the tongue, which can be confusing for some individuals. Instead, it relies on the natural tongue positions during respiration and deglutition, making it a more intuitive and effective method for achieving the desired tongue position during panoramic radiography.
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Avoid mentioning the tongue
The nasopharyngeal airway (NPA), also known as a nasal airway, NPAT (nasopharyngeal airway tube) or nasal trumpet, is a hollow plastic or soft rubber tube. It is used to improve oxygenation and ventilation when bag-valve-mask ventilation is ineffective, or a patient's mouth is difficult to access.
NPAs are inserted into the nose and through the posterior pharynx, displacing the posterior tongue and soft palate to clear the airway. The NPA is designed to prevent the collapse of the tongue and soft tissues at the back of the throat, ensuring unobstructed airflow into the lungs.
To prevent nasopharyngeal airspace on a pan, a simple breathing technique has been developed that does not mention the tongue. This technique is suitable for all patients, including those with intellectual disabilities, and uses a 'tell-show-do' approach. The patient is told they will be having a dental X-ray to capture their teeth and jaws. The patient is then instructed to "breathe in, breathe out, swallow, lips closed and hold still". This technique reduces the intensity of the palatoglossal and pharyngeal airspaces on panoramic radiographs.
By avoiding explicit mention of the tongue, this technique simplifies the instructions and reduces patient confusion. The "breathe-in, breathe-out, swallow" sequence naturally results in the desired tongue position, with the tongue flattened against the hard palate, without requiring patients to consciously hold their tongue in a specific position. This approach helps to ensure effective panoramic radiography, even for patients who may struggle with traditional tongue position instructions.
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Frequently asked questions
The nasopharyngeal airspace is a diagonal radiolucent band extending above the soft palate and continuing under the soft tissue outline of the uvula.
The nasopharyngeal airspace appears as a diagonal radiolucent band on a panoramic image.
The traditional instruction for patients is to hold their tongue to the roof of their mouth.
The simple breathing technique instruction for patients is to breathe in, breathe out, swallow, close their lips, and hold still.
The simple breathing technique instruction is suitable for all patients, including young patients and those with intellectual disabilities.
