Dental hygienists are expected to know how to take diagnostic radiographs and how to interpret them. Dentists will expect them to be able to discuss findings with the patient for educational purposes. Although dental hygienists cannot legally diagnose pathology, they need to have an understanding of normal anatomy and how to recognize pathology including, but not limited to: periodontal disease, caries, periapical pathology, cysts, and other abnormalities of teeth and bone. Their ability to interpret the radiographs and educate the patient is critical so that they can collaborate with the dentist and patient to create a treatment plan that will result in quality care for the patient.
The Radiography course I teach is an undergraduate level class that meets twice a week: 3 hours in a live classroom setting and 3 hours of lab. With 24 students in the class, the lab is divided into A and B groups, consisting of 12 students in each lab. We have Wi-Fi in the classroom, enabling the students to access pertinent websites or participate in online class activities and games. In the lab, we have a Dexis digital sensor for taking radiographs and a digital panoramic X-ray machine. The practice management software we use is Dentrix, which is compatible with Dexis. All digital X-rays are uploaded to the patients’ digital charts for ease of flipping back and forth between the X-rays and other data such as periodontal probe readings or intraoral camera pictures.
The class combines both theoretical and practical learning. The theoretical learning occurs mostly in the classroom and the practical learning occurs mostly in lab. One of the important changes in our field is the introduction of 3-D imaging (primarily Cone Beam Computed Tomography) that is predicted to become a common addition to dental offices in the future. It will improve our ability to view the tissues and subsequently improve treatment. Dental radiography is in the middle of a transition from film-based radiography to digital imaging. CODA (The Commission on Dental Accreditation) requires that we teach both, and it’s a good practice because there are still dental offices in the area that haven’t switched to digital imaging systems.
The students I teach come from varied backgrounds. They are all adult learners, but the ages range from the early 20’s to the mid 40’s. Many of them have experience as dental assistants; this can work for or against them. Sometimes they have bad habits that need to be identified and corrected so they can learn better ways of doing things, but also so they don’t spread their bad habits to other classmates. They come from different socioeconomic groups and cultural backgrounds, but they all share the common goal of becoming hygienists. Many are military veterans.
This will be my third time teaching this class. I have 13 years of practical experience gained by working in clinical practice. I love teaching this class because it’s challenging, fun, and very applicable to the profession of dental hygiene. My strengths are in giving the students real-world examples, hands-on activities, and breaking down difficult topics (chemistry, physics) in a way that makes it easier to understand. Students often comment that they can tell I love what I teach. I’m glad I can share my passion with them and hopefully instill it.
Questions for Formulating Significant Learning Goals
A year (or more) after this course is over, I want and hope that students will know how to safely take quality diagnostic radiographs, interpret them, and be able to discuss findings with their patients and dentist.
Foundational Knowledge
Learners will need to know:
- scientific concepts of X-radiation,
- how X-rays affect film or a digital sensor,
- safety concerns working with radiation,
- how to position film holders,
- how to take radiographs,
- how to correct errors,
- how to interpret radiographs
- how to discuss findings with the patient and doctor
- future technology and its applications
Application Goals
Learners will need to use critical thinking when they interpret radiographs. They will be using their knowledge from other classes such as Dental Anatomy and Oral Pathology to evaluate whether they are viewing normal anatomy or pathology on a film, and list possible diagnoses.
They will use creative thinking when they complete assignments in lab; for instance, one assignment is to create a comic strip depicting the journey of a film through a processor.
They will also use practical thinking when solving issues such as error correction when a film is rendered undiagnostic, or working with challenging patients.
Integration Goals
Students should be able to make connections between the physics of short-wavelength radiation and how it affects human cells to why it is important to take safety measures when working with X-radiation. They should also be able to take the knowledge of using analog film and apply some of the same techniques when working with digital sensors. They should understand that although there are different digital systems available, they work in a similar way. They should be able to use their knowledge of radiographic anatomy and pathology to be able to explain radiographic findings to others.
The information in this course ties into all the other courses in the dental hygiene program. Their class on Periodontology will help them understand the bone loss they may be viewing on a radiograph. Anatomy class teaches them landmarks on a skull that they can translate into a picture on a radiograph. Oral Pathology teaches them about cysts, inflammatory lesions, and even manifestations of systemic diseases that can be seen on radiographs. Clinic classes that teach them about gathering assessments, creating treatment plans, and working with people also tie in to radiography.
The knowledge the students gain in my class will be used extensively, on a daily basis, in their work lives.
Human Dimensions Goals
Students will learn that they can take great radiographs that will make them an asset to any dental practice. Students will learn whether or not they have good interpersonal skills, and how to improve them.
Students will learn to work as a team, doing group projects in class. They will learn how to effectively interact with patients and make them feel comfortable. They will learn about their role in interacting with the dentist and how to intelligently discuss findings on radiographs and differential diagnoses.
Caring Goals
I hope students will understand the importance of empathy for patients, and learn to cultivate it. I hope they will be ethical in their use of radiation: minimizing re-takes and not taking X-rays too frequently just because insurance covers them. I want them to remember to place the welfare of the patient above profit.
“Learning-How-to-Learn” Goals
I want the students to know they are welcome to use search engines in class or at home to better understand any information they don’t quite “get”. They might be lacking some foundational knowledge that would help them understand certain topics- especially when they’re learning about chemistry and physics.
I want them to work together and learn from their peers, dentists, hygienists, and dental assistants.
In order to become self-directed learners in this course, they will need to align class objectives with what they are studying. They will need to create a plan to read their chapters before class and attend classes and labs.
My Big Hairy Audacious Goal is: By the end of this course, my students will be able to take excellent radiographs, know how to interpret them, and how radiographs are integrated into total patient care.
Using Fink’s Self-Directed Guide for Designing Courses for Significant Learning, I created a table that links learning outcomes, learning activities, and assessment activities for my Dental Radiography class:
| Learning Outcomes | Learning Activities | Assessment Activities |
| Foundational Knowledge
Learners will investigate the concepts of electromagnetic radiation and how X-radiation is used in dentistry.
|
Read Essentials of Dental Radiography for Dental Assistants and Hygienists
Class discussions |
Chapter minute papers
Pre- and Post-class Kahoot quizzes
Exams |
| Application
Learners will practice radiography skills and trouble-shoot errors. |
Lab: hands-on practice with taking X-rays on Dexter: traditional film and digital sensors.
Learners will practice developing their own films and mount them correctly. Using Dentrix, they will practice digital radiography and navigate the software. |
Learners will assess their own radiographs for acceptability and determine ways to correct any errors
X-ray grading by teacher |
| Integration
Learners will analyze how taking quality radiographs aids in proper diagnosis for their patients |
Discussions using case studies; learners will discuss examples of poor quality radiographs and compare them with good quality radiographs, noting what can be diagnosed from each film. | Learners will create their own case studies that demonstrate differences in diagnosis based on good or poor radiographs. |
| Human Dimension/ Caring
Learners will analyze the importance of safety for themselves and their patients. |
Discussions including personal experiences in different types of offices.
Review the ADA guidelines for radiography. Compare and contrast ideal prescription of radiographs and why some offices allow insurance to dictate how often radiographs are taken and what type.
Discuss the ethics of applying ALARA and the need for prescription of radiographs on a case-by case basis as needed. |
Project and presentation: using the learner’s choice of media, they will address and discuss safety concerns. Examples may include:
PPE, dosimeters and lead aprons Calibration of machines/ quality control Radiographs on cancer patients Biological effects of radiation Osteoradionecrosis Non-medical/dental sources of radiation Minimizing re-takes and unnecessary exposure |
| Learning How to Learn
Students will investigate new technology in radiography and how it can improve upon current modalities |
Learners will research current technology available for dental offices and possibilities for future technology. | Project: based on their research, learners will imagine and create their ideal radiography operatory for the future. They will include:
The type of technology they want to incorporate and why What brands they prefer Projected costs How it will benefit the patients How it will benefit the dental practice |
The wonderful thing about teaching radiography is that the students get to practice their skills throughout the dental hygiene program, after the actual radiography class ends. I have many opportunities to continue 
guiding them with real-life examples of challenges and solutions to problems with anatomy or patient management. They continue to use their skills as part of total-patient care, and they get opportunities to learn from the dentists and other instructors in the clinic. Radiography is definitely a skill they will remember, as they will use it every day in their career as dental hygienists.
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