Category: Dental Hygiene

My BHAG

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.ottawa-dentist-jaleel-x-ray

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.seidner-dentistry-randolph-nj-dentist-dental-xrays-image

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.why_dentists_take_xrays1

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 dental-xrayguiding 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.

 

 

In Defense of the Dental Hygiene Program at Concorde

sweet-toothI am a proud instructor at an accelerated dental hygiene program in San Antonio, Texas. I have worked here for almost two years, and have nothing but good things to say about our program director, faculty, clinic manager, and students. We work very hard to ensure the success of our students and it hurts when I hear accusations that suggest the contrary.

 I have to admit that when Concorde opened a dental hygiene program, I initially didn’t like the idea. I had preconceived notions that an accelerated program could not produce quality hygienists. I heard gossip from other hygienists in our city. The program did not receive a warm welcome from the hygiene community.

 However, my dream was to be a teacher. I had a Bachelor of Science degree, which was not enough to work at the university, but it was acceptable for teaching in an Associate degree program. With only two options in my city, I decided to take a look at Concorde. I was impressed.

 After applying for a position as an instructor, I was hired on part-time. Initially I worked as a clinic instructor and assisted the clinic teacher in instrumentation labs. What I saw was the exact opposite of my initial perceptions of the program.

 The clinic at Concorde is beautiful. It is very modern and well-appointed. We have digital sensors and a digital panoramic machine; we are in the process of installing laptops in all 12 operatories so the students can record their notes in Dentrix more easily. Our clinic manager has high standards for infection control and is exceptional at ensuring that we maintain thorough records of timely spore testing and that our equipment is working properly.

 The curriculum is of the same quality as the program I graduated from in 2003. The students are engaged in the learning process, they’re smart and they work hard. The instructors create significant learning environments, ensuring that all learning styles are included in the instruction.

 In my classes, I am constantly thinking of new ways to engage the students. In Oral Histology, we have a lab where the students use microscopes to study different tissues. We use creative materials; last week I had the students sculpt the muscles of mastication out of clay and they attached them to the appropriate origins and insertions on a plastic skull. The students complete table clinics, write papers, collaborate on group projects, practice their skills in clinic, and provide service to the community. The fact is our students succeed. We have very good pass rates on both the National Board and CRDTS. It may be an accelerated program, but it’s very student-centered and we have a great team of educators, so it works.

 IMG_1838Most of our instructors have Master’s degrees or are in the process of obtaining them. I am working on my M.Ed. in Digital Leading and Learning; I plan on introducing more technology into the classroom to facilitate engagement and deeper learning. Concorde offers tuition reimbursement to encourage instructors to earn higher degrees. Actually, Concorde provides a lot of great benefits to its employees and I feel lucky to be a part of an organization where I truly feel valued.

So, to all the hygienists who have negative feelings about Concorde, I invite you to actually take a look at what we provide to our students. Recently, an article was published about another Concorde campus in California. The article contained multiple inaccuracies and sought to perpetuate the negative feelings that some hygienists have about accelerated programs. Don’t jump on the bandwagon without any personal experience. Most likely, if you have the same preconceived notions that I had, it’s because you haven’t seen our school or met the awesome students we serve.

 

 

 

 

Teaching Radiography

Teaching Radiography to dental hygiene students can be a daunting task. The concepts of mA and kVp seem to be among the most difficult to grasp. Many of them have a difficult time understanding how X-rays are created in the dental X-ray tube. When X-rays are created, the kinetic energy of the accelerating electrons has to be converted into electromagnetic energy. The main way this occurs is via bremsstrahlung radiation. Here’s how I explain the process:B978070204600100016X_f16-01b-9780702046001

  1. First, we need a free source of electrons. We do this by heating up the tungsten filament (cathode) to incandescence. I demonstrate this by turning out the lights and holding up a coiled wire as I heat it with a lighter until it starts glowing. I explain that the energy needed to heat the coil to incandescence represents the mA, which is usually in the range of 5-8 volts. As the wire heats up, a cloud of electrons will form around it.
  2. The next thing we need is to impart speed to the electrons and propel them toward the tungsten target (anode). We achieve this by energizing the electrons with about 60-90 kilovolts. This is the kVp. It would be like holding the wire up to a blowtorch instead of a lighter.
  3. At this point, the electrons accelerate toward the tungsten target with tremendous kinetic energy. For X-rays to be created, we need to convert the kinetic energy of the electrons into electromagnetic energy. Remember energy cannot be created or destroyed, but can change form.
  4. As the electrons slam into the tungsten target, the sudden stop converts their energy from kinetic to electromagnetic (and other energy like heat). About 1% will be converted into X-rays. Bremsstrahlung means “braking”, and describes this sudden stop.
  5. To help them visualize Bremsstrahlung radiation, I ask them to think about what happens if a car accelerates and crashes into a concrete wall. The sudden stop will convert the kinetic energy of motion into heat and sound waves (the crashing sound). It’s similar to what happens in an X-ray tube, just on a much smaller scale.

This explanation seems to help my students understand these difficult topics. The textbook explanations can be so difficult to understand; I always think the answer is to simplify and demystify tough concepts. Visuals and dramatic storytelling always help too. After all, we’re teachers, but we’re also actors up on stage. Give them something engaging and fun, and they will learn.