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Radiographic Decision Making (RDM)-Outline

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Radiographic Decision Making (RDM)-Outline

I. Introduction

A. Overview of current California law

In California, non-RDM-certified auxiliaries can perform specific intra-oral procedures,

including taking radiographs, probing, and prophylaxis.

1. Legal requirements for taking X-rays

According to California law, there are specific requirements for taking X-rays. Non-

RDM-certified auxiliaries can only perform intra-oral procedures on patients who are

already in the dentist's records, have had their medical history reviewed, and have

undergone a preliminary oral exam by the dentist.

B. Assembly Bill 1174 and RDM Certification

1. Benefits and privileges of RDM certification

RDM certification expands the role and responsibilities of auxiliaries in the dental

practice. It allows certified auxiliaries to make decisions regarding the radiographs

needed for diagnosis and to take those radiographs before the dentist sees the patient.

This certification empowers auxiliaries to contribute to the diagnostic process.

2. Requirements for RDM certification

To obtain RDM certification, auxiliaries must complete 4 hours of lecture and clinical

simulation training. This includes attending a lecture, passing a multiple-choice and

visual exam, practising RDM on a classmate, and creating, presenting, and passing an

RDM case study for three patients. The passing grade for certification is 75%.
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II. Goals of Teaching RDM

a) Developing professional judgment for auxiliaries

The aim is to develop professional judgment in auxiliaries, enabling them to determine

which radiographs are necessary for diagnosis.

b) ADA/FDA Guidelines and ALARA principle

Following ADA/FDA Guidelines and the ALARA principle (As Low As Reasonably

Achievable) is crucial in developing this judgment.

III. Resistance to Change

a) Professionals' adherence to ingrained learning and beliefs

Professionals may need to change their established learning and thoughts despite

scientific evidence.

b) Overcoming resistance to change in behaviour

Overcoming resistance to change in behaviour is a challenge, as it often takes a long time

for the profession to adopt new practices.

IV. ALARA Principle

a) Meaning and significance of "As Low As Reasonably Achievable."

The "As Low As Reasonably Achievable" principle emphasizes minimizing radiation

exposure through reasonable methods.

b) Minimizing radiation exposure and avoiding unnecessary radiation

Regardless of the dose, radiation that offers no direct benefit should be avoided.
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Initiatives like "Image Gently" and "Image Wisely" are endorsed by the ADA, FDA,

AMA, and the American Academy of Pediatrics.

V. ADA/FDA Guidelines for Radiographs

a) Individualizing X-rays for reduced radiation and accurate diagnosis

Individualized X-rays help reduce needless radiation while providing sufficient

diagnostic information.

b) Studies supporting radiation reduction without compromising diagnosis

Studies show that radiation can be reduced without compromising the ability to detect

diseases.

VI. Types of X-rays and their Purposes

a) Bite-wing X-ray (BWX)

They are used to identify interproximal caries (closed contacts) and assess bone levels.

b) Periapical X-ray (PA)

Suitable for diagnosing symptomatic teeth, pulpal pathology, impacted teeth, and

significant bone loss.

c) Full Mouth X-rays (FMX)

They are recommended for periodontal disease, high caries rate, and extensive previous

treatment.

d) Panoramic X-ray (Pano)

Helpful in detecting global pathology, developmental concerns, and impacted teeth.

VII. Factors Influencing X-ray Decision Making

a) Verbal information from the patient

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Verbal information from the patient, such as age, pain, missing teeth, bleeding, and

concerns, helps determine the need for specific X-rays.

b) Visible absence or presence of periodontal disease

Visible absence or presence of periodontal disease and other signs like bad breath,

swollen gums, bleeding, loose teeth, and limited probing assist in deciding the necessity

for x-rays.

c) Reason to suspect pathology or malocclusion

Reason to suspect pathology or malocclusion includes missing teeth, tooth alignment,

symptoms, and visible pathology.

d) Visible caries and interproximal caries

Visible caries and interproximal caries require appropriate X-rays, while their absence (in

the absence of symptoms) may eliminate the need for specific X-rays.

e) Anterior interproximal caries

Anterior interproximal caries can be seen with strong light and trans-illumination. If no

caries are visible, anterior periapical X-rays may not be necessary (in the absence of

symptoms).

VIII. Guidance for X-ray Decision Making

a) When to take more than BWX

Clinical signs or symptoms and additional considerations can guide the decision to take

additional X-rays.

Specific recommendations for X-rays depend on the patient's age, dentition type, risk

factors, and previous dental treatments.

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IX. Additional Considerations for X-rays

a) Positive history findings

Positive history findings, such as previous periodontal or endodontic treatment, pain or

trauma history, familial dental anomalies, postoperative evaluation, remineralization

monitoring, presence of implants, or previous implant-related issues, may indicate

additional x-rays.

b) Positive clinical signs and symptoms

Positive clinical signs and symptoms, such as periodontal disease, large or deep

restorations, deep carious lesions, malposed or impacted teeth, swelling, dental/facial

trauma, tooth mobility, sinus tracts, growth abnormalities

X. New Perspective on Radiographs

a) Dentists order additional radiographs based on the expected impact on patient care.

Dentists are encouraged to order additional radiographs based on the expected impact on

patient care.

b) Moving away from FMX and baseline radiographs for all patients

The old thinking was that every patient should receive the same schedule of radiographs,

including FMX and baseline radiographs. The idea behind the baseline FMX was to have

a comprehensive set of X-rays that can be referred to if any problems arise.

XI. Balancing Patient's Best Interest and Educational Needs

a) Aligning educational requirements with patient care

Aligning educational needs with patient care means providing the necessary education to

auxiliary staff and ensuring optimal patient care.

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XII. Conclusion

a) Fulfilling educational needs while considering patient care

Emphasizes the importance of fulfilling educational needs while also regarding patient

care.

b) Reducing radiation exposure by questioning the necessity of additional X-rays

Reducing radiation exposure can be achieved by questioning the necessity of additional

X-rays and ensuring that each X-ray is justified based on clinical indications.

c) Importance of reducing radiation exposure and focusing on patient benefits

The focus should be reducing radiation exposure and prioritizing patient benefits, such as

accurate diagnosis and minimizing unnecessary procedures.