Home About us Editorial board Ahead of print Current issue Archives Submit article Instructions Subscribe Search Contacts Login 
  • Users Online: 600
  • Home
  • Print this page
  • Email this page

 Table of Contents  
Year : 2022  |  Volume : 34  |  Issue : 1  |  Page : 112-115

Dental Radiography of Special Needs Patients: Report of Two Cases

1 Dental Assistant, Oral and Maxillofacial Radiology Clinic, Dental Hospital, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
2 Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand

Date of Submission02-Sep-2021
Date of Decision30-Nov-2021
Date of Acceptance19-Jan-2022
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Suchaya Pornprasertsuk-Damrongsri
6 Yothi Road, Ratchathewi, Bangkok - 10400
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaomr.jiaomr_254_21

Rights and Permissions

In recent decades and an aging society, the prevalence of special needs dental patients has increased noticeably both in children and adults. In most dental patients, the dental radiograph is one of the essential diagnostic tools that help make the proper diagnosis and treatment plan. In this article, we report two cases of special needs patients; aging, bedridden, and teenage autism. In the first case, the periapical bisecting-angle and occlusal topographic radiography were taken with the patient on the mobile hospital bed. In the second case, the oblique lateral radiographs were performed for diagnosis of third molar impaction. The principle of periapical bisecting-angle, occlusal topographic, and oblique lateral radiography is also reviewed.

Keywords: Autism spectrum disorders, bedridden, dental radiography

How to cite this article:
Suyalan S, Chaikantha S, Pornprasertsuk-Damrongsri S. Dental Radiography of Special Needs Patients: Report of Two Cases. J Indian Acad Oral Med Radiol 2022;34:112-5

How to cite this URL:
Suyalan S, Chaikantha S, Pornprasertsuk-Damrongsri S. Dental Radiography of Special Needs Patients: Report of Two Cases. J Indian Acad Oral Med Radiol [serial online] 2022 [cited 2022 Dec 6];34:112-5. Available from: http://www.jiaomr.in/text.asp?2022/34/1/112/340748

   Introduction Top

Patients with special needs are those individuals who have physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairments.[1] Nowadays, the aging population is growing globally, including bedridden, leading to several oral health problems.[2] Furthermore, the prevalence of autism has increased worldwide.[3] Taking dental radiographs for special needs is challenging. Modification of radiographic techniques must be applied with consideration of the “as low as diagnostically achievable” being indication-oriented and patient-specific principle.[4],[5]

These two case reports aim to demonstrate the intraoral radiographic technique for a bedridden patient and the oblique lateral radiographic technique for the diagnosis of impaction in teenage autism. This study was approved by the Faculty of Dentistry/Faculty of Pharmacy, Mahidol University, Institutional Review Board with the COA.No.MU-DT/PY-IRB 2021/051.0406.

   Case Reports Top

Case 1

Patient information and clinical findings

A bedridden 80-year-old female patient presented with a chief complaint of pain on the upper right posterior teeth for 2 weeks. She had Alzheimer's disease, Parkinson's disease, cataracts, and uncontrolled diabetes. Intraoral examination revealed generalized mild calculus deposition and more than 10 retained roots.

Timeline of history

Diagnostic assessment

She was referred to the Oral and Maxillofacial Radiology clinic for all remaining teeth radiographs to be diagnosed and treatment to be planned properly. Due to the limitation of her mouth opening, the paralleling radiographic technique with the film holders was not possible for this case. We applied a bisecting-angle technique using a Snap-A-Ray Xtra phosphor plate holder (Rinn, Dentsply Sirona Inc., Pistoia, Italy), intraoral phosphor plates, and imaging plate scanner (VistaScan Mini Plus, DÜrr Dental Se, Bietigheim-Bissingen, Germany). The periapical radiographs of all remaining teeth from this patient are shown in [Figure 1]. Several retained roots, root caries, and severe horizontal bone loss were revealed to be valid for proper treatment plans.
Figure 1: The all-remaining set of periapical radiographs in a bedridden 80-year-old female patient

Click here to view

One month later, she received full-mouth scaling and fluoride varnish application and then lost follow-up. One year and eight months later, she presented with mild right facial swelling for 2 days. Intraoral examination revealed multiple caries and retained roots at the upper right posterior teeth.

Panoramic and occlusal topographic radiographs were requested to determine periapical abscess. However, only occlusal topographic radiography was taken due to the limitation of patient positioning for panoramic radiography. The head support of the mobile hospital bed was tilted upward about 45° [Figure 2]a. The size-4 imaging plate was inserted with the exposure side facing toward the maxilla. The vertical angulation was about 65° [Figure 2]b. The resulting occlusal topographic radiograph showed multiple retained roots [Figure 2]c.
Figure 2: (a) Positioning of the bedridden patient. (b) imaging plate placement and beam adjustment of upper right posterior teeth. (c) occlusal topographic radiograph of upper right posterior teeth

Click here to view

Therapeutic intervention

The retained roots of the upper right molars were extracted under local anesthesia according to the chief complaint. Full-mouth rehabilitation under general anesthesia was suggested for further complete treatment.

Follow-up and outcomes

Due to COVID-19 situation and bedridden condition, the patient has not currently received complete treatment.

Patient perspective

The patient had no pain on right maxilla. No complication or adverse effect occurred after tooth extraction.

Case 2

Patient information and clinical findings

A 19-year-old male with autism had congenital blindness, no history of the previous extraction, and clinical absence of wisdom teeth.

Timeline of history

Diagnostic assessment

The patient was referred for panoramic radiography to evaluate the presence/absence of impacted teeth. Based on his behavior and possibility of movement during panoramic exposure (15 s), we decided to take a special extraoral radiographic technique called “oblique lateral” that required a significantly shorter exposure time (0.25 s) than panoramic radiography. The positioning of the oblique lateral technique is described in [Table 1]. To prevent the patient's movement during exposure, we asked his mother to hold his head and cassette with lead apron protection for both [Figure 3]a. The exposure setting was 65 kVp, 10 mA, 0.25 s (Gendex, Kavo Dental, California, USA). The imaging plate was then scanned using the Carestream DirectView Elite Computed Radiography system (Carestream Health, Inc, New York, USA). The oblique lateral radiographs revealed right and left impacted mandibular third molars with incomplete root formation [Figure 3]b and [Figure 3]c.
Table 1: Principles of the periapical bisecting-angle, occlusal topographic, and oblique lateral radiography

Click here to view
Figure 3: A 19-year-old male patient with autism. (a) positioning of right oblique lateral radiography. (b) right oblique lateral radiograph. (c) left oblique lateral radiograph

Click here to view

Therapeutic intervention

The patient was scheduled for surgical removal of wisdom teeth and 15, 25 malposition under general anesthesia. However, this schedule was postponed due to the COVID-19 situation.

Follow-up and outcomes

The parent notified that she wanted to have her son treated at a local hospital due to the inconvenience of traveling to a pandemic area.

Patient perspective

The wisdom teeth caused no symptoms to her son and there was no need for urgent treatment.

   Discussion Top

Patients with special needs have the potential for oral health problems, including periodontal disease, dental caries, impaction, and so on. Providing dental treatment to special needs is essential to maintain adequate oral health and quality of life.[6] The dental radiograph is usually requested to determine the stages of these problems, such as periapical radiograph, bitewing radiograph, and/or panoramic radiograph.

Due to the limitation of physical condition in elders, modification of standard radiographic techniques was applied. For example, in a bedridden patient, the paralleling periapical radiography was changed to the periapical bisecting-angle radiography. However, in a small dental x-ray room or at a nursing home, the handheld portable dental x-ray equipment should be used with the consideration of the principle of radiation protection.[7] Moreover, in case of extreme limited mouth opening and requiry of large coverage of periapical areas, occlusal topographic radiography should be requested [Table 1].

In special needs with a mental condition, several approaches for dental radiographic examinations in autism were suggested by Dailey and Brooks.[8] These approaches included using two radiographic aprons, a sand timer, earplugs, videos, dental pictorials, a radiographic practice kit, and so forth.[8] In our case report, the oblique lateral radiographs were performed instead of panoramic or periapical radiographs to demonstrate the presence/absence of impacted teeth. This radiographic technique requires a short exposure time compared to that of the panoramic radiographic technique.[9]

In conclusion, our clinical cases showed that the dental radiographic techniques for special needs patients could be successfully done by conventional radiographic techniques, which provide adequate radiographic details for diagnosis and treatment planning.

Declaration of patient consent

The authors certify that two patients have obtained all appropriate patient consent forms. Both patients have given their consent for their images, radiographs, and other clinical information to be reported in the scientific publication without revealing the identity.


The authors also wish to appreciate Associate Professor Dr Jira Kitisubkanchana and Ms Malisa Malasai as dental radiographers for the actual patients.

Key Messages

To properly take dental radiographs in special needs patients, the dentist should request a suitable radiographic technique. The periapical radiograph could be taken in the bedridden patient on the hospital mobile bed. Moreover, the oblique lateral radiograph should be requested in detecting the third molar impaction of teenage autism.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

American Academy of Pediatric Dentistry. Council on Clinical Affairs. Guideline on management of dental patients with special health care needs. Pediatr Dent 2012;34:160-5.  Back to cited text no. 1
Bakker MH, Vissink A, Spoorenberg SLW, Wynia K, Visser A. Self-reported oral health problems and the ability to organize dental care of community-dwelling elderly aged ≥75 years. BMC Oral Health 2020;20:185.  Back to cited text no. 2
Chiarotti F, Venerosi A. Epidemiology of autism spectrum disorders: A review of worldwide prevalence estimates since 2014. Brain Sci 2020;10:274.  Back to cited text no. 3
White SC, Scarfe WC, Schulze RK, Lurie AG, Douglass JM, Farman AG, et al. The image gently in dentistry campaign: promotion of responsible use of maxillofacial radiology in dentistry for children. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:257-61.  Back to cited text no. 4
Kuhnisch J, Anttonen V, Duggal MS, Spyridonos ML, Rajasekharan S, Sobczak M, et al. Best clinical practice guidance for prescribing dental radiographs in children and adolescents: An EAPD policy document. Eur Arch Paediatr Dent 2020;21:375-86.  Back to cited text no. 5
Anders PL, Davis EL. Oral health of patients with intellectual disabilities: A systematic review. Spec Care Dentist 2010;30:110-7.  Back to cited text no. 6
Berkhout WE, Suomalainen A, Brullmann D, Jacobs R, Horner K, Stamatakis HC. Justification and good practice in using handheld portable dental X-ray equipment: A position paper prepared by the European Academy of DentoMaxilloFacial Radiology (EADMFR). Dentomaxillofac Radiol 2015;44:20140343.  Back to cited text no. 7
Dailey JC, Brooks JK. Autism spectrum disorder: Techniques for dental radiographic examinations. J Dent Hyg 2019;93:35-41.  Back to cited text no. 8
Verhoeven JW, Cune MS. Oblique lateral cephalometric radiographs of the mandible in implantology: Usefulness and accuracy of the technique in height measurements of mandibular bone in vivo. Clin Oral Implants Res 2000;11:39-43.  Back to cited text no. 9


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

   Abstract Introduction Case Reports Discussion Article Figures Article Tables
  In this article

 Article Access Statistics
    PDF Downloaded245    
    Comments [Add]    

Recommend this journal