PAGD Keystone Explorer Winter 2020

Keystone Explorer | Winter 2020 19 dentistry issues Q treating the airway. Structures such as Glabella, Nasion, soft tissue landmarks of the tip of nose and bottom of chin, and C1-C5 vertebrae can be captured with a large FOV. By capturing all of these landmarks, the clinician is able to visualize all of the teeth, the maxillary sinuses, the nasal cavity, and the entire maxilla and mandible including the hard tissue structures of the TMJ. As an added bonus, it allows the clinician to visualize the entire airway from the point of air entry (nose), through the naso and oropharynx, to just above the inferior border of the larynx, where the trachea begins. Visualization of this entire pathway is important because a patient can have more than one area of airway obstruction. Information about an individual’s entire airway space helps to formulate customized treatment plans and allows for better communication with the patient’s medical team. The value of these large FOV images goes beyond the general dentistry practice and airway management. Consider a patient with the chief complaint of TMJ pain. A large FOV CBCT may show an abnormal curvature of the spine and thus the clinician may choose to refer the patient to a chiropractor as part of his or her treatment plan. Another example is a young child that presents with snoring and symptoms of sleep disordered breathing otherwise missed by the pediatrician. A large FOV CBCT may give valuable clues to pharyngeal and palatine tonsillar inflammation that may have been clinically unremarkable. These images can be shared with the patient’s pediatrician and ENT. Sharing these images and our treatment plans for these patients with their medical teams helps to bridge the gap between professions and allows for more predictable treatment outcomes. It may also serve to educate other medical professionals in all that dentistry has to offer. Furthermore, this type of open communication among local medical professionals serves to promote the best health and wellness options for the patients that we serve in our communities. “Sharing these images and our treatment plans for these patients with their medical teams helps to bridge the gap between professions and allows for more predictable treatment outcomes. It may also serve to educate other medical professionals in all that dentistry has to offer.” The images of 12-year-old male. Medical hx significant for ADHD. Pt has undergone phase 1 ortho with relapse because he was unable to wear his retainer. CBCT obtained and reveals possible airway obstruction of the upper airway as noted with large nasal turbinate structures and adenoidal tissue. CBCT will be used to coordinate successful orthodontic treatment. Referral to his pediatrician to rule out OSA and also to ENT to evaluate nasal breathing ability prior to further orthodontic treatment.