牙科放射線學 (1)

陳玉昆助理教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

Communication skills in dentistry with emphasis on oral radiography

接受 X 光影像攝影的溝通技巧

學 習 目 標學 習 目 標

- 認識牙科 X光影像攝影-了解牙醫師與病患 ( 含 X 光影像攝影 )溝通技巧

根尖片

平行法 分角線法 難題解決

牙科放射線影像攝影臨床指引根尖片咬翼片咬合片

全 口 X 光 片

左 邊

小 臼 齒

右 邊

小 臼 齒

小 臼 齒大 臼 齒

大 臼 齒

咬 翼 片

咬 翼 片 咬 翼 片

咬 翼 片

上 顎

下 顎

門 齒

門 齒 犬 齒

犬 齒 犬 齒

犬 齒 小 臼 齒 大 臼 齒

大 臼 齒

後 牙

橫 放橫 放

左上、右下 象限 右上、左下 象限

前 牙直 放

upper

前 牙直 放

lower

平 行 法

Positioning

上 顎 門 齒

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

上 顎 門 齒

平 行 法

上 顎 犬 齒

Positioning

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

上 顎 犬 齒

平 行 法

Positioning

上 顎 小 臼 齒Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

上 顎 小 臼 齒

平 行 法

上 顎 大 臼 齒

Positioning

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

上 顎 大 臼 齒

平 行 法

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

下 顎 門 齒

Patient positioning

Patient positioning

下 顎 門 齒

平 行 法

下 顎 犬 齒

Positioning

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

下 顎 犬 齒

平 行 法

下 顎 小 臼 齒

Positioning

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

下 顎 小 臼 齒

平 行 法

Positioning

下 顎 大 臼 齒

Anterior Posterior

Metal supporting

indicator rod

White locator ring

Bite block

Bite block

Patient positioning

下 顎 大 臼 齒

平 行 法

正確 錯誤

平 行 法

分 角 線 法

Alveolar bone levelis not accurate

Vertical angulation too small

原 理

前 牙

2 - 3mm beyondthe incisal edge

Long axisof thefilmpacket vertical

Long axis of the filmpacket horizontal

後 牙

2 - 3mm beyondthe occlusal edge

水 平 角

下 顎上 顎

正 確 入 射 路 徑

正確

原 理 錯

誤

錯誤

分 角 線 法

後 牙

前 牙Bite fork 鱷 魚 夾

分 角 線 法

上 顎 犬 齒

Vertical angle

上 顎 門 齒

Vertical angle

Patient positioning

Patient positioning

分 角 線 法

Patient positioning

Patient positioning

上 顎 小 臼 齒

上 顎 大 臼 齒

分 角 線 法

分 角 線 法

Patient positioning

Patient positioning

下 顎 犬 齒

下 顎 門 齒

Patient positioning

Patient positioning

分 角 線 法 下 顎 小 臼 齒

下 顎 大 臼 齒

下顎第三大臼齒 嘔 吐 感 根管治療 無牙區域 小孩子 殘障病患

難 題 解 決

1. The dentist–patient relationship is a crucial factor

that has an influence on the viability of the average dental practice

2. Dental students should be educated about the importance of developing and mastering sound communication skills with patients.

Importance of patients communication for dentists

3. Little emphasis was placed on the development of sound communication skills because dental students’ cognitive and clinical development have always been emphasized4. It has been noted that the ability to communicate skillfully and with purpose rarely occurs as a gift, but is learned, the reality is that the term ‘communication skills’ is perceived as an intrinsic part of an individual’s personality, his/her cognitive functioning and social experience

Importance of patients communication for dentists

A. Opening the interview (creates safe environment) :

1. Greets patient2. Obtains patient’s name3. Introduces self4. Attends to patient’s physical comfort (here and throughout interview)5. Identifies and confirms patient’s chief complaint

Steps for patients communication for dentists

B. Gathering information: structuring the interview (explains interview process):

1. Negotiates an agenda for consultation2. Attends to timing

Steps for patients communication for dentists

C. Gathering information: exploration of problems (determines chief complaint) :

1. Encourages patient to give history of chief complaint2. Uses open questioning technique(s)3. Uses closed questioning technique(s)4. Listens attentively (no interruptions; allow time for patient to think before answering)

Steps for patients communication for dentists

5. Facilitates patient’s responses (use of encouragement, silence, repetition, paraphrasing, interpretation)6. Clarifies patient’s statements which are vague and need amplification7. Summarizes at end of a specific line of inquiry to verify own interpretation of what patient has said to ensure no important data was omitted

Steps for patients communication for dentists

D. Understanding the patient’s perspective (determines expectations, psychosocial issues & emotions) :

1. Determines patient’s expectations regarding each problem2. Picks up verbal cues (patient’s need to contribute

information/ask questions; information overload; distress)

3. Encourages expressions of feelings4. Encourages patient to contribute ideas/

suggestions/preferences/beliefs5. Accepts legitimacy of patient’s views/beliefs (non-

judgmental)

Steps for patients communication for dentists

E. Sharing information (presents treatment plan) :

1. Discusses treatment options2. Discusses consequences of not proceeding with treatment plan (in non-threatening manner)3. Provides information about procedures, processes, benefits & advantages, value & purpose4. Uses easily understood language (avoids or adequately explains technical terminology)5. Shares own thoughts & ideas

Steps for patients communication for dentists

F. Reaching an agreement on treatment plan(s) (treatment plan acceptance) :

1. Obtains patient’s view of need for action (perceived benefits)2. Negotiates mutually acceptable treatment plan

(encourages patient to make choices; address concerns)

Steps for patients communication for dentists

3. Elicits patient’s understanding about treatment plan(s)

4. Takes patient’s lifestyle, beliefs, cultural background and abilities into consideration

5. Encourages patient to be involved in implement-ing treatment plan (to take responsibility and be self-reliant)

6. Asks about patient’s support network for decision-making

Steps for patients communication for dentists

G. Closing the interview :

1. Summarizes session briefly2. Contracts with patient regarding next step(s) for patient and dentist3. Explains possible unexpected outcomes and safety-nets appropriately

Steps for patients communication for dentists

H. Nurturing the relationship (employs relationship building blocks) :

1. Demonstrates interest2. Demonstrates respect3. Communicates warmth4. Demonstrates appropriate non-verbal behavior (for example eye contact, posture & position, movement, facial expression, use of voice)5. Reading, writing, use of computer do not interfere with dialogue/rapport6. Shows empathy with patient7. Deals sensitively with embarrassing & disturbing topics

Steps for patients communication for dentists

當病患現有懷孕時：A.在放射線照射前，應告知她的法律權益B.應警告她有流產的可能性C.應告知她絕不可拍攝牙科 X 光片D.視情況在適當的防護下可拍攝牙科 X 光片 ( 上列何者最正確 ) http://www.scmh.org.tw/dental/dental_information/dental_x-ray.htm

當病患現有懷孕時：A.在放射線照射前，應告知她的法律權益B.應警告她有流產的可能性C.應告知她絕不可拍攝牙科 X 光片D.視情況在適當的防護下可拍攝牙科 X 光片 ( 上列何者最正確 ) http://www.scmh.org.tw/dental/dental_information/dental_x-ray.htm

Steps for patients communication for dentists

1. The culture of dentistry places a high premium on technology. Dental schools should ensure a balanced approach in their training of dentists to ensure that the focus on technology is not at the expense of the dentist–patient relationship

Summaries

2. Since dental care occurs in the context of relationships amongst patients and dentists, dental schools should complement students’ cognitive and clinical development by teaching the human dimensions of dental care by means of the development and implementation of courses in communication skills

Summaries

3. Standardized patient (SP): a professional actress was trained as SP to portray the case study (clinical scenario) in a consistent, reproducible and measurable manner )4. To assist the SP in understanding the nature of the dental scenario and its presenting signs and symptoms, written case notes were prepared for the SP to review

Summaries