154 | Journal of Disability and Oral Health (2016) | 17/4 Pradhan and Gryst: Lateral oblique radiographs in patients with special needs This case series describes four cases on the use of oblique lateral radiographs as an alternative technique where intra-oral radiographs or an orthopantomogram (OPG) are not possible due to the patients’ physical and/or intellectual disabilities. The cases represent patients across different age-groups (25-83 years), medical conditions (autism, dementia, intellectual disability) and varying clinical situations (assessment of third molars, decision to restore or extract teeth). The oblique lateral radiographs provided adequate radiographic information to confirm diagnosis and treatment. Due to the very short time exposure needed, oblique lateral radiographs are good alternatives to OPGs and still have a significant role in the diagnosis, treatment planning and therefore treatment outcomes for patients with special needs. Key words: Radiographs, special needs, diagnosis, treatment planning Date Manuscript Received: 01/08/2016 Date Manuscript Accepted: 30/10/2016 Doi: 10.443/JDOH/Pradhan_05 A Pradhan 1 and M Gryst 2 Abstract 1. Senior Lecturer, Oral Health Centre, The University of Queensland, 2. Senior Consultant, Special Needs Unit, Adelaide Dental Hospital, Australia The use of lateral oblique radiographs in dental treatment planning for patients with special needs Introduction Radiographs are essential in the diagnosis and therefore treatment outcomes for patients. Modern digital radiographs and techniques are excellent for the general population where there is full patient co-operation and anatomy is within the normal range. However, these techniques may not be applicable to people with special needs, where anatomy may not be within the expected range and patient compliance may be poor or nil. Several tips on radiology for such challenging cases can be adopted as suggested by Greenwood (2013). Tese include using circular collimation instead of rectangular collimation to allow for slight movements; occlusal radiographs or large periapical radiographs using the bisecting angle technique; models and pillows. Where intra-oral radiographs are not possible for children or patients with limited jaw opening, or adults with intellectual disabilities who are unable to cooperate/tolerate, cannot/will not open their mouths, or hold the flm in position while intra-oral radiographs are being taken, the orthopantomogram (OPG) can provide an overview of the dental status. However, some patients may not be able to stand in position even for the duration of taking an OPG. Oblique lateral radiographs are ofen used as an alternative in such circumstances (Greenwood, 2013). Additional use for this method is where the anatomy or physical posture of the patient does not allow the OPG to be taken, for example, patients with severe arthritis of the neck, patients who are wheel-chair users and patients with Down syndrome where the anatomy of the neck and shoulders may cause difculty. Other patients who can utilise this method are those with cerebral palsy, Parkinson’s disease, multiple sclerosis, Huntington’s Chorea and other neurological impairments who are unable to remain still due to involuntary movements. Te preferred radiographic option for patients in Australia with nil/poor compliance undergoing dental treatment under general anaesthesia (GA) would also be an oblique lateral radiograph. In some units, periapical and bitewing radiographs are also taken as necessary. With the move towards digital direct capture, issues in continuing this method of radiography due to difculty in maintaining the use of flms/cassettes and intensifying screens or digital cassettes were raised (Dalley, 2009; Greenwood, 2009). Te general belief is that with the advent of modern, digital techniques, ‘old fashioned techniques’ are outdated and no longer of use. However, these modern digital radiographs and techniques available to general patients cannot be used for people with special needs, where compliance or physical anatomy are barriers. Tis is due to the size of the digital plate available on the Australian