Examination and Diagnosis

8/6/2019 Examination and Diagnosis

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EXAMINATION AND DIAGNOSIS

Examination is the hands on process of

observing both normal and abnormal

conditions.

Diagnosis is a determination and judgment of

variations from normal


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General consideration

Examination of orofacial soft tissues

Examination of teeth and restoration Review of periodontium

Examination of occlusion

Examination of the patient in pain


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GENERAL CONSIDERATION

Charting of records

Tooth denotation system

Preparation for clinical examination

Interpretation and use of diagnostic aids.


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Charting of records

Uncomplicated

Comprehensive

Accessible

current


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Need for charts and records

Proper care-provides basic information for anaccurate ,comprehensive, treatment plan.

Third-party communication-communicate tothird party agencies.

Practice audits and quality assessment-measures the quality of care provided.

Legal proceedings-evidence for negligence andmalpractice


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FORENSIC USES-IDENTIFY DECEASED PERSON

TOOTH DENOTATION SYSTEM

Universal system.


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EXAMINATION OF OROFACIAL SOFT

TISSUES

SUBMANDIBULAR LYMPH NODES

CERVICAL LYMPH NODES

MASTIGATORY MUSCLES PALPATION OF

CHEEKS,VESTIBULES,MUCOSA,TONGUE,FLOOR

OF

THE MOUTH.


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EXAMINATION OF TEETH AND

RESTORATION

CLNICAL EXAMINATION OF CARIES

VISUAL CHANGES

TACTILE SENSATION

RADIOGRAPHS

TRANSILLUMINATION


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VISUAL CHANGES

DONE IN A

WELL ILLUMINATED FIELD THROUGH DIRECT VISION AND

REFLECTING LIGHT

Caries tooth appears chalky white/softening/cavitations

TACTILE SENSATION

DONE WITH EXPLORER

DISADV

transfer of pathologic bacteria/fracture of enamel


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RADIOGRAPHS

Bitewing radiograph/appears as aradiolucent area

TRANSILLUMINATION

Mirror or light source placed on lingual side of ant teeth

directing light through it.Caries appear as a dark area along

the marginal ridge.


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PIT AND FISSURE CARIES

PRECARIOUS OR CARIOUS PITS

SMOOTH SURFACE CARIES PROXIMAL SURFACE CARIES/ANT AND POST

CARIES ON THE FACIAL AND LINGUAL SURFACE

OF THE TEETH PARTICULARLY ON THEGINGIVAL AREAS

ROOT SURFACE CARIES


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ARRESTED CARIES

with a slowly progressing caries in a patient withlow caries activity ,darkening occurs over time

because of extrinsic staining, andremineralization of decalcified tooth structureoccasionally may harden the lesion

Appears rough and restoration not required

Dentin termed as eburnated or scleroticUsually seen gingival to contact area in older pts

Formation of florhydroxyappatite crystals


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PIT AND FISSURE CARIES

Appears as brown gray discoloration radiating

peripherally from the fissure or pit.

Visual/tactile/radiographic examination.


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PRECARIOUS OR CARIOUS PITS

Occur on the occlusal two thirds of facial and lingual

surface of posterior teeth/lingual surface of anterior

teeth.

Visual/tactile examination


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PROXIMAL SURFACE CARIES

White chalky appearance or shadow appears under

the marginal ridge.

Visual/tactile/radiographic/transillumination

examination.

SMOOTH SURFACE CARIES ON F/L SURFACE

Appears as white spot which partially or totallydisappear on wetting


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ROOT SURFACE CARIES

Occur on cemental surface in older patients.

Seen as well defined discolored area adjacent to

gingival margin near CEJ.

Softer than adjacent tissues.

Visual/tactile/radiographic examination.

Difficult to diagnose in pts with attachment loss and

no gingival recession. Vertical bite wing radiograph used.


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Clinical examination of amalgam restoration

Amalgam rests are evaluated as follow

Amalgam blues Proximal over hangs

Marginal ditching

Voids

Fracture lines

Lines indicating interface between abutted rests


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Improper proximal contacts

Recurrent caries

Improper occlusal contacts.


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CLINICAL EXAMINATION OF CAST RESTORATION

Same as amalgam.

CLINICAL EXAMINATION OF COMPOSITE ANDOTHER TOOTH COLOURED RESTS

Same as amalgam.


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CLINICAL EXAMINATION OF ADDITIONAL

DEFECTS

Nonhereditary hypo calcified areas.

Appears as intact hard white areas on f/l/cusp tips

h/o fever /trauma,fluorosis,arrested caries.

Opaque white even after drying.

Chemical erosion

Caused due to acidic agents

Defective surface is smooth


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IDIOPATHIC EROSION

Cervical wedge shaped defect /more angular.

Caused due to abfractionABRASION

ATTRITION

FRACTURE OR CRAZE LINES


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ADJUNCTIVE AIDS FOR EXAMINING TEETH AND

RESTORATION

PERCUSSION TESTS-gently tapping on the occlusal surfaceof affected teeth/+ve result suggest injury to periodontal

membrane due pulpal or periodontal inflammation.

PALPATION-rubbing the index finger on the facial and lingualsurface of periapical region of the teeth/tenderness or

swelling.

THERMAL TESTS

HOT/COLD TESTS-normal pulp/hyperemia/irreversiblepulpitis


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ELECTRIC PULP TESTER

TEST PREPARATION

STUDY CASTS


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REVIEW OF PERIODONTIUM

CLINICAL EXAMINATION

Healthy gingiva-pink,firm,knife edged and

stippled.

Unhealthy gingiva-red,oedematous,glazed

smooth surface.

PROBING

Check for the depth of the gingival sulcus.Check for bifurcation and trifurcation involvement.


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GINGIVAL RECESSION

MOBILITY

PLAQUE OR DEBRIS

RADIOGRAPHIC EXAMINATION

Bite wing radiograph

Check for bone loss-localized or generalized.

-vertical or horizontal


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Examination of occlusion

Examine for

signs of occlusal trauma

plunger cusp.

PLUNGER CUSPPlunger cusp is a pointed cusp

plunging deep into the occlusal plane of theopposing arch. A plunger cusp may be contacting

directly b/w 2 adjacent marginal ridges inmaximum intercuspation or positioned in deepfossa.This can result in food impaction or restnfracture.


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EXAMINATION OF THE PATIENT IN PAIN

Subjective symptoms

described by the patient

1.onset and duration

2.stimulus-heat/cold/sweets/chewing/air

3.spontaneity

4 .Intensity

5.Factors that relieve the pain.

--------come to preliminary diagnosis.


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OBJECTIVE TESTS

1.Percussion test

2.Palpation

3.Transillumination[cracks,caries,toothcolor changes]

4.Electric pulp tester

5.Periodontal probing

6.Integrity of restoration.


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Diagnosis of vertical fracture[tooth sloothtest]

Anesthetic Test


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TREATMENT PLANNING

GENERAL CONDITION

-Examination and diagnosis

-Decision to recommend intervention-Identification of treatment alternatives.

-Selection of the treatment with the patients

involvement.


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TREATMENT PLAN SEQUENCING

URGENT PHASE

CONTROL PHASE

RE EVALUATION PHASE DEFINITIVE PHASE

MAINTENANCE PHASE


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URGENT PHASE

A patient with pain , swelling

bleeding/infection should be managed.CONTROL PHASE

eliminate active diseases such as

caries/inflammation..,eliminate the cause

begin preventive dentistry.


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RE EVALUATION PHASE

It is the time between

control phase and definitive phase.allow forresolution of inflammation and healing.

DEFINITIVE PHASE

Asses initial treatment and

determine the need for further care . This may

include endo , perio ,orthointervention.


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MAINTENANCE PHASE

regular recall examination.

Low risk- 9-12 monthsHigh risk- 3-4 months.


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INTER DICIPLINARY CONSIDERATION IN

OPERATIVE TREATMENT PLANNING


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INDICATION FOR OPERATIVE

TREATMENT

OPERATIVE PREVENTIVE TREATMENT

RESTORATION OF INCIPIENT CARIES

ESTHETIC TREATMENT TREATMENT OF

ABRASION,ATTRITION,EROSION

TREATMENT OF ROOT SURFACE SENSITIVITY REPAIRING AND RESURFACING EXISTING

RESTORATION


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REPLACEMENT OF EXISTING RESTORATION

INDICATION FOR AMALGAM RESTORATION

INDICATION FOR DIRECT COMPOSITE ORTOOTH COLOR RESTORATION


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TREATMENT PLAN APPROVAL

Examination and Diagnosis

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