diagnosis in operative dentistry

The seminar is prepared by :Dr. Hiba Hassan Thabit

Supervised by :Dr. Aymen Sabah

• Pretreatment considerations consisting of patient assessment, examination and diagnosis, and treatment planning are the foundation of sound dental

• Patient assessment • Before the examination and diagnosis of

teeth, periodontium, and orofacial soft tissues, attention is given to infection control, the patient's chief complaint, medical review, sociologic and psychological review, dental history, and risk assessment.

• Before, during, and after any patient visit, appropriate IC (infection control) measures must be instituted.

• Chief Complaint• Before initiating any treatment, it is important to

determine the patient’s chief complaint, or the problem that make the patient to visit dental clinic. Record the complaint verbatim (on patient word) in the dental record (case sheet):

• 1- Medical Review• The dentist must identify:• 1- Contagious diseases that require special

precautions or referral, e.g. hepatitis, AIDS.• 2. Allergies that may contraindicate the use of

certain drugs.• 3. Systemic diseases and heart problem (rheumatic

heart disease,) that demand less strenuous procedures or prophylactic antibiotic

• coverage.• 4. Physiologic changes associated with aging that

may alter clinical presentation and influence treatment.

• 2- Sociologic and psychological review• During initial visits the clinician should now the

patient's attitudes, priorities, expectations, and motivations toward dental care. The dentist must begin to explore patient's preferences for dental care.

• 3- Dental history• 1. Past dental history consists of reviewing

previous or past dental problems and treatment. if a patient has difficulty tolerating certain types of procedures or has encountered problems with previous dental care, an alteration, of the treatment or environment may help avoid future complications.

• 2- Patient present problem, the patient guided to discus the current problem in clouding onset, duration and related factors.

• Clinical Examination • Examination: is the process of

observing both normal and abnormal condition.

Then have

extra oral examination intra oral examination

• The extra oral examination:• The extraoral head and neck soft

tissue examination includes checking for asymmetries, a lymph node examination and a brief temporomandibular joint examination.

• The intra oral examination: should be examine:

the soft tissue teeth

• The soft tissue examination:• The intraoral soft tissue examination

includes checking the soft tissues of the mouth, the throat, the tongue and the gums.( Lips and labial mucosa , Buccal mucosa and vestibular mucosa ,hard and soft palate, Floor of mouth, Gingiva and alveolar mucosa)

• The examination of teeth: include examination:

the crown pulp

• The examination of crown include :• 1. caries• 2. amalgam• 3. fracture

• The examination of pulp include:• Thermal test• Electrical test• Bite test• Anesthesia test

• Caries :• Caries is mostly located in pits and fissures of the occlusal

surfaces. When the probe placed in pit and fissure it will provide a tag-back or resistance of removal.

• proximal surface caries, smooth-surface caries, is usually diagnosed radiographically. However, it also may be detected by careful visual examination either following tooth separation or

through fiber-optic transillumination .

• Brown spots on intact, hard proximal enamel surface gingival to the contact area are often seen-in older patients whose caries activity is low .

• proximal-surface caries in anterior teeth may be identified by radiographic examination, visual inspection (transillumination optional) and or probing with an explorer. Transillumination is accomplished by placing the mirror, on the lingual side of the anterior teeth and directing light through the teeth.

• Another form of smooth-surface caries often occurs on the facial and lingual surfaces of the teeth,particularly gingival area that are less accessible for cleaning. This-is Incipient caries (white spot) which partially or totally disappear with wetting, while drying again will cause it to reappear.

• This disappearing reappearing phenomenon distinguishes• the smooth surface incipient- carious lesion from the • white spot resulting from enamel hypocalcification.

• Fracture: the fracture of crown due to trauma or badly carious teeth and other reason( high spot, unsupported teeth structure) .

• Have forms of crown fracture:a. fracture in enamel.

b. fracture in enamel and dentine

• C. complete crown fracture.

• Amalgam :• Several conditions may be

encountered when amalgam restorations are evaluated:

• (1) Amalgam blues.

• (2) Proximal overhangs

• (3) Marginal ditching

• (4) Voids

• (5) Fracture lines

• (6) Lines indicating the interface between abutted restorations.

• (7) Improper anatomic contours.

• (8) Marginal ridge incompatibility

• (9) Improper proximal contacts.

• (10) Recurrent caries.

• 11) Improper occlusal contacts

• The examination of pulp: include:• 1.Thermal test: which test the vitality of the

tooth. A cotton applicator tip sprayed with a freezing agent or hot gutta-percha is applied directly to the tooth.

• If the pain subside within a few seconds following removal of the stimulus indicates healthy pulp.

• Pain lasting 10 to 15 seconds or less after stimulation by heat or cold suggests a hyperemia , an inflammation that may be reversed by timely removal of the irritant.

• Pain of longer duration from hot or cold usually suggests irreversible pulpitis.

• Lack of response to thermal tests may indicate that the pulp is necrotic.

• 2. Electrical test: also has value in determining the vitality of the dental pulp. The electric pulp tester is placed on the tooth and not on a restoration, A small electric current delivered to the tooth causes a tingling sensation. Results of an electric pulp test should not be the sole basis for a pulpal diagnosis because false positives or false negatives can occur

• 3.Bite test: if a patient complains of pain on chewing and there is no evidence of periapical inflammation , an incomplete fracture of the tooth may be suspected . biting on a wood stick in these cases can elicit pain

Usually on release of biting pressure.

• 4.Anesthesia test: in cases where the patient can not locate the pain and the thermal test is negative, a reaction may be obtained by asking the patient to sip hot water from a cap. The patient is instructed to hold water first against the mandibular teeth on one side and then by tilting the head to include the maxillary teeth. If a reaction occurs , an intraligamental injection may be given to anaesthetize the suspect tooth and hot water is then again applied to the area , if there is no reaction , the pulpitis tooth has been identified.

Thank You