examination and diagnosis
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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
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