case history, diagnosis and treatment planning
TRANSCRIPT
![Page 1: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/1.jpg)
DR. AMINAH M ( POST
GRADUATE )
CASE HISTORY, DIAGNOSIS, TREATMENT PLANNING
![Page 2: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/2.jpg)
Synopsis CONTENTS
• Definition• Introduction• Guidelines • Vital statistics• History• Examination• Provisional diagnosis• Investigation• Differential diagnosis• Final diagnosis• Treatment planning• Conclusion • References
![Page 3: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/3.jpg)
DEFINITION
The planned professional conversation that enables the patient to communicate his/her symptoms, feelings and fears to the clinician so as to obtain an insight in to the nature of patient’s illness and his/her attitude to them.
Bricker
![Page 4: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/4.jpg)
INTRODUCTION
It is a classic form of documentation ranges from clinical sketches to highly detailed and extended accounts that help in arriving at a diagnosis and formulation of treatment plan of a person before treatment.
select a closest
possible choice :Final diagnosis
Make a differential diagnosis of all possible
complications
Analyse and interpret the assembled clues to reach the provisional
diagnosis
Assemble all the available facts gathered from chief complaint, medical history, dental history,
diagnostic tests
Tandon S
![Page 5: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/5.jpg)
To distinguish between
normal and abnormal condition
To aid in treatment
plan
To establish the
diagnosisTo
determine the length of
the appointment
To determine whether
delivery of dental care
requires complex
procedures
To detect any
medical problem
![Page 6: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/6.jpg)
GUIDELINES
non-clinical setting
Relaxed, casual, non aggressive questions
Rephrase the question
Children under 5 yrs,
parent is interviewed
Definite outline
organized, systematic, complete
and accurate
BE A GOOD LISTENER
![Page 7: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/7.jpg)
STATISTICS / Biographical Data CHIEF COMPLAINT HISTORY----- History of presenting illness Medical history Past dental history Family history EXAMINATION------General examination Extra oral examination Intra oral examination DIAGNOSIS-----Provisional diagnosis Investigations Final diagnosis TREATMENT PLAN
![Page 8: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/8.jpg)
Statistics/Biographical data
Name & nick namePatient registration number and date
Age and date of birth
Address/Phone number
Class /SchoolParents name
and occupation
Gender
Favourite teacher, subject & activity
![Page 9: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/9.jpg)
Name & Nick name :
For identification For communication Record maintenance Psychological benefit mainly in
pediatric patients
Nick name: To build a rapport with patient To alleviate apprehension
![Page 10: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/10.jpg)
Patient registration no. and Date
Patient registration number useful for:Record maintenance Medico-legal aspectsBilling purposes
Date: Useful for reference and record maintenance
FEB
07
![Page 11: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/11.jpg)
Age
As a growth assessment parameter
To recognize the disparities between the dental – chronological age
aid in treatment planning
to calculate the drug dosage
Helps in forensic odontology
In caries :– Window of
infectivity– Caries predilection
sites vary distinctly according to age
(Mejare et al,1999) In trauma:
– Peak ages – 2 – 4 yrs
childhood– 8 – 10 yrs
middle– school child
Andearson
![Page 12: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/12.jpg)
![Page 13: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/13.jpg)
Growth spurts:
Just before birth
One year after birth
Mixed dentition growth spurt: Boys:8-11yrs Girls:7-9 yrs
Pre-pubertal growth spurt: Boys:14-16 yrs Girls:11-13yrs
Growth spurt are faster in girls than boys…
![Page 14: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/14.jpg)
MENTAL AGE : IQ X CHRONOLOGICAL AGE 100
IQ Range Classification
Above 145 Genius or near genius
130-145 Very superior
115-130 Superior
85-115 Normal
70-85 Dullness
Below 70 Borderline deficiency
<69 MR
Alfred Bionet Standford bionet testWISC
![Page 15: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/15.jpg)
Behaviour management techniques change according to age
Infant
• Baby needs parents presence – basic trust maintained
• Delay in attending the infants demand - panic builds up
Toddler(15 mths – 2 yrs)
• He/ she displays an ambivalent nature
Pre-schooler(2 – 6 yrs)
• More effective in interpersonal communications
• His/her role is more role playing
Middle aged child (6 – 12yrs)
• He/she understands only what is seen
• An anaesthetic syringe may poses a strong threat
• Learns conversation & his/her thinking becomes logical and reversible
![Page 16: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/16.jpg)
CHRONOLOGICAL AGE(days, weeks, months, or years) : time elapsed from birth
DENTAL AGE :
Determination of dental age was based upon the rate of development and calcification of tooth buds.
Dental age estimation was done using Demirjian′s method.
![Page 17: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/17.jpg)
SKELETAL AGE: The bone age was assessed by means of hand-wrist radiograph using Bjork, Grave and Brown s method -9 stages′ Fishman’s skeletal maturity indicator -11 stages
SMIFISHMAN 1982
![Page 18: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/18.jpg)
Diseases present in children and young adults : Nursing bottle caries Juvenile periodontitis OSMF Fissured tongue Eruption cyst Dental caries Dentigerous cyst Pulp polyp
Diseases present in infancy: Haemangioma Thalassemia Palatal cyst of newborn Fibrous dysplasia of the jaw
Diseases present at birth : Cleft palate Cleft lip Micro and macro glossia Cleft tongue Erythroblastosis fetalis
Diseases present in adults and older patients: Attrition Gingival recession ANUG Lichen planus Periodontitis Leukoplakia Herpes zoster
![Page 19: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/19.jpg)
Gender
• Sex related diseases like haemophilia, G6PD deficiency
(causes haemolytic anaemia)• As an aid in treatment
planning– Growth spurts in
girls are ahead of boys
In trauma:– Boys sustain more
injuries than girls– Ratio approx – 2:1
Females : Dental caries Lichen planus MPDS Anaemia Sjogren’s syndrome Juvenile periodontitis
Males : Leukoplakia Herpes simplex Hodgkins lymphoma Attrition
![Page 20: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/20.jpg)
Address
Communication Record purpose To know certain endemic diseases
High fluoride content – dental/skeletal fluorosisFilariasis
![Page 21: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/21.jpg)
Class/school
• Helps to correlate the patient’s chronological age with mental age
![Page 22: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/22.jpg)
Parent’s name/occupation
• For communication• Reflects the socioeconomic status• (lower socioeconomic status are
much more likely to develop chronic illness like heart disease, COPD, etc.,)
Favourite teacher, subject and activity
• To create interest in communication
• To know the child better
![Page 23: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/23.jpg)
CHIEF COMPLAINT
• Reason which prompted the patient to seek dental treatment
• Better ask the question first to the child before involving the parents Recorded in child’s own words in a
chronological order
In kids < 5yrs, Parents – 'Best Historians'.
![Page 24: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/24.jpg)
HISTORY OF PRESENTING ILLNESS
Elaboration/detailed description of the chief complaint
• Duration• Mode of onset• Progression• Severity• Nature• Aggravating/relieving factors• Postural variation• Any medications/treatment
received for the same
PAIN
![Page 25: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/25.jpg)
Detailed history of particular symptom
PAIN
Anatomical location (site) Origin and mode of onset Intensity of pain Nature of painProgression of pain Duration of painMovement of pain Effect of functional activity
![Page 26: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/26.jpg)
Pain
• Most common complaint that leads to dental treatment• According to intensity
Mild pain
• Controlled by simple analgesics
Moderate pain
• Controlled with narcotic analgesics
Severe pain
• Cannot controlled with analgesics
• Require elimination of cause
![Page 27: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/27.jpg)
According to nature
– Pricking/piercing– Throbbing– Lancinating – Aching– Dull, boring, gnawing
Localization of pain
Localised when patient can point to a specific tooth or site
Sharp , piercing and lancinating pain in a tooth responds to cold and is easy to localize
Dull, boring pain is diffuse and responds abnormally to heat than to cold is difficult to localize.
![Page 28: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/28.jpg)
According to duration
According to onset
• Pain of short duration & seperated by wholly pain free period Intermittent
• Pain of longer durationContinuous
• Two or more similar episodes of painRecurrent
• Characterized by regularly recurring episodePeriodic
Spontaneous
• Pain occurs without being provoked
Induced
• Provocation causes painful sensation
Triggered
• When evoked response is out of proportion to the stimulus
![Page 29: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/29.jpg)
Referred pain
![Page 30: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/30.jpg)
SWELLING
SWELLING Anatomical location (site) Duration Mode of onset Symptoms Progress of swelling Associated features Secondary changes Impairment of function Recurrence of swelling
![Page 31: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/31.jpg)
BLEEDING
Gingivitis Periodontal disease Allergy Deficiency of coagulation factors Haemangioma
![Page 32: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/32.jpg)
BURNING SENSATION
Viral or fungal infection Anaemia Geographic tongue Fissured tongue Vitamin deficiency Anaemia Xerostomia
![Page 33: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/33.jpg)
Loose teeth
Periodontal disease Trauma Normal resorption AIDS Hemangioma
Xerostomia
Local inflammation Autoimmune disease Post radiation changes Infection of major
salivary gland
![Page 34: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/34.jpg)
Bad taste
Aging changes Poor oral hygiene Heavy smoking Dental caries Periodontal disease ANUG
Halitosis
Poor oral hygiene Periodontal disease ANUG Tobacco use Decayed teeth Gastric problems
Occlusal problems
Delayed teeth
![Page 35: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/35.jpg)
Social/Family historyQuestions to be asked
Health of his/her parents Number and age of siblings and their
health Consanguineous marriage Any familial conditions / traits exists
Inherited disorders (diabetes, hemophilia, G6PD, b-thalassemia, familial hyperlipidemia, allergies)
![Page 36: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/36.jpg)
Medical history
Check list of medical history-by Scully and Cawson -Anemia -Bleeding disorders -Cardio respiratory disorders -Drug treatment and allergies -Endocrine disorders -Fits and faints -Gastrointestinal disorders -Hospital admissions and surgeries -Infections -Jaundice and liver diseases -Kidney disease
![Page 37: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/37.jpg)
– Ex: juvenile diabetes: increased risk of dental caries– Asthma and Epilepsy are strongly associated with dental
procedures
Various diseases and functional disturbances predisposes to oral problems either directly or indirectly. History about multiple/prolonged hospital admissions
![Page 38: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/38.jpg)
Systemic diseases associated with..
DENTAL CARIES are ,
– Diabetes– Asthma– Sjogren’s syndrome– Scleroderma– Hereditary ectodermal dysplasia– Rheumatoid arthritis
![Page 39: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/39.jpg)
Pre-natal HistoryCondition of mother during pregnancy??? Disease Trauma Medications Food and habits Radiation Anomalies scan Gene testing
Abnormal fetal position – abnormal pressure on some part of face ----- FACIAL ASYMMETRY
Were you on any drug therapy??? Which??? How long??? Tetracycline – discoloration of the teeth
DISEASES
Viral infections – cleft lip & palateGerman measles in 1st trimester – cleft lip & palateMaternal rubella, fetal alcohol syndrome
ACCIDENTS / TRAUMA -- Orofacial deformities
![Page 40: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/40.jpg)
![Page 41: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/41.jpg)
Natal History
• Term of delivery: Full term/ premature
• Patent ductus arteriosus, encephalopathy, cerebral palsy, respiratory distress syndrome, kernicterus
• Type: Normal / Forceps / Caesarian
• Forceps delivery ---- injury to TMJ --- retarded growth of mandible
• Intracranial hemorrhage
Cyanosis at birth : congenital heart defect
Rh incompatibility : erythroblastosis fetalis.
![Page 42: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/42.jpg)
Post natal
Post Natal Feeding history-Duration ,
Weaning? Natal or neonatal teeth?
Vaccinations DPT BCG OPV Tetanus MMR
• Milestones of development• Habits • Childhood diseases• History of tonsillectomy and adenoidectomy
![Page 43: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/43.jpg)
2015
2015
![Page 44: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/44.jpg)
Milestones Developmental Milestones: Any delays !!!
Crawling Sitting Standing unsupported Walking Running Speaking sentences
![Page 45: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/45.jpg)
Reflexes present at birth
![Page 46: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/46.jpg)
Social/behavioural history
Behavioural Pedodontics: It is a study of science which helps to understand development of fear , anxiety , and anger as it applies to child in the dental situations.
![Page 47: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/47.jpg)
Which school and class child studying and performance?
What is the child’s nature in the school? Is your child following you commands? How do you discipline your child? How does your child react to separation from
you? Does he has many friends? Preference of games Any problems in
learning/reading/understanding
![Page 48: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/48.jpg)
Quite ---cooperative Stubborn---resists treatment and can be made cooperativeFearful ---considerable support requiredHyperactive---child resorts to screaming and kickingComplaint----whining type of behaviourShy/Timid---cooperates treatment
Wilson-1975
![Page 49: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/49.jpg)
Frankel behaviour rating scale
![Page 50: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/50.jpg)
Personal history
Oral hygiene history– Method of cleaning teeth– Who brushes the teeth– Type of brush – Method of brushing– No. of times of brushing– Other oral hygiene aids used like
flossing, rinses– How often it is changed– Fluoridated/non fluoridated tooth
pastes
![Page 51: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/51.jpg)
Diet history
It includes recording of the following :
Veg/non-veg/mixed dietNo. of meals/dayCariogenic snacks/dayDoes your child eat everything you prepareDoes your child constantly snack on foodFavourite foodsOther food habits
![Page 52: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/52.jpg)
DETERMINE THE ADEQUACY OF DIET:
Dental health diet score = Food score+ nutrient score - sweet score
![Page 53: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/53.jpg)
FOOD SCORE:
Milk 3 *8
Meat 2 *12
Fruits & Vegetables 1 *6
Vitamin c 1 *6
Others 2 *6
Breads and cereals 4 *6
FOOD RDA NO OF SERVINGS
![Page 54: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/54.jpg)
NUTRIENT SCORE:Mark one score for each nutrient consumed
SWEET SCORE:Liquid : (*5)Solid and sticky : (*10)Slowly dissloving : (*15)
![Page 55: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/55.jpg)
ASSESMENT DENTAL HEALTH DIET SCORE:
SCORE RESULT INTERPRETATION
72-96 Excellent Counseling not required
64-72 Adequate Educate the patient
56-64 Barely adequate Counseling required
56 OR less Not adequate Counseling with diet modification
![Page 56: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/56.jpg)
Nutritional Status
NUTRITION is the “science that interprets the interaction of nutrients and other substances in food in relation to growth, development and maintenance of an organism” (WHO)
![Page 57: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/57.jpg)
![Page 58: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/58.jpg)
STEPS IN DIETARY COUNSELING VISIT:
PURSUE DIARY FOR COMPLETION
DETERMINE DAILY ROUTINE
EXPLAIN THE CAUSE OF DECAY
ISOLATE SUGAR FACTORS
![Page 59: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/59.jpg)
ANALYSE SWEETS INTAKE
DETERMINE ADEQUACY OF DIET
DIET PRESCRIPTIONS AND SUGESSTED MENU
REINFORCEMENT BY FOLLOW-UP REEVALUATION
![Page 60: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/60.jpg)
Diet diary
Recording diet chart for a pediatric patient
How to plan a diet ??
![Page 61: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/61.jpg)
Toddler Pre-school School Adolescent Adult Pregnant women
Calorierequired
1200-1500
1500 1800 2500 2800 3200
Protein -RDA
18-20g 22g 33g 50g 55g 100g
AAPD
![Page 62: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/62.jpg)
Obesity Cachexia
Anorexia Nervosa Bulimia
![Page 63: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/63.jpg)
Nutritional status and its correlation with dental caries:
-Nutrition affects the teeth during development and malnutrition may exacerbate periodontal and oral infectious diseases.
-The most significant effect of nutrition on teeth is the local action of diet in the mouth on the development of dental caries and enamel erosion.
Public Health Nutrition
![Page 64: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/64.jpg)
Dental history Child’s first dental visit? Any unfavourable dental experience? How much satisfied was the previous treatment? Does your child complain of tooth ache ? Has your child suffered any injury to teeth? Did he have any fluoride treatment done before? Source of drinking water? Place of residing for the last few years?
![Page 65: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/65.jpg)
Does your child have any abnormal Oral habits history
Finger/thumb sucking, nail biting, lip biting, tongue thrusting, bruxism, mouth breathing
Frequency Intensity Duration
![Page 66: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/66.jpg)
EXAMINATION
![Page 67: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/67.jpg)
Clinical examination
General examination:– Assessment of general appearance should start before the child is
seated in the dental chair– It includes
1. Child’s stature/ built 2. Weight 3. Height 4. Gait 5. Speech 6. Vital signs
![Page 68: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/68.jpg)
William Sheldon's-1940
Endomorph
Mesomorph
Ectomorph
Body built
![Page 69: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/69.jpg)
Height and weight
Height and Weight Compared with
growth charts Stadiometer
Significance: Genetic Endocrine (GH, Thyroid) Sotos Syndrome
![Page 70: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/70.jpg)
Gait
![Page 71: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/71.jpg)
(Jerky, uncoordinated)Multiples sclerosisBrain tumours,CNS)
(Hip elevation exagerrated, a duck-like walk)Muscle dystrophy
the knees and thighs hittingor crossing in a scissors-likemovement (cerebral strokes, multiple sclerosis)
High stepping, Neuropathic gait
typical of Parkinson's in which,during walking, steps becomefaster and faster with Progressively shorter steps
![Page 72: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/72.jpg)
Speech
Aphasia Delayed speech Sluttering speech Cluttering speech
Significance:
-For Management of child in the dental chair -To know if any systemic diseases associated
Aphasia-CNS disordersSluttering speech – parrot like speech (Autism)
![Page 73: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/73.jpg)
Vitals
Temperature Normal Oral
37C/98.6F Axillary, Rectal,(>0.5 -1 F)
Pulse 60-100 beats/min
BP 120-80 mm Hg
![Page 74: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/74.jpg)
Heart Rate (general)<60bpm – Brady>100bpm – Tachy
Respiratory Rate (general)Children – 16-20/min
Adults – 12-16/min
![Page 75: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/75.jpg)
Extra Oral Examination
See
Head Face Hair Eyes Ears Nose Lips
Feel
Lymph Nodes TMJ Swallow
Shape ProfileSymmetry
![Page 76: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/76.jpg)
Head
Maximum skull width (Transverse dimension)
Cephalic index = (CI) Maximum skull length (Anteroposterior dimension)
Martin and Saller (1957)
![Page 77: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/77.jpg)
Head Forms (Cephalic)
Mesocephalic - (76-80.9)Brachycephalic - (81-85.4)Dolichocephalic - ( <75.9 )
Hyperbrachycephalic (>85.5)
• It is Brachycephalized Dolichocephalic Crainal Index
![Page 78: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/78.jpg)
Face
Martin and Saller (1957)
![Page 79: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/79.jpg)
Facial profile
Class II div 1 Class I
![Page 80: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/80.jpg)
Class III malocclusionClass I Class II
![Page 81: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/81.jpg)
Facial Symmetry
Gross Asymmetry of face can be due to :
Abscess due to dental infection
Parotid enlargement Unilateral condylar
hyperplasia Unilateral ankylosis of TMJ
![Page 82: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/82.jpg)
Facial divergence
• It is the anterior or posterior inclination of the lower face relative to the forehead
![Page 83: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/83.jpg)
FACIAL HEIGHT
UPPER FACIAL HEIGHT
45% of the total facial height
LOWER FACIAL HEIGHT
55% of the total facial height
![Page 84: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/84.jpg)
Increased :
• Skeletal open bite• Long face syndrome
Lowered :
• Growing children• Skeletal deep bite• Class II div 2
Lower facial height
![Page 85: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/85.jpg)
Lip Position
Competent lip Incompetent lip Potentially incompetent lip
![Page 86: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/86.jpg)
Lip step profile
• Positive lip step• Normal lip step• Marked negative lip step
![Page 87: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/87.jpg)
Naso labial angle
• Angle formed between lower border of nose to the upper lip(90-110degree)
Increased:Retrusive maxilla
Decreased :Proclined maxilla
![Page 88: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/88.jpg)
Mentolabial sulcus
Seen between lower lip and mentalis muscle
• Normal - class I occlusion• Deep - class II div 1 occlusion• Shallow -bimaxillary protrusion
![Page 89: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/89.jpg)
Chin
Chin prominence is related to mandibular position
• Recessive chin-class II molar relation
• Prognathic chin-class III molar relation
• Normal position-class I occlusion
![Page 90: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/90.jpg)
Thank You
![Page 91: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/91.jpg)
![Page 92: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/92.jpg)
Lymph node examination
Look for:
Location Number Size
> 1.5 cm in jugulo diagastric nodes> 1.0 cm in other nodes
Consistency Discrete or matted nodes Tenderness Fixity to the overlying skin/deeper
structures
Texture Soft – Infection Firm – Granuloma,
Lymphoma? Matted - Tuberculous Stony hard –
Carcinoma?
Mobility Indurated –
Carcinoma? Mobile – infection
- Neck lymphnodes are better palpated while standing behind the patient- Neck is slightly flexed to that side to relax the muscles
![Page 93: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/93.jpg)
Lymphatic drainage of teeth
Lymphatic drainage of
teeth
Maxillary teeth Mandibular posteriors
Submandibular lymphnodes
Deep cervical lymph nodes
Mandibular anteriors
Submental lymphnodesSubmandibular
lymphnode
![Page 94: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/94.jpg)
![Page 95: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/95.jpg)
![Page 96: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/96.jpg)
![Page 97: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/97.jpg)
TMJ examination• Symmetry• Interincisal opening• Mandibular movement---Observe path of closure for deviations,Range of motion(also in lateral movements)
• Palpation of the joint– Pretragus palpation– Intra-auricular palpation
• Auscultation of the joint– Clicking– Crepitus
![Page 98: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/98.jpg)
Mouth opening
• Adults:– Males- 50 – 60 mm– Females- 45 – 55 mm
• Children:– 35-45 mm– Lateral movements- 8 – 12 mm
![Page 99: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/99.jpg)
• Altered path of closure• Occlusal prematurities• Lingually or palatally
erupting incisors• Class II div 1-habitual• Class III-forward
placement• Backward or lateral path
of closure
• Discrepancies of TMJ:• Muscular imbalance• Deviation/swelling/redness, trismus or spasm of muscles
![Page 100: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/100.jpg)
Swallow :
• Infantile swallow (Visceral)• Adult swallow
Teeth apart swallow : no temporalis contraction Teeth together swallow : temporalis contraction seen
![Page 101: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/101.jpg)
INTRA ORAL EXAMINATION
Soft Tissue
Lips Mucosa – Labial + Buccal +
Vestibule Frenum Tongue Floor of mouth Palate – Hard + Soft Gingiva and periodontium Pharynx Tonsils
Hard Tissue
Teeth
![Page 102: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/102.jpg)
SOFT TISSUES
Lips
Check for:
Color Texture Any lesions Pigmentation Herpes simplex
Cleft lip
Melanotic macule
![Page 103: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/103.jpg)
Diseases of lip
• Double lip• Congenital lip pits• Chelitis granulomatosa• Chelitis glandularis• Angular chelitis• Syphilis • Herpes simplex infection
Ascher’s syndromeVan der woude’s syndromeMelkersson –Rosenthal syndromeCrusted lips(baelz’s disease)Rhagades ChancreHaemorrhagic and matted
![Page 104: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/104.jpg)
Mucosa – Labial + Buccal + Vestibule
Check for:
Ulcerations Swellings Growths Pigmentation Texture lesions
![Page 105: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/105.jpg)
Fordyces granules
leukoedemaLinea alba
Mucocele
![Page 106: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/106.jpg)
Keratotic Patch
Major Apthous Ulcer Capillary Hemangioma
Fibroma
Lichen planus
![Page 107: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/107.jpg)
Diseases
• Lichen planus• Measles
Grispan syndromeKoplik’s spots
![Page 108: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/108.jpg)
Frenum
Check for: High labial frenae Tongue Tie
High labial frenae may cause Midline diastema when attached highly - to incisal papilla
Blanch test confirms
![Page 109: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/109.jpg)
Classification of frenum
Mucosal Gingival
![Page 110: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/110.jpg)
Tongue
Check for...
– Volume– Colour– Swelling and ulcer– Mobility – Tongue thrusting on swallowing
Variations in size Macroglossia Micoglossia
Range of movements
Benign migratory glossitis/Geographic Tongue
Hairy tongue Fissured tongue
Median rhomboid glossitis
Coated tongue
Foliate papillitis/lingual tonsil
![Page 111: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/111.jpg)
Diseases
• Ankyloglossia • Bifid tongue• Fissured tongue
• Median rhombhoid glossitis• Geographical tongue• Atropic glossitis• Depapillation
Oro facial digital syndromeOrofacial digital syndromeMelkerson-rosenthal syndrome
Atrophy candidiasisBurning sensationPlummer vinson syndromeIron defeciency anaemia
![Page 112: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/112.jpg)
Floor of Mouth
Character and extent of gland secretions
Saliva viscosity and flow
Swellings(tori)
Sialoliths Tenderness
![Page 113: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/113.jpg)
Palate – Hard & Soft
Hard Palate
Clefts Fistulae (syphilitic
gumma) Inflammation Swellings Pigmentations Ulcerations Hyperkeratinization
Soft Palate
![Page 114: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/114.jpg)
Palatal Lesion
• Torus
• Inflammatory papillary hyperplasia
• Denture stomatitis
• Nicotine stomatitis
![Page 115: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/115.jpg)
Diseases • Necrotising
sialometaplasia
• Stomatitis nicotina
• Cleft palate
• Inflammatory papillary hyperplasia
Numbness and looseness in the palate
Dried mud appearance
Pierre robin syndromeVander woude’s syndrome
Over ripe berry, cobblestone appearance
![Page 116: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/116.jpg)
NO SPECIFIC LOCATION
TRAUMATIC ULCER
LEUKOPLAKIAPAPILLOMA
APTHOUS ULCER
![Page 117: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/117.jpg)
Gingiva and periodontium
Child gingiva Adult gingiva
Marginal gingiva is thicker and rounded Marginal gingiva is knife edge margin
Attached gingiva:
• Less stippling• Less keratinization• Red in color• Interdental clefts• Retrocuspid papillae
Attached gingiva:
• Stippling is common• Keratinized• Coral pink
Mostly pyramidal shape interdental gingiva
Col shape interdental gingiva is common
![Page 118: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/118.jpg)
Gingival and periodontal tissues– Colour– Contour– Consistency– Surface texture– Position– Bleeding– Ulceration– Any sinus present
Check for bleeding on probing using probe
![Page 119: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/119.jpg)
Mandibular tori Amalgam tatooPericoronitis
ANUGHerpetic gingivostomatitis Fibromatosis gingiva
![Page 120: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/120.jpg)
• Sturge weber syndrome• Papillion lefevre syndrome
• Drug induced gingival enlargement
Massive gingival growthJuvenile periodontitis and inflammatory gingival enlargement
PhenytoinCyclosporineNifidipine
![Page 121: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/121.jpg)
Periodontal evaluation
• Selective probing of anterior teeth and permanent first molars
• Mobility test• Depressibility test• Grading of mobility-Miller • Periodontal pocket evaluation• Furcation involvement
![Page 122: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/122.jpg)
Periodontal diseases and conditions
• Chronic gingivitis• Acute pericoronitis• Acute necrotizing ulcerative gingivitis (ANUG)• Gingival fibromatosis and hyperplasia• Prepubertal periodontitis• Early-onset periodontitis• Leukemia, Cyclic neutropenia, Hypophosphatasia, Papillo-Lefevre syndrome, Histocytosis, Down’s
syndrome.
![Page 123: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/123.jpg)
Gingival Index- loe and sillness(1963)
![Page 124: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/124.jpg)
Periodontal index- CPITN(1982)
![Page 125: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/125.jpg)
Pharynx
• Hoarseness of voice• Any swelling,nodules,adenoid,discharge are
checked• Airway assessment
Mallampati classification
![Page 126: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/126.jpg)
Tonsil
• Color• Size • Any abnormalities• Airway restriction• Any discharge • Tenderness
![Page 127: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/127.jpg)
Tonsils 1. The palatine tonsils or simply referred to as 'the tonsil'- inbetween the anterior & posterior pillars of oropharynx
2. The Nasopharyngeal tonsils or the adenoids- in the nasopharynx
3. The tubal tonsils- near opening of eustachian tubes.
4. The Lingual tonsils- in the base of the tongue.
Peritonsillar abscess/quinsy
Hockey stick appearance
![Page 128: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/128.jpg)
TEETH
Caries Fractured teeth Hypoplastic teeth Retained teeth Erupting teeth Supernumerary teeth Any other dental anomalies Orthodontic evaluation
HARD TISSUE EXAMINATION
![Page 129: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/129.jpg)
DENTAL CARIES
EROSION ABRASIONFRACTURED TEETH
HYPOPLASTIC TEETH
![Page 130: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/130.jpg)
DMFT INDEX- Klien,Carrole & Knutson(1938)
WHO MODIFICATION -1986
![Page 131: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/131.jpg)
OHI INDEX - Greene and Vermillion(1960)
![Page 132: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/132.jpg)
![Page 133: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/133.jpg)
Dean’s flurosis index-modified(1942)
![Page 134: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/134.jpg)
Retained teeth
Erupting teeth
![Page 135: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/135.jpg)
PRIMARY TEETH
AAPD
![Page 136: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/136.jpg)
PERMANENT TEETH
![Page 137: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/137.jpg)
Other dental anomalies
Fusion Hutchinson’s incisor
Supernumerary teeth
![Page 138: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/138.jpg)
Orthodontic Evaluation
• Alignment
• Tooth number
• Tooth structure
• Tooth position
![Page 139: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/139.jpg)
Alignment
TERMINAL PLANE RELATIONSHIPBaume (1950)
MOLAR RELATIONSHIP IN PERMANENT TEETH
CANINE RELATIONSHIP-Baume (1950)
![Page 140: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/140.jpg)
• Midline deviation • Cross bite
![Page 141: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/141.jpg)
-Inter arch relationship• Class II div 1 – more prone for
trauma• Bimaxillary protrusion
-Presence of crowding/spacing-Deviations/Displacements
Malocclusion
-Severe skeletal abnormalities-Overjet and overbite-Increased overjet – may predispose to trauma-Anterior open bite – skeletal problem, digit sucking habit, tongue thrust
3mm=abnormal (Reddy et al 2010)
Instruments used: Boley gauge (Ravn)Stainless steel scale(Farsi)
>3mm overlap = abnormal(Reddy et al 2010)
![Page 142: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/142.jpg)
Number of tooth
![Page 143: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/143.jpg)
Tooth structure
![Page 144: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/144.jpg)
Tooth Position
• Ectopic eruption • Transposition • Impaction • Primary failure of eruption
![Page 145: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/145.jpg)
Provisional diagnosis
A provisional diagnosis is one that is initially determined to be the diagnosis, except for the fact that all test results have not been received and/or analyzed
Also called Tentative/Working diagnosis
Arrived after evaluating the case history and Clinical examination
![Page 146: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/146.jpg)
Investigations
• Conventional methods– Visual and tactile
examination– Radiographs
• IOPA• Bitewing X-rays
• Non-conventional methods– Digital radiography– Digital subtraction
radiography– Transillumination
FOTI & DIFOTI– Fluorescence– Infrared LASER
Fluorescence(DIAGNOdent)
Dental caries
![Page 147: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/147.jpg)
Investigations
• Pulp tests to assess vitality– Thermal stimulation
• Ethyl chloride• Ice• Dry ice(carbon-di-oxide
snow 78 – 108 ˚F)– Electric pulp testing– Test cavity– Laser doppler flowmetry– Pulse oximetry
• Radiographs– Extraoral views
• To exclude facial fractures
– Intraoral view• To assess trauma of
individual tooth
• Photographic documentation is necessary
Dental Trauma
![Page 148: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/148.jpg)
OTHER INVESTIGATIONS
• Orthodontic treatment planning:
Cephalometric analysisModel analysis
• Occlusal radiographs• OPG• CT• Vista scan
![Page 149: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/149.jpg)
Dental caries
IOPA
BITE WING RADIOGRAPH
![Page 150: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/150.jpg)
OCCLUSALRADIOGRAPH
OPG
![Page 151: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/151.jpg)
DIGITAL
Digital OPG
DIGITAL IMAGING
![Page 152: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/152.jpg)
VISTA SCAN
LIGHT INDUCED FLUORESCENCE
CBCT scan
![Page 153: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/153.jpg)
Cold test
PULP test :
Heat test
False negative responses:
Recently erupted tooth, Recent traumaExcessive calcifications, Patients on pre-medications
![Page 154: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/154.jpg)
ELECTRIC PULP TESTING
LASER DOPPLER FLOWMETRY
PULP OXIMETRY
![Page 155: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/155.jpg)
FOTI & DIFOTI
DIAGNODENT
![Page 156: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/156.jpg)
USES:
Helps in orthodontic
treatment planning
Evaluation of treatment results
Helps in predicting the growth related changes and changes associated with surgical treatment.
CEPHALOMETRIC ANALYSIS
![Page 157: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/157.jpg)
DIFFERENTIAL DIAGNOSIS
“Differential diagnosis is distinguishing a particular disease or condition from others that present similar clinical features”.
Differential diagnosis can be regarded as implementing aspects of the hypothetico-deductive method, in the sense that the potential presence of candidate diseases or conditions can be viewed as hypotheses that physicians further determine as being true or false.
Benign Reactive swelling
Inflammatory swelling
Posttraumatic swelling
Hamartoma
Vascular tumors
Myofibroma
Malignant Lymphoma
Soft tissue sarcoma
Rhabdomyosarcoma
Ewing sarcoma
Synovial tumors
Fibrosarcoma
Differential diagnosis of soft tissue masses/ subcutaneous swelling in children :
![Page 158: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/158.jpg)
Final/Definitive diagnosis
• Chronologic organization and critical evaluation of the information obtained from the case history, physical/clinical examination and the result of radiologic and other
investigative procedures leads to definitive diagnosis.
• It identifies the chief complaint first and then the subsidiary diagnosis of other problems
![Page 159: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/159.jpg)
In case of pulp therapy in primary teeth
![Page 160: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/160.jpg)
![Page 161: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/161.jpg)
![Page 162: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/162.jpg)
In case of pulp therapy in permanent teeth
![Page 163: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/163.jpg)
![Page 164: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/164.jpg)
In case of trauma
The goal of treatment for traumatically injured teeth is to return the teeth to acceptable function and appearance.
![Page 165: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/165.jpg)
Acute treatment:
• There are situations where treatment within a few hours can significantly affect the outcome.
– Tooth avulsions, alveolar fractures, extrusive and lateral luxations, and possibly root fractures.
– Early repositioning and stabilization will promote the best PDL repair
Subacute treatment:
• Treatment within 24 h after injury allow the following injuries proper care
– Concussion, subluxations, and intrusive luxation, and crown fractures with pulpal exposure.
– Pulpal and PDL responses do not seem to be adversely affected by a delay of 24 h
![Page 166: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/166.jpg)
Delayed treatment:
• Crown fractures without pulpal exposure appear to have the same prognosis whether treatment is performed within a few or several hours
Immediate care :
• It may be initiated with the emergency treatment provided, such as pulp protection for continued root formation in developing teeth with complicated crown fractures.
In cases of luxation and avulsion injuries, the immediate concern is to stabilize the tooth in its normal position to allow re-attachment and re-organization of the periodontal ligament support.
![Page 167: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/167.jpg)
Emergency treatment – Primary anterior teeth
![Page 168: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/168.jpg)
![Page 169: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/169.jpg)
Emergency treatment – Permanent anterior teeth
![Page 170: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/170.jpg)
![Page 171: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/171.jpg)
Prognosis
• Prediction of the probable course, duration and outcome of the disease based on a general knowledge of the pathogenesis and the presence of risk factor of the disease
• Established after the diagnosis is made and before the treatment plan
![Page 172: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/172.jpg)
TREATMENT PLANNING
![Page 173: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/173.jpg)
Treatment planning
Development of a treatment plan is the most critical step in the successful future management of the child and parent
![Page 174: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/174.jpg)
5 Phases of the Treatment Plan
Emergency Phase/ Acute phase
Systemic Phase
Preventive OR Preparatory Phase
Definitive treatment or Corrective Phase
Maintenance Phase
![Page 175: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/175.jpg)
Acute Phase :
Emergency Treatments
Maxillofacial trauma,
Swelling,
Systemic infection,
Severe pain
![Page 176: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/176.jpg)
Splinting periods
• Extrusive luxation 2 weeks/flexible• Lateral luxation 4 weeks/flexible• Intrusive luxation 6-8 weeks/flexible• Avulsion 1-2 weeks/flexible
Root fracture:• Cervical third 4 months/rigid• Middle/apical third 4 weeks/flexible• Alveolar fracture 4 weeks/flexible
![Page 177: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/177.jpg)
Systemic Phase
Premedication Antibiotic Prophylaxis Managing anticoagulants Adrenal/Thyroid insuffiency
cases
![Page 178: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/178.jpg)
Preventive Phase
Caries risk assessment
Oral hygiene counseling
Diet counselling
P&F sealants
Fluoride application
![Page 179: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/179.jpg)
Preparatory Phase
Behavioural managment
Caries control
Oral Prophylaxis
Preventive orthodontics
Extraction of unrestorable teeth
• Pre-prosthetic treatment
![Page 180: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/180.jpg)
MECHANICAL AIDS:
GAUZE PIECEMoist gauze piece wrapped around finger for cleaning gum pads in infants
BRUSHING TECHNIQUE Common method :
Circular brushing method (or) Fone’s technique is used twice daily.
DENTRIFICE
No flouridated tooth paste should be used till 3years.Till the child is 7 years of age only pea size quantity of dentrifice should be dispensed.
![Page 181: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/181.jpg)
POWERED TOOTH BRUSH
Patients who lack manual dexterity
Orthodontic patients
DENTAL FLOSS Waxed dental floss is used in children
Longer handle floss are used
Floss with 8 to 10 vertical strokes
Floss atleast once a day
The important time to floss is before going to bed
![Page 182: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/182.jpg)
MOUTH WASH:Chlorhexidine:(rexidin,clohex)
Chlorhexidine(CHX)Recommended in a concentration of 0.12% in a range of 5 to 1o ml once daily.
Not recommended under the age of 7 years
![Page 183: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/183.jpg)
![Page 184: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/184.jpg)
![Page 185: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/185.jpg)
Decision making tree for dental caries(Nyvad & Fejerskov,1997)
Status of the tooth
Filling
Active lesion
Cavity Repair/
replacement
No cavity Non operative treatment
Inactive lesion No treatment
Defect
Ditching/Overhanging
No treatment/reburnishing
Fracture/Food impaction
Repair/replacement
No defect No replacement
Lesion
Active
Cavity Operative treatment
No cavity Non operative treatment
Inactive No treatment
Clinically sound No treatment
![Page 186: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/186.jpg)
Definitve Rx Phase
Restorative and Pulpal treatment
Prosthetic rehabilitation
Orthodontic interventions – serial extractions, space management, tooth movements
Orthognathic surgery
Periodontal therapy
![Page 187: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/187.jpg)
Maintenance Phase -3-6 month recalls
-review check up of oral health indices
-repeat caries activity tests
-reinforcement of home care measures
-motivation and re-counseling of the parent
-follow up of treatment procedures
![Page 188: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/188.jpg)
Anticipatory Guidance It is defined as pro-active counseling of parents and patients about developmental changes that willoccur in the interval between health supervision visits that includesinformation about daily caretaking specific to that upcoming interval. If child is sleeping with a bottle, or if there are incipient white spot lesions, then the dentist
should make recommendations on how to stop the bottle habit or improve oral hygiene.
![Page 189: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/189.jpg)
Informed consent
• Sufficient information must be given by the dentist to the parent /guardian, so that the parent has a reasonable understanding of the proposed dental care for the child
• Basic concepts of informed consent (Schultz,1985)
A standard consent form is not a substitute for a dentist parent discussion
Nonremote risks to careAny referral to other health providersConsequences if proposed treatment is refusedAcceptable alternatives
![Page 190: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/190.jpg)
![Page 191: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/191.jpg)
Scheduling operative treatment
The following are general rules of thumb
• Small, simple restorations should be completed first• Maxillary teeth should be treated before mandibular teeth• Posterior teeth should be treated before anteriors• Quadrant dentistry should be practised • Endodontic treatment should follow completion of simple
restorative treatment • Extractions should be the last items of operative care
unless the patient presents with an acute problem.
![Page 192: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/192.jpg)
Conclusion
“ ACCURATE DIAGNOSIS OF A DISEASE DEPENDS UPON THE ART OF TAKING CASE HISTORY”
![Page 193: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/193.jpg)
References • Pediatric Dentistry: A Clinical Approach by Goran Koch, Sven Poulsen• Dental caries by Ole Fejerskov and Edwina Kidd• Textbook and colour atlas of traumatic injuries of teeth by J.O.Andreasen
and F.M.Andreasen• Fundamentals of pediatric dentistry by Richard.J.Mathewson• Pediatric dentistry:principles and practice by M.S Muthu and N.Sivakumar• Textbook of pedodontics by Shobha Tandon• Orthodontics The Art and Science – Balaji• Oral Diagnosis, Oral Medicine and Treatment Planning – Bricker &
Langlais• ENLOW AND HANS-facial growth of orthodontics• Grabers textbook of orthodontics• Principles and practice of pedodontics-Arathi rao
![Page 194: Case history, diagnosis and treatment planning](https://reader036.vdocuments.us/reader036/viewer/2022062412/5870f9341a28ab5f528b54ab/html5/thumbnails/194.jpg)