hard tissue charting
TRANSCRIPT
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Hard Tissue ChartingHard Tissue Charting
Dental Hygiene TheoryDental Hygiene Theory
Instructor: Nickee dela Cruz R.R.D.H.
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Hard Tissue Charting• Is completed & documented at the
ASSESSMENT appointment
• Is updated at each maintenance appointment
• Should follow a routine so that nothing is missed (sequencing)
• Do not use erasers or white out, if you make a mistake stroke 1 line through it & date & initial the change
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Charting• Conditions which exist or are present in the
oral cavity are recorded in BLUE
• Carious lesions, teeth requiring treatment (extractions & other pathologic conditions, such as abcesses) are recorded in RED
• SUSPECTED carious lesions are charted in GREEN, but if they are diagnosed by the DDS as being decay, they are changed to RED
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Normal, Atypical, & Abnormal Findings to Observe during Hard
Tissue Exams
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The dental hygienist should be able to …
• Recognize signs of development anomalies & acquired tooth damage & bring them to the DDS’s attention
• Be able to properly document in the odontogram (hard tissue) in the client’s chart
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Anomalies of the Teeth
• HyperdontiaHyperdontia – or supernumary teeth, extra teeth such as mesiodens which will occur between the maxillary anterior teeth
• HypodontiaHypodontia – absence of 1 or 2 teeth or anodontia, congenitally missing teeth most common are 3rd molars than maxillary lateral incisors, than mandibular premolars
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Mesiodens
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Mesiodens (arrow). A, Radiographic
appearance. B, Clinical appearance
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Hypodontia
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Microdontia (arrow)
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Supernumary Teeth
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Anomalies of the Dental Tissue
• Macrodontia – larger than normal teeth, they tend to be wider, longer, & higher than normal teeth, may affect several or all teeth in the dentition
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Anomalies of the Dental Tissue
• GeminationGemination – a tooth tries to split or twin
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Gemination (arrow)
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Anomalies of the Dental Tissue
• Dens in denteDens in dente – a tooth within a tooth usually the lingual of maxillary incisors
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Dens in dente
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Anomalies of the Dental Tissue
• DilacerationsDilacerations – severe distortion or crown or root by trauma during formation
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Dilaceration
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Definition of DYSPLASIA
• medically abnormal development or growth of a part of the body, for example, an organ, bone, or cell, including the total absence of such a part
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Intrinsic StainingIntrinsic StainingStain or discoloration within the toothStain or discoloration within the tooth
Enamel Enamel dysplasia HYPOPLASIAHYPOPLASIA – (rough, pitted enamel surface,
ameloblasts disrupted during the matrix formation of the tooth)
• Interruption of the enamel developmental Interruption of the enamel developmental process results in irregular enamel process results in irregular enamel formation or lack of enamel formation. formation or lack of enamel formation. Restorative treatment may be required Restorative treatment may be required because of susceptibility to decay and to because of susceptibility to decay and to improve appearance.improve appearance.
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Enamel Hypoplasia
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Enamel hypoplasia
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Syphilitic enamel hypoplasia.
• A, Hutchinson's incisors.
• B, Mulberry molars.
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Enamel Dysplasia
HYPOCALCIFICATIONHYPOCALCIFICATION – defect in enamel during mineralization, spotted surface is generally smooth, may be from trauma, nutritional deficiencies, excess fluoride intake
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Enamel Hypocalcification
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Enamel DysplasiaAMELOGENESIS IMPERFECTA – AMELOGENESIS IMPERFECTA – hereditary
condition where dentin & pulp develop normally but enamel is easily chipped or worn away
• A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only.
• teeth vary in color from white opaque to yellow to brown
• all teeth are affected, smaller and pitted
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Amelogenesis Imperfecta
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Enamel Dysplasia
Dentinogenesis Imperfecta
• The bluish color and translucent features of this dentition are very suggestive of dentinogenesis imperfecta.
• Unlike amelogenesis imperfecta, the enamel in dentinogenesis imperfecta is normal; it is the underlying dentindentin that is structurally deficient.
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Here is another example of the clinical features of dentinogenesis imperfecta.
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Dentin Dysplasia (Rootless Tooth)
• A hereditary defect in dentin formation in which the coronal dentin and tooth color is normal; the root dentin is abnormal with a gnarled pattern and associated shortened and tapered roots
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Taurodontism
• A malformed multirooted tooth characterized by an altered crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and the pulp chamber being abnormally large.
• Observed on radiographs – shows enlarged pulp chamber resulting in thinner dentin
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Taurodontism
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Talon Cusp• Lingual of maxillary & mandibular
anterior teeth
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Acquired Anomalies• Attrition – wear from tooth on tooth
Attrition of the mandibular anterior teeth
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Abrasion• Mechanical tooth wear caused by a
foreign substance
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Erosion
• Loss to tooth surface due to a chemical agent
• Erosion from sucking on lemons (arrow) NEXT SLIDE
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Tooth Fracture• Small to large chips or breaks in the enamel
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Surfaces of the Teeth
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Quadrants Primary vs. Permanent
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Charting Symbols for Oxford Dental Hygiene Clinic
Chapter 13 Chapter 13 pg 247pg 247
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Missing Teeth M
• Teeth that are not present because of extraction or are congenitally missing
• Charting procedurePlace a vertical line or
X through the facial, occlusal & lingual surfaces
• Chart in BLUE ink
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Unerupted Teeth U
• Teeth that have not yet erupted or are impacted
Circle facial, occlusal, & lingual surfaces of tooth
Chart in RED ink
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Teeth to be extracted Ex
• Teeth to be extracted because of pathologic or orthodontic reasons
• Draw a RED diagonal line through the tooth, or an alternative method is to draw 2 RED parallel lines through the tooth
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Amalgam Restorations A
• Alloy of silver/mercury; silver or dark grey in color; widely used as a restorative material
• Chart surfaces where the restorations appear
• Outline the shade in BLUE for precise notation use Black’s classification
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Tooth Colored Restorations R = resin CR = Composite resin
• Outline exact size & shape of restoration
• Shade with BLUE ink
• Chart surfaces involved
• Use Black’s Classification
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Temporary Restorations Temp, T
• Temporary filling cements; zinc oxide-eugenol cement
• Chart temporary restorations the same as amalgam or resins in BLUE ink, but distinguish from amalgams with the abbreviation
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Veneer Ven
• Veneer or layer of resin that is used to cover the unsightly area of tooth
• Outline & shade in surface of tooth where veneer is found
• Chart in BLUE ink
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Full Gold Crown FGC
• Can be onlays or inlays or crowns
• Outline & fill in with diagonal lines covering all surfaces
• Chart in BLUE ink
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¾ Gold Crown ¾ GC
• Covers less than ¾ of tooth surfaces
• Outline & fill with diagonal lines places on all surfaces or portion of surfaces covered by crown
• Chart in BLUE ink
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Ceramic to Metal CrownsGCFP = crown, GCFP = crown,
porcelain faceporcelain faceGCAF = gold crown, GCAF = gold crown,
acrylic faceacrylic face
Chart similarly to gold Chart similarly to gold crowns crowns
Abbreviation can be Abbreviation can be used to distinguish it used to distinguish it from full gold or ¾ from full gold or ¾ crownscrowns
Chart in Chart in BLUEBLUE ink ink
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Gold Inlay GI
• Does not cover the cusps
• Outline the shape of the restoration on the surfaces where it appears
• Chart in BLUE ink
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Gold Onlay GO• Restoration which
involves the cusp tips• Outline & color the
shape of the restoration on the surfaces where it appears
• Chart in BLUE ink
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Fixed Bridges• Each tooth may be
labeled with the appropriate abbreviations FGC, GCPF, ¾ GC
• Outline abutment & pontic teeth in BLUE ink & fill in with diagonal lines on occlusal, facial, & lingual surfaces
• Chart the pontic teeth as extracted
• Place 2 horizontal lines between the occlusal surfaces of the teeth to represent the splinted unit
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Dental Implants IMPL
• Make a written comment under the teeth involved
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Dental Caries C
• Outline the SUSPECTED carious area(s) in GREEN
• Once diagnosed as caries by DDS, outline in RED
• On completion of the restoration, fill in the RED areas with BLUE
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Black’s Classification
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Black’s Classification
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Black’s Classification
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Recurrent Decay RD
• Outline the area of recurrent decay in RED
• Recurring caries around the margin of an existing restoration
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Appliances – Partial or Complete Dentures
PUD = partial upper PUD = partial upper denturedenture
PLD = partial lower PLD = partial lower denturedenture
CUD = complete upper CUD = complete upper denturedenture
CLD = complete lower CLD = complete lower denturedenture
Chart the missing teeth with Chart the missing teeth with vertical lines or X’s vertical lines or X’s through all surfacesthrough all surfaces
Join vertical lines or X’s Join vertical lines or X’s with horizontal line at with horizontal line at root apex & label to root apex & label to indicated upper or lower indicated upper or lower & partial or complete & partial or complete denturedenture
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Overhanging Restorations OH
• Chart with triangular symbols in the interproximal area
• Chart in BLUE ink
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Dental Sealants S
• Encircle & place abbreviation inside the circle
• Chart on occlusal surface in GREEN
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Root Tip RT
• Chart tooth as missing & place abbreviation symbol near root apex
• Chart in BLUE ink
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Root Canal RC
• Place vertical line through pulpal area of root
• Label with abbreviation
• Chart in BLUE ink
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Decalcification or Hypocalcification Decal
• Outline the area & label with abbreviation
• Chart in BLUE ink
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Erosion Ero
• Shade area in BLUE & place symbol
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Hypoplasia Hypoplas
• Chart using wavy lines to denote the irregularity of enamel with symbol
• Indicate with abbreviation
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Attrition Att
• Place a horizontal line over the affected surfaces
• Chart in BLUE ink
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Abrasion Abr
• Chart 2 horizontal lines in BLUE ink
• Caused by mechanical wear caused by improper toothbrushing or other habits such as chewing on pencils, pipe smoking
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Supernumary Teeth Su
• Draw additional tooth in location found
• Chart in BLUE ink• Label with
abbreviation
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Other Dental Anomalies
• Other anatomic variations such as dens in dente, should be clearly indicated in the record section of the dental chart
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TMJ Evaluation
• Detecting or noting any noises while bilaterally palpating the TMJ
• Noises include
- CREPITUS (cracking/grinding of the CREPITUS (cracking/grinding of the bones rubbing together)bones rubbing together)
- POPPING or CLICKING POPPING or CLICKING
Tenderness & pain/muscle tension should also be noted
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Percussion
Is done on each tooth to check for sensitivity, by gently tapping the dental mirror handle tip on each tooth & recording the finding’s noted as:
• Normal = WNL
• Sensitive = +P
• Very Sensitive = ++P
• Extremely Sensitive = +++P
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Open Bite
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Crossbite
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Overbite
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Occlusal relationship of primary molars
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Reviewing Radiographic Findings
Relevant to the Clinical Assessment
Found on the back of the Hard Tissue
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Radiographic Findings
• Review normal or pathological findings
• Is part of the ASSESSMENT phase & can be used in the IMPLEMENTATION phase
• Radiographs are also required for documentation & record keeping of client’s dentition ( ie. Forensic dentistry often uses radiographs)
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Periodontal Conditions Observed in Radiographs
1. Normal anatomy & the tooth crown to root ratio2. Confirmation of clinical findings & topography of
root surfaces3. Status of the lamina dura4. Changes in the PDL5. Remaining bone height6. Local irritants such as calculus & overhanging
restorations7. Patterns or extent of disease8. Possible furcation areas9. Disease progression or remission by serial
radiography