3/4: Types of Dental Clinical Examinations Flashcards
The foundation of any form of successful treatment is _________________
Accurate diagnosis
What is diagnosis the bridge between?
The study of disease and the treatment of illness
_______ before you _______
Inform; perform
If it isn’t written, it ___________________
Didn’t happen
What are types of clinical examinations?
- comprehensive dental diagnosis
- periodic/recall/recare diagnosis
- diagnosis of a specific problem
- emergency diagnosis
- screening diagnosis
The diagnostic method can be modified to most effectively do what?
Address the needs of the patient (Chief complaint)
What does the diagnostic method alter?
The amount of diagnostic information collected initially and the scope of diagnostic decisions made by the clinician
What are examples of chief complaints that require immediate attention?
Pain, acute infection, bleeding or traumatic injury
What can chief complaints also be a request for?
Less urgent care
What do you do if a patient reports several complaints?
List in order of priority, AS STATED BY THE PATIENT
What is the most extensive diagnostic assessment?
Comprehensive dental diagnosis (initial dx, IOE)
What is comprehensive dental diagnosis appropriate for?
The patient who requests total dental care and HAS NOT BEEN EVALUATED PREVIOUSLY
What patients are comprehensive dental diagnosis used for?
- patient of record who has not been seen in several years (3-5)
- patient of record who has had major change in medical/dental history
What starts the minute you see the patient when performing a comprehensive dental diagnosis?
Physical exam and assessment
What does a detailed medical history assess?
Systemic diseases
Surgeries
Current medications (both RX and OTC)
Allergies
Establish ASA class
What is included in a comprehensive dental diagnosis?
Physical exam and assessment
Detailed medical history
Intra/extra oral evaluation and perioral/periodontal conditions
Dental radiographs
Diagnostic casts
What does comprehensive dental diagnosis data reflect?
The patient’s initial status, which serves for comparison later in assessing treatment effectiveness
What requires a considerable time, but provides a sound diagnostic foundation for comprehensive dental care?
Comprehensive dental diagnosis
What does comprehensive dental diagnosis protect the clinician by?
Documenting the patient’s initial status if treatment complications lead to accusations of sub-standard care
What are medical emergencies typically seen in a dental office?
Vasovagal syncope (63%)
Angina (12%)
Epileptic seizures (10%)
Choking (5%)
Asthma (5%)
Vasovagal syncope
What is periodic (recall) appropriate for?
A patient who requests total dental care when the results of a prior comprehensive dental diagnosis are available
What do you assume in a periodic diagnosis?
Portion of past information is still accurate but other aspects of the patient’s medical/dental history may have changed
What month interval are periodic diagnosis?
6 month
What is the goal in a periodic diagnosis?
Identify the conditions that have changed and supplement the prior database so that it reflects the patient’s current status
What is a periodic diagnosis as simple as?
Asking patient if there has been changes since the last appointment (always good practice regardless of the time interval)
What is a periodic diagnosis as complex as?
Repeating most of the comprehensive dental diagnosis
What do updates that come from a periodic exam do for a dentist?
Refamiliarize the dentist with the patient’s original conditions and provides the new findings for comparison
What do you do if a different clinical conducted the original diagnosis?
The current dentist must confirm the accuracy of prior data and record current findings prior to diagnosis decisions
(almost like doing a comprehensive exam)
What is the dentist frequently asked to provide an opinion regarding?
A specific problem
- for a recently evaluated patient (second opinion)
What is the soap evaluation an effective approach to?
Such situations if the available diagnostic database is current and accurate
- soap form is in axium
What is “s” in the SOAP form?
S-Subjective information or symptoms of the condition as supplied by the patient. Patient’s chief concern or complaint. It is recorded in the patient’s own words
S- “Toothache on the upper right for the last 2
weeks-getting worse.” Patient reports pain to
cold and hot, duration 5-10 minutes, loss of
sleep and requires Motrin 3-4 x day
What is the “O” in the SOAP form?
O-Objective or physical findings of the clinician. Includes visual findings,
periodontal assessment, clinical tests (percussion, palpation, vitality tests)
O- # 3Grossly decayed (+) response to percussion & palpation,(-) swelling, mobility. #3 is non-vital to electric pulp testing(EPT), no
apical change interpreted on the periapical radiograph
What is the “A” in the SOAP form?
A-Analysis or clinical impression of the condition by the clinician This is the diagnosis
A-Caries, necrotic pulp, -tooth is restorable
What is the “P” in the SOAP form?
P-Plan or recommended management of the problem. May be specific
treatment, referral, or dismissal of the condition as clinically insignificant
P- Discussed treatment options including RCT
and crown vs. extraction. Risk/benefits of each
procedure explained. Patient prefers RCT and
understands that the tooth may need crown
lengthening procedure
What are emergency diagnosis designed to manage?
A chief complaint such as pain, bleeding, or acute infection that requires immediate attention
What is the comprehensive diagnostic evaluation sacrificed in?
The interest of providing attention to the urgent problem
What is limited in most aspects to the chief complaint?
Physical examination
What can be demanding because the patient’s concern of the “CC” can interfere with obtaining an adequate patient history?
Emergency diagnosis
What do screening diagnosis answer?
A specific question about the patient
What are screening diagnoses evaluation limited to?
Obtaining the information needed to answer the question without accepting comprehensive diagnosis or treatment responsibility for the patient
Why do institutions rely on screening diagnosis?
To determine the patient’s general dental treatment needs
*see this when students are looking for board lesions
What is the most common symptom arising in the mouth, face, and neck area?
Pain
What is the most common reason for emergency appointments?
Pain
What is pain?
Subjective and unlike an ulcer, there may be nothing to assess visually
What do you need to be as a dentist?
Good listener and have good follow up questions
What are questions to ask when diagnosing pain?
How would you describe the pain?
- dull/throbbing, sharp/stabbing, burning
- when did you first notice it?
- is the pain continuous or does it go away? How long does it last?
- does it wake you up at night?
- Has it gotten better/worse or stayed the same?
- anything make it worse? anything make it better?
- have you taken anything for the pain?
Pain arising from pathology is usually _________
Unilateral
What may indicate an inefective organ?
Swelling, discharge, bad taste, bad breath, elevated temperature, malaise or cervical lymphadenopath
