Chapter 9 J: Patient Evalution, Diagnosis, And Treatment Planning

Question 1

Parts of patient evaluation:

Answer 1

1. Case history
2. Chief complaint
3. History of present illness
4. Past dental history
5. Medical history
6. Current dental history

Question 2

Case history:

Answer 2

The purpose is to discover whether the patient has any general or local condition that might alter the course of treatment

Patient’s symptoms in their OWN words

Question 3

Chief complaint:

Answer 3

Very important because the overall treatment plan revolves around it, the information that promoted the patient to visit

Question 4

History of present illness:

Answer 4

Signs, symptoms, duration, intensity of pain, relieving ad exaggerating actors
This indicates the severity and urgency of the problem

Question 5

Past dental history:

Answer 5

Helps to know any previous dental experience and past restorations

Question 6

Medical history:

Answer 6

Some medical conditions that require special care:
A. Allergies and medications
B. Communicable disease
C. Systemic diseases (diabetes, Sjögren’s syndrome, bulimic disorder)
D. Physiological changes associated with aging

Question 7

Current dental history:

Answer 7

Give special attention to pain history , this will give us invaluable information for a proper diagnosis

Question 8

Parts of clinical examination:

Answer 8

A. Inspection
B. Palpation
C. Percussion
D. Auscultation
E. Exploration

Question 9

Additional techniques of evaluation:

Answer 9

A. Radiographs
B. Study casts
C. Laboratory investigations
D. Occlusion examination
E. pulp vitality test

Question 10

Inspection:

Answer 10

• intra oral
• extra oral: begins as soon as the patient enters the clinic, look for unusual gait and habits
• general dental status

Question 11

In the intraoral inspection we look at the following structures:

Answer 11

• buccal, labial, and alveolar mucosa
• hard and soft palate
• floor of the mouth and tongue
• retromolar region
• posterior pharyngeal wall and facial pillars
• salivary glands and orifices

Question 12

General dental state:

Answer 12

• oral hygiene status
• amount and quality of restorative work
• prevalence of caries
• missing tooth
• presence of soft or hard swelling
• periodontal status
• presence of any sinus tracts
• discoloured teeth
• tooth wear and facets

Question 13

Palpation:

Answer 13

palpation of submandibular salivary glands, TMJ, and lymph nodes and intraoral palpation

Question 14

Percussion gives information about?

Answer 14

the periodontal status of the tooth and indicates inflammation in the PDL

Question 15

How to perform percussion?

Answer 15

Gentle tapping with the handle of the dental mirror , on all surfaces of each tooth

Degree of response to percussion—-> degree of inflammation

Question 16

Auscultation:

Answer 16

Important for TMJ
Crepitations, clicking sounds

Question 17

Exploration:

Answer 17

With a probe or explorer, explore every surface of the teeth

Question 18

How can periodontal conditions be assessed?

Answer 18

By palpation, percussion, mobility of the tooth and probing

Periodontal examination shows change in color, contour, form, density, level of attachment and bleeding tendency

Question 19

How are dental caries diagnosed?

Answer 19

• visual changes in the tooth surface
• tactile sensation with explorer
• radiography
• transillumination

Question 20

One of the most important tools in making a diagnosis is?

Answer 20

Radiographs

Question 21

How do radiographs help:

Answer 21

• establishing diagnosis
• determining the prognosis of the tooth
• disclosing the presence and extent of caries
• check the thickness of the periodontal ligament
• see presence or absence of lamina dura
• look for lesions associated with the tooth
• see number, shape, length, and pattern of root canals
• check for any obstruction present in the pulp space
• check any previous root canal treatment done
• look for presence of any intra radicualar pins or posts

Question 22

Study casts are very helpful in?

Answer 22

• patient’s education
• occlusal relationship analysis
• plunger cusps
• wear facets

Question 23

Laboratory investigations, the most common ones require:

Answer 23

• TLC
• DLC
• BT
• CT
• HIV tests

Question 24

Occlusion examination:

Answer 24

Teeth are examined for abnormal wear patterns such as nocturnal bruxism or para functional habits in addition to unfavourable occlusal relationships such as plunger cusps which may result in food impactation

Question 25

Pulp vitality tests:

Answer 25

• they not only determine the vitality of the tooth but also the pathological state of the pulp
• thermal test (cold or heat tests)
• electrical pulp testing
• test cavity
• anaesthesia testing
• bite testing

Question 26

5 phase of treatment planning:

Answer 26

• urgent phase
• control phase
• holding phase
• definitive phase
• maintenance phase

UC HDM

Question 27

The urgent phase is:

Answer 27

Treatment mainly aims at providing relief from symptoms, ex: incision and draining of abscess , endo treatment with acute irreversible pulpitis

Question 28

The control phase is?

Answer 28

involves halting the progress of primary disease by removing etiological factors
This is beneficial for the long term treatment of caries and perio diseases
Ex: caries or periodontal problem

Question 29

The holding phase is?

Answer 29

The time between the control and the definitive phases, allows time for healing and analysis of the inflammation , patient is advised home care habits

Question 30

The definitive phase is?

Answer 30

Involves many procedures like endo, Ortho, perio, oral surgical and operative procedures prior to further treatment

Question 31

The maintenance phase is?

Answer 31

Regular recall examination of patient is done, helps in prevention of the recurrence of the diseases and malintencionado of the previous treatment results