Chapter 9 J: Patient Evalution, Diagnosis, And Treatment Planning Flashcards
Parts of patient evaluation:
- Case history
- Chief complaint
- History of present illness
- Past dental history
- Medical history
- Current dental history
Case history:
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
Chief complaint:
Very important because the overall treatment plan revolves around it, the information that promoted the patient to visit
History of present illness:
Signs, symptoms, duration, intensity of pain, relieving ad exaggerating actors
This indicates the severity and urgency of the problem
Past dental history:
Helps to know any previous dental experience and past restorations
Medical history:
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
Current dental history:
Give special attention to pain history , this will give us invaluable information for a proper diagnosis
Parts of clinical examination:
A. Inspection
B. Palpation
C. Percussion
D. Auscultation
E. Exploration
Additional techniques of evaluation:
A. Radiographs
B. Study casts
C. Laboratory investigations
D. Occlusion examination
E. pulp vitality test
Inspection:
- intra oral
- extra oral: begins as soon as the patient enters the clinic, look for unusual gait and habits
- general dental status
In the intraoral inspection we look at the following structures:
- 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
General dental state:
- 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
Palpation:
palpation of submandibular salivary glands, TMJ, and lymph nodes and intraoral palpation
Percussion gives information about?
the periodontal status of the tooth and indicates inflammation in the PDL
How to perform percussion?
Gentle tapping with the handle of the dental mirror , on all surfaces of each tooth
Degree of response to percussion—-> degree of inflammation
Auscultation:
Important for TMJ
Crepitations, clicking sounds
Exploration:
With a probe or explorer, explore every surface of the teeth
How can periodontal conditions be assessed?
By palpation, percussion, mobility of the tooth and probing
Periodontal examination shows change in color, contour, form, density, level of attachment and bleeding tendency
How are dental caries diagnosed?
- visual changes in the tooth surface
- tactile sensation with explorer
- radiography
- transillumination
One of the most important tools in making a diagnosis is?
Radiographs
How do radiographs help:
- 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
Study casts are very helpful in?
- patient’s education
- occlusal relationship analysis
- plunger cusps
- wear facets
Laboratory investigations, the most common ones require:
- TLC
- DLC
- BT
- CT
- HIV tests
Occlusion examination:
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
Pulp vitality tests:
- 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
5 phase of treatment planning:
- urgent phase
- control phase
- holding phase
- definitive phase
- maintenance phase
UC HDM
The urgent phase is:
Treatment mainly aims at providing relief from symptoms, ex: incision and draining of abscess , endo treatment with acute irreversible pulpitis
The control phase is?
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
The holding phase is?
The time between the control and the definitive phases, allows time for healing and analysis of the inflammation , patient is advised home care habits
The definitive phase is?
Involves many procedures like endo, Ortho, perio, oral surgical and operative procedures prior to further treatment
The maintenance phase is?
Regular recall examination of patient is done, helps in prevention of the recurrence of the diseases and malintencionado of the previous treatment results
