clinical examination and testing Flashcards

1
Q

The Objective of Clinical
Testing is to?

A

The Objective of Clinical
Testing is to reproduce
chief complaint and find
an etiology for the
patient ́s pathosis.

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2
Q

Clinical Testing is
performed based on?

A

performed based on CC.

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3
Q

info to collect during pt interview

A
  1. CHIEF COMPLAINT & Relevant Dental HX.
  2. Complete Medical HX (supplemental as necessary)
    Blood Glucose
    PT time
    Pregnancy test
  3. Rx Medications Taken (dose/
    frequency)
  4. Supplements
    or other non Rx
    DRUGS
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4
Q

when to do interview and vital signs

A

Do the Patient Interview and Vital Signs together
starting with the walk back from the waiting are

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5
Q

Intraoral Examination
when its an emergency
new pt?

A

If it is emergency or pain related: Do a “problem focused exam”
If it’s a new patient; Do the
prescribed exam sequence

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6
Q

tests used in AOS

A

You can do palpation/
percussion testing,periodontal
probing and mobility testing in
the specific Area Of Suspicion
(AOS)

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7
Q

what to note in intraoral exam

A

note tissue color,
consistency swelling , DST, and
any inconsistencies or
irregularities.

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8
Q

Periodontal and Mobility testing methods

A

Take at least 6 probings on each tooth.
Turn the probe around; add a
mirror handle on the lingual/
palatal and wiggle the tooth to
test mobility

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9
Q

Palpation
what to look for?

A

gently feel the Tissues
Look for:
Tenderness
Swelling
Unusual texture, color or
composition
Draining sinus tract (DST)

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10
Q

root palpation due to ortho

A

can lead to roots being placed outside the bone and can be palpated, leads to some discomfort but not pain

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11
Q

A DST usually is associated with?
Pulp is expected to be _________?
pain?

A

A DST usually is associated with a CHRONIC Apical
Abscess;
Pulp is expected to be necrotic Most are minimal pain or none due to drainage.

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12
Q

tracing DST?

A

trace with gutta percha cones and radiograph

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13
Q

percussion testing
where to start? why?

A

gently tap on the teeth
NEVER start on the suspected tooth!!
You are trying to establish a BASE-LINE of normal response for this patient
Begin your percussion testing GENTLY in an area of the mouth NOT RELATED to the
Area Of Suspicion
MAINTAIN a CONSISTANCY of
percussion technique on ALL teeth tested

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14
Q

how to determine post teeth restorability?

Appropriate Radiographs for diagnostic purposes

A

Radiographs must be “Diagnostic” in quality

Peri-Apical films are required to see the surrounding tissues
Straight-on and Angled P/A (Shift Shot 20º change in horizontal angulation)

Bite Wing film (B/W XR) on posteriors to determine RESTORABILITY

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15
Q

Pulp Sensibility Test

A

Assessment of pulp sensory response.
Sensibility test is defined as an ability to respond to stimulus,
and this is therefore an accurate and appropriate term for typical and common clinical pulp tests, such as thermal and electrical tests, given that they do not detect or measure the blood supply of the dental pulp

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16
Q

Thermal & EPT Testing: in the mouth procedure

A
17
Q

what to look for with thermal testing?

A
  1. What is NORMAL for this patient at this time
  2. What is decidedly DIFFERENT for a particular tooth
  3. The TIME to RECOVERY is much more important
    than the SEVERITY of PAIN reported
18
Q

intensity or duration for thermal testing

A

The intensity of discomfort is not generally significant but the
period of time to return to normal following cold stimulation must
be noted before continuing.

A (“lingering” of discomfort) for more than 10-15 seconds is significant to test and record. (“Normal” is 3-8 seconds) but it varies from patient to patient.

19
Q

what must you have fr thermal testing results to be proper

A

a base line control

20
Q

A false-negative response is common when cold is applied to

A

teeth with calcific metamorphosis presumably due to reduction
in hydrodynamic fluid flow.

21
Q

A false-positive response to cold may occur with

A

A false-positive response may result if cold contacts gingiva
or is transferred to adjacent teeth with vital pulps.

22
Q

early and late pulpitis thermal responses

A

cold sensitivity early followed by hot sensitivity in later stages

23
Q

Heat Testing:

A

Heat testing is NOT performed
unless the chief complaint of the patient is pain produced by warm liquids
Normal teeth are NOT sensitive to HOT
if required isolate tooth with dam and drip 140 degree water on

24
Q

What if you get NO RESPONSE (NR)? (thermal) but there is a normal baseline

A

If NR on a SINGLE tooth with normal BASE-LINE, may mean NECROTIC PULP .
. . (RCT indicated)

25
Q

next step?

IF NR (thermal) on MOST or ALL TEETH:

A

probably older person – test with EPT (any time thermal testing is unclear)

26
Q

when else could we see no thermal response

A
  • YOUNG permanent teeth
    - Teeth immediately following TRAUMA (Recheck
    in 2-4 weeks)
    - Look for INJURY to tooth (if none – may be
    “NORMAL”)
27
Q

Electric Pulp Tester:
procedure?
must establish?

A

DRY the teeth and ISOLATE with Cotton Rolls.
Place a small dab of tooth paste (conductor)
on facial of each tooth to be tested.
Must develop BASE-LINE first here also.

28
Q

What if you have symptoms on a tooth with NO
Caries, NO Trauma, NO Restorations?
what should be suspected? how to prove?

A

•Suspect an axial crack
•How to PROVE it:
•Radiographs
•Biting Tests with “Tooth Slooth”
•Periodontal probing
•Transillumination

29
Q

what does the tooth sluth allow for ?

A

testing biting on individual cusps to look for fx

30
Q

transillumination and fractures

A

An Axial Crown Fracture will NOT allow light to
pass through the line of fracture

31
Q

how can probing be useful for finding fx

A

look for drop off pockets= strong indicator of fracture

32
Q

radiographic evidence of fractures

A

unusual bone loss patterns

33
Q

restorations of fx teeth

A

The Restoration may need to be removed to
view crack. Staining may be indicated.

34
Q

number 1 and 2 prevalence of fractured teeth

A

No.1 Prevalence: Mandibular 2nd Molar
No. 2 Prevalence: Maxillary Premolars

35
Q

treatable vs non treatable fractures

A