Clinical Examination and Testing Flashcards
what is the outline for clinical exam and testing
- chief complaint and vital signs (pt interview and med hx + meds)
- intraoral exam
- radiographs
- thermal and EPT Testing
- evaluate for cracks
- development of tentative diagnosis
- consults as needed
what are the 4 things included in medical hx and meds
- medical hx - blood glucose, PT time, pregnancy test
- rx medications (dose and frequency)
- supplements or other non rx drugs
- chief complaint and relevant dental hx
what should you do in the intraoral exam
- if its an emergency or pain related do a problem focused exam
- if its a new patient do the prescribed exam sequence
- palpation/percussion testing, perio probing and mobility testing in the area of suspicion
- note tissue color, swelling, DST and inconsistencies or irregularities
how many probing should you take on the area of suspicion and what should you look for
6, blanching is important
how should you test mobility
wiggle the tooth and put a mirror on the lingual
what should you look for when palpating
-tenderness
- swelling
- unusual texture, color or composition
- DST
A DST is usually associated with:
CAA
pulp in a CAA is expected to be
necrotic
is there pain associated with CAA and why
minimal or none due to drainage
do you need to use anesthesia to remove or repair DST
no
where should you start in percussion
adjacent teeth to establish a baseline and maintain a constant percussion technique across all teeth
how many teeth should you do percussion on
at least two on each adjacent side of the AOS
what are the appropriate radiographs needed and why
- PA films to see surrounding tissues
- straight on and angled PA
- bite wing on posteriors to determine restorability
- all must be diagnostic in quality
what is a pulp sensibility test
assessment of the pulp sensory response
how do you do thermal and EPT testing
- teeth are isolated and dried
- place cold cotton pellet on facial tooth surface
- patients hand should go up immediately
- observe the seconds until patients hand goes down
- go to next tooth and repeat
what are you looking for in thermal and EPT testing
- what is normal for this patient
- what is decidedly different for a particular tooth
- the time to recover is much more important than the severity of pain reported
what is the normal amount of time pain should linger after cold or EPT
3-8 seconds
what is the amount of time after a thermal or EPT test that would indicate endo tooth
20-30 seconds
sensitivity to cold is considered a symptom of:
early pulpal inflammation
sensitivity to hot is a symptom of____; indicating that _____
late stage pulpal inflammation; gas is being produced via deterioration of the pulp
if patient is sensitive to hot what will bring them relief
cold water
when is heat testing done
only if the patient’s CC is pain produced by warm liquids
how do you do heat testing
- isolate 1 tooth at a time with rubber dam
- heat water to 140 degrees F and drip on isolated tooth
- keep cold water handy to cool tooth if hot sets it off
what would no response on a single tooth with a normal base line indicate
necrotic pulp and RCT is indicated
what do you do if no response on most or all of teeth
-probably an older person
- test with EPT
you will routinely get no response on:
- young permanent teeth
- teeth immediately following trauma (recheck in 2-4 weeks)
- look for injury on tooth
how do you use to EPT
- dry the teeth and isolate with cotton rolls
- place small dab of tooth paste on facial of each tooth to be tested
- develop base line first
what should you suspect if you have symptoms on a tooth with no caries, no trauma, no restorations
- an axial crack
how do you prove an axial crack
- radiographs
- biting tests with tooth slooth
- periodontal probing
- transillumination
what will an axial crown fracture show in transillumination
it will not allow light to pass through the line of fracture
what do you do if a crack has extended to root
extract
what do you do if positive tooth sleuth test and pt responds to cold
crown
