Clinical Examination and Testing Flashcards
What do you need to find out in the patient interview?
- Complete medical history
- Rx Medicaitions
- Supplements
- Chief Complaint
What is included/supplemental in a complete medical history?
- blood glucose
- PT time
- Pregnancy test
What should you document from the patient interview?
a. Get an accurate Health History and Meds Taken
b. Patient’s CC, symptoms & related dental HX
c. Are other tests needed? (M.D. consult, etc. p.r.n.)
d. How can you help them: Expectations/Desires
What is the outline of an objective examination?
- VITAL SIGNS
- EXTRAORAL EXAMINATION
- INTRAORAL EXAMINATION
What vital signs do you need to get during the examination?
- Blood Pressure
- Respiratory rate
- Pulse
- Temperature should be taken in patients reporting swelling or signs and symptoms
What do you need to notice on an extraoral examination?
GENERAL APPEARANCE
- Skin tone
- Facial Asymmetry
- Swelling
- Discoloration, redness
- Extraoral scars or sinus Tract
- Lymphadenopathy
What would you look for during an intraoral examination?
- Tenderness
- Swelling
- Unusual texture, color or
composition - Draining sinus tract (DST)
Take at least ___ probings on each tooth in the area of suspicion
6
What is important to look for during periodontal eval?
blanching
How do you test a tooth for mobility?
Turn the probe around; add a mirror handle on the lingual/palatal and wiggle the tooth to test mobility
Why test tooth mobility?
determine status of PDL
What does this show?
DST
- draining sinus tract
can insert Gutta Percha to determine location origin
What is percussion during an intraoral examination?
- gently tapping on the tooth (incisal or occlusal surface)
- do not start with the suspected tooth
Why should you not start with the suspected tooth during endo testing (percussion, etc.)?
You are trying to establish a BASE-LINE of normal response for this patient
Maintain a ___________ of percussion technique on ALL teeth tested
CONSISTANCY
Radiographs must be ________ in quality
Diagnostic
_____________ films are required to see the surrounding tissues
Peri-Apical
What type of peri-apical films can be used to view surrouding tissues?
Straight-on and Angled P/A
Bite Wing film on posteriors to determine…
RESTORABILITY
What is the definition of a sensibility test?
ability to respond to stimulus, and hence this is 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
What are the rules for thermal and EPT testing in the mouth?
- Teeth to be tested are properly ISOLATED & DRYED
- Place COLD cotton pellet on facial tooth surface
- Patient’s hand should go up immediately (If NOT hold cotton on tooth until it does)
- Observe the seconds until patient’s hand goes down
- Then go to next tooth and repeat
What are you looking for during thermal and EPT testing?
- What is NORMAL for this patient at this time
- What is decidedly DIFFERENT for a particular tooth
- The TIME to RECOVERY is much more important than the SEVERITY of PAIN reported
What is signficant for thermal cold testing?
the period of time to return to normal following cold stimulation
What is NOT signficant for thermal cold testing?
The intensity of discomfort
A “lingering” discomfort for more than _____ seconds is significant.
20-30
Normal discomfort is _____ seconds but varies from patient to patient.
3-8
All endo testing results mean NOTHING without _________ for each Patient
BASE-LINE
Sensitivity to COLD is considered to be a symptom of…
EARLY pulpal inflammation
Sensitivity to _____ is considered to be a symptom of EARLY pulpal inflammation
COLD
Sensitivity to HOT is a sign of…
LATE stage of pulpal inflammation
Sensitivity to ____ is a sign of LATE stage of pulpal inflammation
HOT
Why is sensitivity to hot a sign of later state pulpal inflammation?
indicates that gas is being produced via deterioration of the pulp
When would a patient find relief from cold water and may even bring cold water with them?
LATE stage pulpal inflammation
Heat testing is NOT performed unless the chief complaint of the patient is pain produced by…
warm liquids
Normal teeth are or are not sensitive to HOT?
are not
How do you perform a heat test?
- If hot testing is required, (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 does it indicate if you get no response on a single tooth with a normal baseline on other teeth?
may mean Necrotic Pulp - RCT indicated
If no response (NR) on most or all teeth:
Probably older person and you should TEST WITH EPT
What should you test with if thermal testing is unclear?
EPT
What is EPT?
electric pulp tester
How do you perform an EPT (electric pulp tester)?
- 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.
What does a low EPT reading mean?
healthy
What does a high EPT reading mean?
possibly necrotic
Can you do EPT (electric pulp tester) with crowns?
No
What if you have symptoms on a tooth with NO Caries, NO Trauma, NO Restorations?
Suspect an axial crack
How do you test for an axial crack?
- Radiographs
- Biting Tests with “Tooth Slooth”
- Periodontal probing
- Transillumination
What does a tooth slooth allow for?
This Instrument allows us to have the patient bite on individual cusp tips to help identify an axial crack.
What happens to a normal tooth during transillumination?
normal tooth lights up like a light bulb
What happens to a cracked tooth during transillumination?
An Axial Crown Fracture will NOT allow light to pass through the line of fracture
What might need to be removed to view a crack?
restoration
Where is the number 1 prevalence of cracks?
Mandibular 2nd Molar
Where is the number 2 prevalence of cracks?
Maxillary Premolars
What are periodontal ways to suspect an axial crack?
- drop-off pocket
- unusual bone loss
Is this tooth treatable or non-treatable?
treatable
Is this tooth treatable or non-treatable?
non-treatable
THE accuracy of your diagnosis and the appropriateness of your treatment depends entirely upon…
- The thoroughness of your Clinical Examination & Clinical Testing
- Your Interpretation of Results, Symptoms and Radiographs
Everything you do following an inaccurate diagnosis is…
WRONG
