Clinical Examination & Testing

Question 1

The Objective of Clinical
Testing is to

Answer 1

reproduce
chief complaint and find
an etiology fo r the
patient´s pathosis.

Question 2

C l i n i c a l Te s t i n g i s
performed based on

Answer 2

CC

Question 3

1.(a) Patient Interview: MEDICAL HX. & MEDS:

Answer 3

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

Question 4

1.(b) PATIENT INTERVIEW : “NEVER TREAT A STRANGER”

Answer 4

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

How can you help
them: Expectations
Desires
(Document)

Question 5

3. Intraoral Examination: (1 and 2 done)
   If it is emergency or
   pain related:

Answer 5

Do a
“problem focused
exam”
You can do palpation/
percussion testing,periodontal
probing and mobility testing in
the specific Area Of Suspicion

Question 6

3. Intraoral Examination: (1 and 2 done)
   If it’s a new patient;

Answer 6

Do the
prescribed exam sequence

Take a mirror and look in the
mouth: note tissue color,
consistency swelling , DST, and
any inconsistencies or
irregularities

Question 7

Periodontal and Mobility
TESTING
— is important.
Take at least — probings on each
tooth.

Answer 7

Blanching
6

Question 8

Turn the probe around; add a
mirror handle on the lingual/
palatal and wiggle the tooth to
test —

Answer 8

mobility

Question 9

Palpation:

Answer 9

gently feel the Tissues

Question 10

Palpation
Look for:
(4)

Answer 10

Tenderness
Swelling
Unusual texture, color or
composition
Draining sinus tract (DST)

Question 11

A DST usually is associated with a

Answer 11

CHRONIC Apical
Abscess;

Question 12

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

Answer 12

necrotic

Question 13

Percussion:

Answer 13

gently tap on the teeth

Question 14

Percussion
NEVER start on the

Answer 14

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

Question 15

4. Appropriate Radiographs

Answer 15

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

Question 16

Pulp Sensibility Test

Answer 16

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.

Question 17

Thermal & EPT Testing: in the mouth
(5)

Answer 17

1. Teeth to be
   tested are properly
   ISOLATED & DRIED
2. Place COLD
   cotton pellet on
   facial tooth surface
3. Patient’s hand should go
   up immediately (If NOT
   hold cotton on tooth until
   it does)
4. Observe the seconds
   until patient’s hand
   goes down (NOTE)
5. Then go to next tooth
   and repeat

Question 18

You are looking for:
(3)

Answer 18

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

Question 19

Thermal Cold Testing: INTERPRET RESULTS

Answer 19

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.

Question 20

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

Answer 20

10-15

Question 21

All Results mean NOTHING without — for each Patient.

Answer 21

BASE-LINE

Question 22

A false-negative response is common when

Answer 22

cold is applied to
teeth with calcific metamorphosis presumably due to reduction
in hydrodynamic fluid flow

Question 23

A false-positive response may result if

Answer 23

cold contacts gingiva
or is transferred to adjacent teeth with vital pulps.

Question 24

Sensibility to COLD is considered to be a symptom of

Answer 24

EARLY pulpal inflammation

Question 25

Sensibility to HOT is a

Answer 25

LATE stage of pulpal
inflammation indicating that gas is being produced via
deterioration of the pulp. (Patient now finds relief from
cold water & may bring cold water with them)

Question 26

Heat Testing:

Answer 26

Heat testing is NOT performed
unless the chief complaint of the
patient is pain produced by warm
liquids

Question 27

Normal teeth are NOT sensitive to

Answer 27

HOT

Question 28

If hot testing is required,

Answer 28

(isolate 1 tooth at a time with rubber dam).
Heat water to 140 degrees F. and drip on isolated tooth.

Question 29

What if you get NO RESPONSE (NR)? First

Answer 29

If NR on a SINGLE tooth with normal BASE-LINE, may mean NECROTIC PULP .
. . (RCT indicated)
IF NR on MOST or ALL TEETH: probably older person – test with EPT (any time
thermal testing is unclear)

Question 30

What if you get NO RESPONSE (NR)?
You will also routinely get NR on:
(3)

Answer 30

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

Question 31

Electric Pulp Tester:

Answer 31

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

Question 32

What if you have symptoms on a tooth with NO
Caries, NO Trauma, NO Restorations?

Answer 32

• Suspect an axial crack

Question 33

• Suspect an axial crack
• How to PROVE it:
(4)

Answer 33

• Radiographs
• Biting Tests with “Tooth Slooth”
• Periodontal probing
• Transillumination

Question 34

Electric Pulp Tester:
This Instrument allows us to have the

Answer 34

patient bite on individual cusp tips
to help identify an axial crack.

Question 35

Use of Transillumination
normal
axial crown fracture

Answer 35

D 6435 A NORMAL TOOTH lights up like a light bulb
An Axial Crown Fracture will NOT allow light to
pass through the line of fracture

Question 36

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

Answer 36

removed

Question 37

7. Develop YOUR Tentative DIAGNOSIS: (5&6 done)

Answer 37

You should now be able to determine accurately the vitality status of the pulp in
question (Response WNL)
You should now have discovered any DST or swelling and any
possible PARL (Peri-Apical Radiolucent/Opaque Lesion)
You should now be able to develop
Your “Tentative Diagnosis”

Question 38

FINALLY
NOW and ONLY NOW are you ready to call for

Answer 38

CONSULT(S)

Question 39

If cannot arrive at a supportable DX,
you cannot…

Answer 39

do any treatment.