Clinical Examination & Testing Flashcards
The Objective of Clinical
Testing is to
reproduce
chief complaint and find
an etiology fo r the
patient´s pathosis.
C l i n i c a l Te s t i n g i s
performed based on
CC
1.(a) Patient Interview: MEDICAL HX. & MEDS:
- CHIEF
COMPLAINT &
Relevant Dental
HX. - Supplements
or other non Rx
DRUGS - Complete Medical
HX (supplemental as
necessary)
Blood Glucose
PT time
Pregnancy test - Rx Medications
Taken (dose/
frequency)
1.(b) PATIENT INTERVIEW : “NEVER TREAT A STRANGER”
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)
- Intraoral Examination: (1 and 2 done)
If it is emergency or
pain related:
Do a
“problem focused
exam”
You can do palpation/
percussion testing,periodontal
probing and mobility testing in
the specific Area Of Suspicion
- Intraoral Examination: (1 and 2 done)
If it’s a new patient;
Do the
prescribed exam sequence
Take a mirror and look in the
mouth: note tissue color,
consistency swelling , DST, and
any inconsistencies or
irregularities
Periodontal and Mobility
TESTING
— is important.
Take at least — probings on each
tooth.
Blanching
6
Turn the probe around; add a
mirror handle on the lingual/
palatal and wiggle the tooth to
test —
mobility
Palpation:
gently feel the Tissues
Palpation
Look for:
(4)
Tenderness
Swelling
Unusual texture, color or
composition
Draining sinus tract (DST)
A DST usually is associated with a
CHRONIC Apical
Abscess;
A DST usually is associated with a CHRONIC Apical
Abscess;
Pulp is expected to be _________?
Most are minimal pain or none due to drainage.
necrotic
Percussion:
gently tap on the teeth
Percussion
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
- Appropriate Radiographs
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
Pulp Sensibility Test
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.
Thermal & EPT Testing: in the mouth
(5)
- Teeth to be
tested are properly
ISOLATED & DRIED - 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 (NOTE) - Then go to next tooth
and repeat
You are looking for:
(3)
- 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
Thermal Cold Testing: INTERPRET RESULTS
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 — seconds is significant to
test and record. (“Normal” is 3-8 seconds) but it varies from patient to
patient.
10-15
All Results mean NOTHING without — for each Patient.
BASE-LINE
A false-negative response is common when
cold is applied to
teeth with calcific metamorphosis presumably due to reduction
in hydrodynamic fluid flow
A false-positive response may result if
cold contacts gingiva
or is transferred to adjacent teeth with vital pulps.
Sensibility to COLD is considered to be a symptom of
EARLY pulpal inflammation
Sensibility to HOT is a
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)
Heat Testing:
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 hot testing is required,
(isolate 1 tooth at a time with rubber dam).
Heat water to 140 degrees F. and drip on isolated tooth.
What if you get NO RESPONSE (NR)? First
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)
What if you get NO RESPONSE (NR)?
You will also routinely get NR on:
(3)
- YOUNG permanent teeth
- Teeth immediately following TRAUMA (Recheck
in 2-4 weeks) - Look for INJURY to tooth (if none – may be
“NORMAL”)
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 if you have symptoms on a tooth with NO
Caries, NO Trauma, NO Restorations?
• Suspect an axial crack
• Suspect an axial crack
• How to PROVE it:
(4)
• Radiographs
• Biting Tests with “Tooth Slooth”
• Periodontal probing
• Transillumination
Electric Pulp Tester:
This Instrument allows us to have the
patient bite on individual cusp tips
to help identify an axial crack.
Use of Transillumination
normal
axial crown fracture
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
The Restoration may need to be — to
view crack. Staining may be indicated
removed
- Develop YOUR Tentative DIAGNOSIS: (5&6 done)
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”
FINALLY
NOW and ONLY NOW are you ready to call for
CONSULT(S)
If cannot arrive at a supportable DX,
you cannot…
do any treatment.
