Diagnosis Flashcards
What things need to be done prior to treatment planning (in order)?
- chief complaint
- medical history
- dental history
- radiographs
- head, neck, and oral cancer exam
- periodontal exam
- hard tissue exam
- occlusion exam
- mounted study models
- consults by specialists if needed
Types of dental radiographs include:
- panoramic radiograph
- periapical radiograph
- bitewing radiographs
- cone beam computerized tomography (CBCT)
What type of radiograph is this? What can be seen in this radiograph?
Panoramic radiograph; implant & no 3rd molars
Radiographs that allow you to visualize the apices of the teeth:
periapical radiograph
What numbers are bitewing radiographs taken in (dependent on the number of teeth the patient has)
2s or 4s
radiographs that are good for visualizing caries
bitewing radiographs
What type of radiograph is seen in this image?
periapical radiograph
What type of radiograph is this? What can be seen in this image?
periapical radiograph; abscess
What type of radiograph is this? What can be seen in this image?
bitewing; caries
What type of radiograph is seen in this image?
cone beam computerized tomography (CBCT)
What are the clinical situations for which radiographs may be indicated (2 broad categories)?
- positive historical findings
- positive clinical signs/symptoms
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Isolated periodontal problem, pockets of less than 5mm
- periapical
- conventional bitewings
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Isolated periodontal problem, pockets greater than 5mm
- periapical
- vertical bitewings
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Symptomatic tooth, restorability in question
- periapical
- bitewings
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Symptomatic tooth, restorability NOT in question
periapical radiograph
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Nonrestorable tooth
Panoramic or periapical radiograph that images the entire root and nearby anatomic structures including the sinus floor and the mandibular canal
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Eruption pain
Panoramic or periapical radiograph that images the entire root and nearby anatomic structures including the sinus floor and the mandibular canal
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Possible jaw fracture
Panoramic radiograph (and other views as indicated)
Below is the presenting condition of your patient. What is the recommended radiographic images you should take?
Blunt trauma to tooth or teeth
Periapical radiographs of traumatized tooth or teeth and any opposing teeth
The ____ has guidelines on radiographs
ADA
If a patient is high risk you should take radiographs ____ whereas a lower risk patient you should take radiographs ___
more frequently; less frequently
An examination performed by a dentist or doctor to look for signs of cancer or precancerous conditions in you mouth:
oral cancer screening
The goal of oral cancer screening is to identify:
mouth cancer early, when there is a greater chance for a cure
What lymph nodes should be palpated during the head and neck exam? (8)
- prearuicular
- post-auricular??
- tonsilar
- submental
- submandibular
- anterior-cervical
- posterior-cervical
- supraclavicular
During an ____ you take a look at the entire oral cavity
oral exam
Individualized radiographic exam consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be visualized or probed. Patients without evidence of disease and with open proximal contacts may not require a radiographic exam at this time:
New patient- child with primary dentition (prior to eruption of 1st permanent tooth)
Individualized radiographic exam consisting of posterior bitewings with pano exam or posterior bitewings and selected periapical images:
New patient- child with transitional dentition (after eruption of first permanent tooth)
Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images. A full mouth intraoral radiographic exam is preferred when the patient has clinical evidence of generalized oral disease or a history of extensive dental treatment:
New Patient- adolescent with permanent dentition (prior to eruption of 3rd molars
New Patient- adult dentate or partially edentulous
Individualized radiographic exam, based on clinical signs and symptoms:
New patient- adult edentulous
Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot be examined visually or with probe:
Recall patient with clinical caries or at increased risk for caries- child with primary dentition (prior to eruption of first permanent tooth)
Recall patient with clinical caries or at increased risk for caries- child with transitional dentition (after eruption of first permanent tooth)
Recall patient with clinical caries or at increased risk for caries- adolescent with permanent dentition (prior to eruption of third molars)
Posterior bitewing exam at 6-18 month intervals:
Recall patient (with clinical caries or at increased risk for caries)- adult, dentate or partially edentulous
Radiographic exam is “not applicable”:
Recall patient (with clinical caries or at increased risk for caries)- adult, edentulous
Recall patient (with no clinical caries and not at increased risk for caries)- adult, edentulous
Posterior bitewing exam at 12-24 month intervals if proximal surfaces cannot be examined visually or with a probe:
Recall patient (with no clinical caries and not at increased risk for caries)- child with permanent dentition (prior to eruption of first permanent tooth)
Recall patient (with no clinical caries and not at increased risk for caries)- child with transitional dentition (after eruption of first permanent tooth)
Posterior bitewing exam at 18-36 month intervals:
Recall patient (with no clinical caries and not at increased risk for caries)- adolescent with permanent dentition (prior to eruption of third molars)
Posterior bitewing exam at 24-36 month intervals:
Recall patient (with no clinical caries and not at increased risk for caries)- adult, dentate or partially edentulous
Screening radiograph for edentulous patient:
panoramic radiograph
Screening radiograph for partially edentulous (less than 10 teeth):
Panoramic & PAs of remaining teeth
Screening radiograph for dentulous- patients with no significant history of dental disease:
Pano & 2-4 BWs & isolated PAs
Screening radiograph for dentulous- with history of dental disease:
FMX
Screening radiograph for dentulous- with history of dental disease and third molars:
FMX and panoramic
What are the diagnostic tools for an oral cancer screening?
VELScrope & brush biopsy
Examination of the teeth and dental implant to evaluate the topography of the gingiva related and related structures; to measure probing depths, the width of keratinized tissue, gingival recession, and attachment levels
periodontal exam
Exam to evaluate the health of the subgingival area with measure such as BOP and suppuration; to assess clinical furcation status; and to detect ednodontic periodontal lesions
periodontal exam
Periodontal exam is the assessment of the presence, degree, and/or distribution of:
- plaque/biofilm
- calculus
- gingival inflammation
Hard tissue exam charting includes: (4)
- previous dental work
- positional conditions
- diagnostic conditions
- endodontic conditions
What category of hard tissue exam charting does “rotated teeth, tipped teeth, etc” fall under?
positional conditions
What category of hard tissue exam charting does “caries, defective restorations, occlusal wear, abfractions/erosions, etc.” fall under?
diagnostic conditions
What category of hard tissue exam charting does “PA abscess, symptomatic tooth, sinus tract, etc.” fall under?
endodontic conditions
Occlusal exam includes (3):
- orthodontic classification
- occlusal interferences
- centric relation
Any tooth contact that inhibits the remaining occlusion surfaces from achieving stable and harmonious contacts:
occlusal interference
Three signs of instability include:
- hyper mobility of teeth not related to periodontal disease
- excessive wear
- change in tooth position
Five SIGNS of stability include:
- TMJ is healthy and stable
- All teeth are firm
- No excessive wear
- All teeth have stayed in their present position
- Supporting structures are healthy
Five REQUIREMENTS for stability:
- stable TMJ
- anterior guidance in harmony with mandibular function
- non-interfering posterior teeth
- all teeth in vertical harmony with contraction of elevator muscles
- all teeth in horizontal harmony with neutral zone
What do we mean by the requirement for stability “non-interfering posterior teeth”? (2)
- equal intensity of contacts in CRO or CO
- Posterior disclusion when condyles leave CR
The area where the forces exerted by the tongue are balanced by the forces exerted by the musculature of the cheek and lips:
neutral zone
Mounted casts should be mounted with facebow transfer for:
extensive (3 units or more) crown and bridge work & for removable partial dentures
Unmounted casts should be taken to:
treatment planning appointments
When mounting casts, a custom guide table is required for:
- anterior crowns
- FPDs
- veneers
Consults by specialists include:
- periodontal disease
- restorative (removable & fixed prosthodontics treatment)
- oral lesion
- oral surgery
