History and Examination Flashcards
When making a care plan for a patient, what steps must you do
- Patient’s general health
- History
- Care options (advice, prevention, maintenance, referral)
- Clinical findings
- Disease diagnosis, extent and rate of progression
- Risk assessment
- Patient preferences and expectations
- Risk-based review interval
What should be covered in notes
- Referred by
- C/O
- HPC
- MH
- SH
- Examination E/O and I/O
- Special investigations
- Provisional diagnosis
- tx plan (list each visit aim)
- Acute management
Who can consent for a child?
- Child’s mother
- Child’s legally appointed guardian
- PErson who has obtained a residency order for the child from a court
- Local authority designated in a care order in respect of the child
- Child’s father if he was married to the mother at the time of birth
Unmarried fathers if they have acquired parental responsibilities in the following way:
- Marry the mother of their child
- Obtain a parental responsibility order from court
Unmarried fathers can also have parental responsibility of children aged 15+ if
- they register the child’s birth jointly with the mother at time of birth
- re-register the birth if they are the natural father
at what age can young people consent
- 16 years and above can consent without consent of parent/guardian
- Minors under age of 16 can give consent if deemed gillick competent although rare in dentistry. mainly dental emergencies
what basic general info would you like to know as patient walks through the door before taking a history
- date
- name
- age
- gender
- bday
- accompanying person
- who referred patient
- why is the patient here? emergency, new patient, tx, recall
what should be asked in dental history
- regular attender?
- past dental history (la, ihs, or other forms of sedation, ga)
- coping abilities
- any specific difficulties, dislikes
- evaluate child’s and parents attitude towards dental tx
what should be asked in social history
- type of school
- age, gender, sibling history
- parental occupation
- siblings/relatives with similar problems
what should be asked in diet history
- bottle-fed duration?
- snacks/drinks and frequency
- treats- when
- type of treats
what should be asked in re to oral history
- brushing- frequency, assisted
- toothpaste
- supplements
- thumb sucking, nail biting, mouth breathing
other than e/o and I/o what else must be examined
- behaviour
- frank-l score
what should you look for on soft tissue io examination
- BM, FOM, tongue, gingival, palate
- abscess, swelling, ulcer, lesions etc
what should be done/looked for in re to teeth on io examination
- charting
- restorations
- cavities
- percussion testing
- tooth wear
- tenderness of palpation
- mobility
- change in colour
- fractures
at what age can you do a bee
- PAtients above 7
- If 7-11, only BPE scores of 0,1 and 2 may be used on index teeth
- IF 12-17, a full BPE should be performed on Index teeth
what should be noted in terms on pt behaviour
- frank l score
- age
- anxiety of parents and patient
- language barriers
- interaction and communication
what further investigations can be done in a patient
- diet sheet/food diary
- disclosure of plaque
- vitality testing
- photos
- rx
- study models
- biopsy
when should you not take a rx
- If rx is not expected to:
- change diagnosis
- change treatment
- add other useful info
it should not be taken
indications for rx in children and adolescents
- detection of caries
- dental injuries (trauma)
- disturbances to tooth development
- examination of other pathological conditions other than caries
what are some benefits of bitewings in kids
- detect caries that cannot be otherwise seen
- use of bitewing radiography in addition to clinical examination increases the number of inter-proximal lesions detected by 2-8
- estimate the extent of lesions
- monitor lesion progression
name some sensitivity tests you can do
-unpredictable in primary dentition but
cold (ethyl chloride) hot (warm gutta percha) electricity (electric pulp therapy) laser doppler flowmetry (vitality testing) test cavity
how to detect caries
COMMON methods -visual (clean, dry tooth, good light and magnification) -tactile sensation -rx examination DO NOT PROBE
ADVANCED methods
- laser-based methods (diagnodent)
- fibre optic transullimination
- dyes
- elective caries meter (ECM)
what kinds of preliminary diagnosis should you be making
- Behaviour/cooperation
- Caries
- Non carious TSL
- Hypodontia, infraocclusion, hypoplasia
- supernumeraries, related conditions
- trauma
- oral hygiene
- ortho classification
- soft tissue lesions, abscess
what factors should be taken into account when making therapy decisions
- age of child
- evidence of therapy outcomes
- caries risk assessment
- parental and dentist preferences and expectations
- natural history of caries progression
what are 3 forms of therapy which could be applied to a child
- no therapy
- preventitive therapy
- restoraton therapy
what are the objectives of tx
Emergency
- refief of pain
- prevent further infection
- maintain vitality
stabilisation of active disease
- prevention
- temporization
corrective
- restorative
- prosthetic
maintenance
- recall
- reinforce prevention
when should you re-assese patients
- recall every 6 months
- if higher risk then 4 months
what should you mention when reviewing cases with parents
- list problems, restorative needs, preventative needs
- explain the sequence of tx
- discuss how anxiety control and pain relief can be achieved
- explain the stage of development
- discuss with parent after each appointment what was accomplished and patient cooperation (as positive as possible)
-obtain informed consent
what should you be able to work out from history examination and investigations
- caries risk level
- dx
- realistic and attainable tx goals
- preventitive programme
- recall interval
