History Taking, Clinical Examination and Diagnosis (Pt. I and II) Flashcards by J L

Terminology oDiagnosis

n The ____ of the nature of a disease

determination

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History
o(1)\_\_\_\_ 
o(2)\_\_\_\_
 o(3)\_\_\_\_aa
o(4)\_\_\_\_

chief complaint
personal details
medical history
dental history

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(1)Chief Complaint
oMain ____ for seeking treatment
oWhen formulating treatment plan, must determine how to resolve

reason

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(1)Chief Complaint
o Categories 
n \_\_\_\_
pPain, sensitivity, swelling n \_\_\_\_
pDifficulty in mastication or speech
n \_\_\_\_
pBad taste or odor
n \_\_\_\_
pFractured or unattractive
teeth or restorations p Discoloration

comfort
function
social
appearance

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(2)Personal Details

oName oAddress oPhone number oSex oOccupation oWork schedule oMarital status oFinancial status

yay

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(3)Medical History
o\_\_\_\_ taken oMedical conditions
n Affecting treatment methods
pAntibiotic \_\_\_\_, \_\_\_\_, anticoagulants,
allergies to meds or dental materials

n Affecting treatment plan
pPrevious ____ therapy, hemorrhagic disorders, age, illness

n Systemic conditions with oral manifestations
p____, menopause, ____, anticonvulsant
medications, ____, gastroesophageal reflux

n Risk factors to dentist and auxiliaries (“universal precautions”)
p____, HIV, syphilis

medications
premedications
steroids
radiation
diabetes
pregnancy
bulimia
hpeatitis B

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(1)General Examination
oGeneral appearance
oGait oWeight oSkin color
n For signs of \_\_\_\_
oVital signs
n Refer if indicated

anemia or jaundice

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(2)Extraoral Examination oFacial asymmetry
o\_\_\_\_ lymph nodes palpated
oTemporo- mandibular joints
oMuscles of mastication
oLips
n \_\_\_\_

facial

tooth visibility

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(4)Periodontal Examination

Gingiva
n ____, texture, ____, contour, consistency, position

o Periodontium
n \_\_\_\_ probing depths/tooth
n Tooth mobility or \_\_\_\_
n open or deficient \_\_\_\_ n missing or impacted teeth n recession
n \_\_\_\_ involvements

oClinical Attachment level
n Measure distance between ____ extent of probing depth and ____ reference on tooth
pApical extent of restoration and/or CEJ

color
size
6
malposition
contacts
furcation

apical
fixed

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(5)Dental Charting

oOcclusal examination
n(a)Initial tooth contact
n(b)Tooth \_\_\_\_
n(c)\_\_\_\_ contacts
n (d)Jaw maneuverability

alignment

eccentric

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(a)Initial Tooth Contact oBimanual manipulation
nIs there a CR to MI slide?

Yes:
Evaluate possible elevated ___
Evaluate ___ where initial contact occurs
Evaluate ___ on teeth involved in the slide

No:

muscle tone
tooth mobility
wear facets

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(b)General Alignment
oTeeth adjacent to ____ spaces often shift
n ____ movement can affect fixed prosthodontics
pTipped teeth may affect ____
n May need ____ tooth movement

edentulous
small
preparation design
minor

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(c)Lateral and Protrusive
Contacts
oNote \_\_\_\_ and \_\_\_\_ overlap
oObserve \_\_\_\_ during protrusive
oObserve lateral excursions
n Verify with \_\_\_\_
oFremitus

vertical
horizontal
shim stock

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(c)Lateral and Protrusive Contacts
oFremitus
n A ____ ____ when the teeth come into contact

vibration

palpable

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(6)Radiographic Examination
oEvaluate \_\_\_\_ of teeth 
oEvaluate \_\_\_\_ structure oCaries/recurrent caries oExisting restorations
n \_\_\_\_ margins
n \_\_\_\_ margins 
oPulpal health/abscess
n \_\_\_\_ disease 
oPathology 
oPeriodontal ligament 
oOpen contacts

bone support
root
open
overhanging
periapical

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(6)Radiographic Examination oFull periapical series
n Normally ____ for new patients to develop a comprehensive fixed prosthodontic treatment plan
n Limit to what is needed for ____

required

tx decisions

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6)Radiographic Examination oPanoramic Films
n Presence or absence of teeth
n Assessing third molars and impactions
n Evaluating bone before \_\_\_\_
n Screening \_\_\_\_

implant placement

edentulous arches

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(6)Radiographic Examination

____ radiograph DOES NOT provide sufficient data for assessing bone support, root structure, caries, or periapical disease

A full periapical series is ____ for comprehensive fixed prosthodontic treatment plan

panoramic

required

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(7)Vitality Testing
oPulpal health must be assessed
n \_\_\_\_ ptapping
n \_\_\_\_ stimulation
n \_\_\_\_ stimulation
n \_\_\_\_ evaluation

percussion
thermal
electrical
radiographic

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Diagnostic Information

accurate dx casts > ____ > articulator >

Evaluate occlusion and ____
Perform diagnostic procedures (ex. ____) Determine ____

maximum intercuspation/centric relation
occlusal plane
diagnositc waxing
treatment plan

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Diagnostic Impressions o____ hydrocolloid (alginate)
n Control reaction rate with water temperature
pWarm > ____ set
pCold > ____ set

oPour immediately
n \_\_\_\_ 
pAbsorbs water
n \_\_\_\_ 
pGives off liquid
 Results in \_\_\_\_ of impression

irreversible
faster
slower
imbition
syneresis
distortion

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1)Tray Selection
irreversible hydrocolloid

oRetention
n \_\_\_\_, perforations, \_\_\_\_
oLargest tray to fit comfortably
n Greater bulk > more \_\_\_\_
oMaterial must be supported by \_\_\_\_
n May need to \_\_\_\_ tray with modeling
compound or wax 
oTray movement
n Causes \_\_\_\_

adhesive
rim-lock
accurate
tray
extend
distortion

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(2)Impression Making
irreversible hydrocolloid

oTeeth should be clean, but not excessively ____
nImpression may adhere to teeth

oMix to ____ consistency:
Wipe or syringe material into ____ of occlusal surfaces and ____ fold
Load tray

dry
homogenous
crevices
mucobuccal

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(2)Impression Making
irreversible hydrocolloid
oTray is seated into patient’s mouth
n Patient should \_\_\_\_ cheek muscles
n “\_\_\_\_”
pTo capture mucobuccal fold and underneath \_\_\_\_

relax
close gently
upper lip

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(2)Impression Making irreversible hydrocolloid ``` oRemove with a ____ n􏰄teasing􏰅 results in ____ due to ____ flow oRinse and disinfect n____ in plastic bag p10 minutes oPour within ____ minutes ```

``` snap distortion viscous glutaraldehyde 15 ```

(2)Impression Pouring ``` oType ____ or ____ dental stone n Ideal to vacuum mix oSmall amounts added in ____ location to minimize bubbles o Ideal to store tray side ____n until set n Minimize ____ surface n Minimize ____ on teeth oAdd more stone for sufficient base oDo not immerse setting cast in ____ n Due to ____ oIdeally, separate after 1 hour ```

``` IV V one down rough and grainy air bubbles water setting expansion ```

o ____ height from base to occlusal table

1 inch

Corner ____ to canine o____ from gingival margin to base

distal | 10

(4)Articulators o____ do not enable analysis of functional relationships o____ device that simulates mandibular movement oClassified according to how closely they can reproduce ____ movements o If border movements are reproduced, can reduce ____ and adjustments on delivery

handheld casts mechanical mandibular border chair time

Types of articulators (a) ____ (b) ____ (c) ____

small non-adjustable semiadjustable fully adjustable

(a)Small Nonadjustable Articulator oDoes ____ have the capacity to reproduce full range of ____ oOften leads to n Restorations with occlusal ____ p May adjust ____ p If not adjusted, may cause ____ disorders oMany ____ fabricated on this articulator

``` NOT mandibular movement discrepancies intraorally neuromuscular cast restorations ```

(a)Small Nonadjustable Articulator oSignificant difference between hinge of closure on articulator and patient Hinge and tooth distance is less than patient >> Arcing motion results in ____ travel than occurs clinically >> May affect ____ and result in ____ tooth contacts

steeper cusp position premature

``` (b)Semiadjustable Articulators oFor most ____ fixed prostheses n Provides necessary ____ information n Minimizes need for clinical ____ oDoes not require much ____ or expertise oAbout same size as ____ structures they represent n Arcing errors ____ pReduces chairside ____ ```

``` routine diagnostic adjustment time anatomic minimal adjustments ```

(b)Semiadjustable Articulators oMost can adjust ____ inclination (____o in pre-clinic) oMost can adjust progressive and/or immediate ____ (Bennett side shift)-(____o in pre-clinic) n The translatory portion of lateral movement in which the ____ side condyle moves essentially ____ and ____ as it leaves the CR position

``` condylar inclination 30 side shift 15 non-working straight medially ```

(c)Fully Adjustable Articulators o ____ range of positions and can be set to follow a patient’s ____ o Special ____tracing are used to record patient􏰄s border movements n Reproduces border movements of patient o Not often required in ____ practice ____ instrument

wide border movements pantographic general stuart

(c)Fully Adjustable Articulators oAdvantages n May ultimately save ____ time regarding adjustments n Can be useful in very ____ rehabilitations oDisadvantages n ____ consuming n High skill level needed pMay introduce numerous inaccuracies

chairside complex time

Facebow oUsed to record the ____ and ____ spatial position of the maxillary occlusal surfaces in relation to the ____ opening and ____ of the patient’s mandible (hinge axis)

anteroposterior mediolateral transverse closing axis

Facebow Arbitrary vs. Kinematic ``` oArbitrary hinge axis facebow n Approximate ____ axis and rely on ____ n Easily identifiable landmark used to stabilize bow p____ n Utilizes anterior reference point pEx. ____ n Some ____ ```

``` horizontal transverse anatomic average values external acoustic meatus infraorbital foramen inaccuracies ```

Facebow Arbitrary vs. Kinematic ``` oKinematic hinge axis facebow n Determine hinge axis n More ____ than arbitrary facebow n Very____ consuming n Generally limited to ____ prosthodontics pEx. Change in ____ ```

accurate time extensive occlusal vertical dimension

Facebow oAttach to articulator to transfer recorded relationship in correct position to hinge axis of articulator >> oThen, relate mandibular cast to maxillary n ____ n ____

hand articulate | interocclusal record

Centric Relation Record oProvides orientation of ____ to ____ teeth in centric relation n Centric relation pMaxillomandibular relationship in which the condyles articulate with the ____ of their respective disks with the condyle-disk complex in the ____ position against the ____ pIndependent of ____

``` mandibular maxillary thinnest avascular portion anterosuperior articular eminences tooth contact ```

Centric Relation Record oNeed to precisely manipulate the mandible oBimanual manipulation (____) n ____ technique Chair ____ Both thumbs on chin and fingers on ____ border of mandible >> exert gentle downward pressure on thumbs and ____ pressure on fingers >> Manipulate condyle-disk assemblies into their fully seated positions in ____ >> Mandible carefully hinged

dawson reproducible reclined inferior upward manidbular fossae

Centric relation record ``` If manipulation difficult n ____ n Anterior programming device p􏰄____􏰅 n ____ oAfter 30 minutes, may need ____ device ```

cotton rolls lucia jig leaf gauge occlusal

Centric Relation Record oPartially edentulous dentition n If insufficient teeth for ____ stability n Fabricate ____ and occlusal rims pMake on same casts to be articulated n Soft tissue displacement errors if different cast

bilateral | record bases

Mounting Mandibular Cast oPosition ____ on inverted articulator with maxillary cast oOrient ____ into record oStabilize mandibular cast (____!) oAdd ____ to mandibular cast oEnsure pin is touching ____ nCustom guide table may be used to transfer contacts of ____

``` CR record mandibular cast RIGID plaster guide table anteior teeth ```

Virtual Articulators oRecently, virtual casts derived from an optical scan can be positioned within the framework of the virtual articulator oAnother method, casts are positioned in an ____ position based on ____ values oNeed to scan casts which have been articulated and scan maxillary/mandibular relationship of casts oNot yet capable of rendering simulation of ____

arbitrary average mandibular movements

Virtual Articulators Cerec virtual articulator positions virtual casts arbitrarily on the basis of ____ that can be modified Virtual reproduction mandibular movement by placing casts in a ____ (Whipmix)

average values | scanner

``` Mounted Diagnostic Casts oProvide valuable preliminary information and a comprehensive overview of patient􏰄s needs oDiagnostic procedures can be performed n(1)____ n(2)____ n(3)____ ```

diagnostic waxing tooth preparation diagnostic cast modification

(1)Diagnostic Waxing | oHelps ____ complex prosthodontic treatment planning for predictable results

simplify

(2)Tooth Preparation oTrial tooth preparation and waxing n Enables practitioner to rehearse ____ and test on stone cast pProvides information in ____ pHelps ____ treatment to patient n Most ____ diagnostic technique for patients

proposed restorative plan advance explain useful

(3)Diagnostic Cast Modification oChange ____ to plan orthognathic procedures oChange ____ before orthodontics oModify ____ before occlusal adjustment

arch relationship tooth position occlusal scheme

``` Mounted Diagnostic Casts oAlso assists with: n determining ____ n determining choice of ____ n selection of ____ of withdrawal of FDP n treatment ____ n deciding ____ n fabricating ____ ```

``` preparation design abutment teeth optimum path plannign implants fixed vs. removable provisional restorations ```

Photographs oPhotographs provide valuable information for diagnosis and treatment planning n Facial-skeletal ____ concerns n Diagnosis of “gummy smile” (if present) n ____ path n Emergence profile of anterior teeth n Plane of ____ n Texture of existing anterior teeth n Pre-existing ____ n Smile evaluation n Soft tissue (gingival architecture) assessment

esthetic lip closure occlusion shade

``` Prognosis oEstimation of the likely course of the disease nInfluenced by p(1)____ factors p(2)____ factors ```

general | local

``` Prognosis (1)General factors n ____rate n ____ control n Systemic problems pAge and health n High ____ n History and success of previous dental treatments ``` ``` (2)Local factors n Vertical overlap of ____ teeth n Tooth ____ n Root ____ n Root structure n ____ ratios ```

``` caries plaque occlusal anterior mobility angulation crown:root ```

Prosthodontic Diagnostic Index (PDI) ``` oDiagnostic indices for the ____ and ____ patient n Developed by ACP oDetermine appropriate treatment for patients oClass I to IV (uncomplicated > ____) oEsthetic challenge n Increase by ____ levels oTMD symptoms n Increase by ____ levels ```

``` partially edentulous completely dentate complex one or two one or two ```

Prosthodontic Diagnostic Index (PDI) o1. ____ and ____ of the edentulous area or areas** o2. ____ of abutment teeth o3. ____ scheme o4. ____** * * for partially dentate only I: Ideal or minimal II: Moderately compromised III: Substantially compromised IV: Severely compromised

``` location extent condition occlusal residual ridge ```

Prosthodontic Diagnostic Index (PDI) ``` Location and Extent of Edentulous Areas* Moderately compromised-both ____ Substantially compromised>____ teeth Severely compromised-____ prognosis ____ or acquired maxillofacial defect ```

arches 3 guarded congenital

Prosthodontic Diagnostic Index (PDI) Abutment Condition* Ideal or minimally compromised Moderately compromised-____ sextents Substantially compromised-____ sextents Severely compromised -____ sextents *Most advanced finding determines final classification

1-2 3 4+

``` Prosthodontic Diagnostic Index (PDI) Occlusion* Ideal or minimally compromised Moderately compromised-____ treatment Substantially compromised-____ Severely compromised –change in ____ ```

local adjunctive occlusal scheme occlusal vertical dimension

PDI *Most ____ finding determines final classification

advanced

``` Prosthodontic Diagnostic Index (PDI) ____* Class I edentulous Class II edentulous Class III edentulous Class IV edentulous ```

residual ridge

Prosthodontic Diagnostic Index (PDI) Conditions Creating a Guarded Prognosis* Severe oral manifestations of systemic disease ____ (poor movement) and/or ____ (inability to coordinate movements of muscles) ____ condition

maxillomandibular dyskinesia ataxia refractory

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History Taking, Clinical Examination and Diagnosis (Pt. I and II) Flashcards

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