ICP-29 History and Examination of the Adult Patient Flashcards
What are the principles of patient assessment and in what order are they assessed until you get to the treatment options
- History
- Clinical examination
- Provisional/Differential Diagnoses
- Special/Further investigations
- Definitive Diagnoses
- Treatment options
What is a screening form and why is it used
- Enable a logical and structure series of questions to be asked
- Ensure no area is omitted-
- Enables history to be distilled into key factors that will inform: provisional diagnosis, special investigations, diagnosis and treatment plan
What patient information is important to get in patient history and why
Patient information:
- Patient name (introduction)
- DOB (similar names)
- Contact details (appointments)
- Audit trail to clinic/student
What needs to be included in the presenting complaint part of the patient history
- May be no complaint (record it) Commonly: - Pain (where, how long etc.) - Swelling - Bleeding gums - Broken tooth - Lost crown/filling - Loose dentures - Non-dental? - white patches
What is the difference between signs and symptoms
Sign: - Objective evidence of disease - Detectbale by someone as well as other than the patient - e.g. vomiting, bleeding Symptom: - Subjective evidence of disease - Experienced by the patient with the disease - e.g. pain, fatigue
What is the SOCRATES acronym used for and spell it out
This is used when going through patient’s pain history:
S - site
O - Onset (when)
C - Character (type of pain)
R - Radiation
A - Associations (with other signs/symptoms)
T - Time course/pattern (short sharp pain or long lasting)
E - exacerbating (relieving) factors
S - severity (1-10)
Why do we need to know medical history of a patient in their patient information
- Medical emergency can happen at any time
- May affect presenting complaint i.e. diabetes and periodontitis
- May affect treatment planning
Why is it important to ask the patient about any steroids and bisphosphonates they are taking
Steroids - long term and higher dose can affect body’s response to stress as the can’t produce natural corticosteroids
Bisphosphonates - increase mineral content in bone but affects blood supply, long term doses can affect extractions as it won’t arrest so well and can cause ONJ
What is Audit C
- 3 questions
- Scored 0-4
- Overall score determines advice
- score between 5-9 = moderate risk
- score above 10 = high risk/dependency?
What do you do when patient gives you the medical history proforma
Checked by clinician to ask about how well things like hypertension is managed etc, then once happy can sign and date it
What do you include in the past dental history of patient history
- Dental attendance: last visit, frequency?, regular?, pain only?, registered with GDP?, Anxiety levels?
- Treatments/experience: fillings, LA?, RCT?, Crowns/bridges?, implants?. ortho?
- Oral hygiene regimen: How often?, manual/electric?, type of electric?, type of toothpaste?, interdental cleaning?, mouthwash and timing?
What should you include in the social history of a patient’s history
- Occupation
- Family situation
- Brief diet analysis
- Repetition of smoking and Audit C
After this you should verbally present to tutor and get tutor sign and date then proceed to clinical examinations
What should you include in the extra-oral examination of a patient
- TMJ - clicks, tenderness
- Facial symmetry
- Lymph nodes - palpate
- Lips - competent, do they meet?
- Swellings
What needs to be examined when carrying out a TMJ examination
- Joint: pain, sounds
- Muscle of Mastication: insertion/body, tenderness, stiffness
- Opening: Limitation, deviation, end feel
What needs to be examined when carrying out a Facial symmetry examination
- Condular hypertrophy
- Chin point
- Swellings
What abnormalities need to be examined for when examining lymph nodes
Abnormalities:
- Size
- Number
- Consistency
- Tenderness
- Mobility
What groups of lymph nodes are there that need to be examined
Groups:
- Pre-auricular/post auricular
- Occipital
- Submandibular
- Submental
- Cervical
- Supraclavicular
What abnormalities are you looking for when examining soft tissues
- Type of tissue
- Colour
- Location
- Surface texture
- Consistency
What areas need to be examined in an intra-oral examination
- Labial, buccal and vestibular mucosa
- Hard and soft palate
- Oropharynx and fauces
- Floor of the mouth
- Tongue
What specific things need to be examined when examining the tongue
- Colour
- Normal anatomy
- Examine the dorsum, ventral surface and lateral borders
What do we look for when examining the appearance of the gingival tissues
- Pink and healthy?
- Red and swollen?
- Bleeding?
- Make a note of the OH of the gingival tissues
What about the gingival tissue OH do we note in the intra oral examination
- Good/Fair/poor
- Generalised/localised periodontitis etc
- Marginal/interproximal
- Supra/subgingival calculus
- BPE/bleeding: immediate/delayed
What do you need to note when you do a BPE on a patient
- WHO probe, ‘walking action’
- Divide the mouth in 6 (molar to premolar, canine to canine, premolar to molar on the side)
- WHO probe has ball on the end
- ## Record highest score per sextant
What are the 4 main causes of tooth surface loss
- Erosion
- Abrasion
- Attrition
- Abfraction
What is erosion in tooth surface loss
- Loss of hard tissue by chemical means
What is abrasion in tooth surface loss
- Loss of hard tissue by friction with extrinsic agent
What is attrition in tooth surface loss
- Loss of hard tissue by contact with opposing dentition
What is abfraction in tooth surface loss
- Loss of cervical hard tissue due to enamel prism micro-fractures secondary to repeated flexure/compression
What do shaded areas mean on hard tissue charting
Fillings/restorations
What do open circles mean on hard tissue charting
Cavity/caries
What do hashtags mean on hard tissue charting
Tooth has a fracture
What does RF mean on hard tissue charting
Root filling
What does a cross mean on hard tissue charting
Tooth missing/extracted
What does a single diagonal line on hard tissue charting mean
Tooth to be extracted
What needs to be noted in the occlusal assessment of a patient in the intra oral examination
- Static occlusion: how teeth meet when not moving
- Dynamic occlusion: how teeth move over each other
What do you need to note about the static relationship between a patient’s teeth
- The molar relationship
- The incisor relationship
- Overjet/Overbite/Open bite
Describe the molar relationships that need to be noted in a patients intra oral exam
- Class I: where the distobuccal cusp of the lower 6 meets the midbuccal groove of the upper 6, lower jaw is very slightly in front of upper jaw molar wise
- Class II: When lower jaw is a little more back, mesiomuccal cusp of lower 6 meets midbuccal groove of upper 6
- Class III: When lower jaw is further forward, mesiobuccal cusp of lower 7 might meet midbuccal groove of upper 6
Describe the incisor relationships that need to be noted in a patients intra oral exam
- Class I: lower incisor meets mid third of the cingulum of the upper incisor
- Class II: Lower jaw appears further back, lower incisor is behind the cingulum
- Class III: Lower jaw further forward, in front of the upper cingulum
What is overjet and overbite
Overjet - how much incisors relate in a horizontal direction, how much further in front lower teeth
Overbite - How much further in a vertical direction the teeth bite together
What do we look at when noting the dynamic occlusion of a patient’s intra oral exam
- Lateral excursions
- Protrusive excursions
- Interferences: when teeth get in the way of normal excursions - working and non-working side
What are some things about removable prostheses you might need to note in a patient’s intra oral exam
- Partial?
- Tooth-borne/mucosal borne?, supported by these things^?
- Retentive features
- Acrylic/Cobalt-chrome
What are some things about fixed prostheses you might need to note in a patient’s intra oral exam
- Bridges
- Type?: resin-retained, conventional, cantilever/fixed-fixed
- Implant retained?
What do you have to do when request radiographs
- Say what radiographs you want
- Justify it
- Select you views?
- Patient details
- Need to report on radiograph and quality assure it
What do you have to do when doing radiograph reports
- State justification
- Report quality: grade 1,2,3
- Report findings: Describe view, teeth present, resotations present and bone levels
Name some common further investigations that are carried out after clinical examination to get to some diagnoses
Radiographs
Sensibility testing
What is the definition of a prognosis
- An opinion based on medical experience of the likely course of a medical condition, tooth by tooth
What are some things that the prognosis depends on
- Clinical factors: age, severity
- Systemic/environmental factors: smoking, disease, genetics
- Local factors: Plaque control, dental and root morphology
AY BAWS CAN I HABE DE NOTE PLZ
Important to be realistic when telling the patient the potential prognosis and outcomes of the treatments
What are the treatment options that can be offered to a patient, must be listed on sheet ting
- Do nothing, patient needs to be informed
- Simple approach: extractions, restorations
- Complex treatment: replace missing teeth, indirect restorations
- Referral: implants, too severe disease, other pathology
What phases are there in a treatment plan
- Emergency phase: pain, bleeding, trauma, infection
- Investigation/stabilisation
- Rehabilitation
- Maintenance and monitoring
What needs to be done in the investigation/stabilisation phase of a treatment plan
- Severity and distribution of periodontal disease
- Severity and distribution of caries
- Diet analysis
- OH
- Fluoride prescription
- Tobacco cessation
- Alcohol advice
What needs to be included in the maintenance and monitoring phase of a treatment plan
- Risk assessment for dental diseases
- Recall intervals
- Active monitoring plan
What aspects must be included for consent from a patient to be valid
Voluntary:
- Patient’s decision, uninfluenced by anyone
Informed:
- Patient must know all options
- Risk and benefits of all options, including effect of no treatment
Capacity:
- Must be capable to understand all info
- Able to make informed decision based on this info
SIGNED and DATEd by patient and tutor
