lecture 4 Flashcards
this is recorded in pts own words
chief complaint
patient interview
subjective examination
clinical examination and testing outline:
SUBJECTIVE EXAMINATION(patient interview)
A. subjective examination (patient interview)
1. chief complaint (record in patients own words)
2. dental history
3. medical history (list of active medical issues, medications, and allergies)
a. patient interview: medical history and meds:
- complete medical history (supplemental as necessary)
-blood glucose
-PT time
-pregnancy test - Rx medications
-taken(dose/frequency) - supplements
or other non Rx DRUGS - chief complaint
-relevant dental history
do what together with the patient starting with the walk back from the waiting area
patient interview and vital signs
patient interview
a. get accurate:
b. patients:
c.
d.
a. get accurate: health history and meds taken (document)
b. patients: chief complaint, symptoms, and related dental history (document)
c. are other tests needed? (MD, consult)
d. how can you help them expectations, desires, (document)
clinical examination and testing outline:
OBJECTIVE EXAMINATION
- vital signs
- extraoral examination
- intraoral examination
vital signs:
-blood pressure
-respiratory rate
-pulse
-temperature should be taken in patients reporting swelling or signs and symptoms
extraoral examination general appearance
-skin tone
-facial asymmetry
-swelling
-discoloration, redness
-extraoral scars or sinus tract
-lymphadenopathy (enlargement of lymphnodes)
intraoral examination: palpation
look for
-palpation: gently feel the tissues
look for:
-tenderness
-swelling
-unusual texture, color or composition
-draining sinus tract DST
periodontal and mobility testing
take at least 6 probings on each tooth
*blanching is important!!
why probe?
status of PDL and prognosis
endo component always in contact with perio component
to test mobility:
turn the probe around; add a mirror handle on the lingual/palatal and wiggle the tooth
intraoral exam: percussion
look for
gently tap on the tooth
NEVER start on the suspected tooth
you are trying to establish a BASE-LINE of normal response for this patient
begin your percussion testing for intraoral exam in an area of mouth (related/not related) to the area of suspicion.
maintain a consistancy of percussion technique on:
NOT related
on all teeth tested
radiographs must be ______in quality
diagnostic
______are required to see the surrounding tissues
peri-apical films
-straight-on and angled PA
_____on posteriors to determine restorability
bite wing film
assessment of the pulp sensory response
pulp sensibility test
sensibility test is defined as a ability to respond to ______, and hence this is an accurate and appropriate term for typical and common clinical pulp tests such as ____ and _____ tests given that they do not detect or measure the blood supply of the dental pulp!!!
stimulus
thermal
electrical
what do pulp sensibility tests not measure
the blood supply of the dental pulp
thermal and EPT testing in the mouth
- teeth to be tested properly ISOLATED AND DRY
- place COLD COTTON pellet on facial tooth surface (establish base-line first)
- patient’s hand should go up immediately (if NOT: hold cotton on tooth until does)
[stimulating a-delta fibers which are sharp and quick] - observe the seconds until patient’s hand goes down (NOTE)
- then go to next tooth and repeat
what are you looking for with thermal and EPT testing
- what is normal for this pt
- what is decidely different for particular tooth
- the time to recovery is much more important than the severity of pain
the intensity of discomfort is not generally significant, but this is
the period of time to return to normal following cold stimulation
must be noted before continuing
this time is significant to test and record
20-30 seconds (lingering of discomfort)
what is normal time for pulp sens test
3-8 seconds but varies
all results are nothing without _____for each pt
base-line
sensitivity of cold is considered to be a symptom of
early pulpal inflammation
sensitivity to hot is
a late stage of pulpal inflammation indicating that gas is being produced via deterioration of the pulp
pt get relief from cold water
this is not performed unless chief complaint of the pt is pain produced by warm liquids
heat testing
normal teeth (are/are not) sens to hot
not
how to heat test
isolate tooth, use water at 140 F and drip on tooth. keep cold stuff nearby
what if you get no response on single tooth with normal base-line?
may mean necrotic pulp- RCT indicated
what if you get no response on most or all teeth?
probably older person and then test with EPT(electrical pulp test)
explain electric pulp testing
- dry teeth and isolate with cotton rolls
- place small dab of tooth paste (conductor) on facial of each tooth to be tested
- must develop base-line first here also
EPT readings meaning
EPT=80 = tooth necrotic
EPT= not 80= vital
what if you have symptoms on a tooth with no caries, no trauma, no restorations??
suspect an axial crack
how to prove axial crack
- radiographs (j shape)
- bite tests with tooth slooth
- periodontal probing
- transillumination
the bite test with tooth slooth allows us to have the patient bite on:
individual cusp tips to help identify axial crack
release and it hurts=crack
[use of transillumination]
what tooth lights up like a light bulb?
what tooth doesnt?
does= normal tooth
doesnt= cracked tooth
the restoration may need to be removed to view the crack; this might be indicated
staining
number 1 and 2 prevalence of cracked teeth
- mand 2nd molar
- max premolars
when is crack in tooth treatable/not
treatable: only in crown
not: in root
what does cold testing and EPT work on/what do they not?
- cold test works on crowns and restorations [metal is a conductor]
- EPT test works on restorations but NOT metal/crowns
the accuracy of your diagnosis and the appropriateness of your treatment depends entirely on
thoroughness of clinical exam and testing
interpretation of results, sympt, and radiographs
