Lecture 7: Oral Diagnosis Flashcards
What is a full mouth series?
A radiograph set consisting of four bite-wings and 14 periapical films
What are panoramic films used for?
Obtaining a large viewing area of the head and jaw
- -Allows dentist to view the wisdom teeth
- -For detecting casts, and jaw tumors or cysts
- -Should be taken every 3-5 years
How are caries detected directly?
- -Check all un-restored grooves and pits
- -Check edges and condition of restorative work
- -Look for creaks and breakdown of teeth
What to look for on a radiograph?
Changes in density
- -Usually darker grey means decay because the tooth is becoming less dense (absorbing less of the x-ray)
- -Abscesses often will show up as a dark area around the apex of the tooth
But how much do radiographs normally underestimate the problem?
By up to 50%
How quickly do most normal oral lesions resolve ?
In 2-3 weeks
–If a lesion persists beyond this point a biopsy should be sent to a histology lab for testing
What structures are examined during the soft tissue exam intra-oral exam?
Lips, Facial Mucosa, Frenum, Gingival, Tonge, Floor of the mouth, throat, Hard and soft palate
What structures are examined in the extra-oral exam?
Lymph glands
TMJ
Neck
How are Periodontal Screening and Recordings (PSR) performed?
The mouth is divided into six sections:
Upper/Lower Right Posterior, Upper/Lower Anterior, Upper/LowerLeft Posterior
–Each tooth is probed six times (3 facial & 3 lingual) as follows: DF, F, MF, DL, L, ML
How is the PSR score determined?
After probing all of the areas
you will give that section a score based on the worst symptom you detected in
the section
What do the PSR scores mean?
0=Perfect gums
1=Bleeding with probing. All probing less
than 3.5 mm
2= Tartar or rough edges on restorations, all
probing less than 3.5 mm
3=Probing between 3.5 and 5.5 mm
4=Probing greater than 5.5 mm.
What treatments correspond with each PSR score of 0?
0=No treatment
What treatments correspond with each PSR score of 1?
1=Standard cleaning, education and improved
oral home care
What treatments correspond with each PSR score of 2?
2=Normal cleaning to remove tartar or replacement of defective restorations
What treatments correspond with each PSR score of 3?
3=Deep cleaning of pockets, medications and other procedures to resolve the infection
What treatments correspond with each PSR score of 4?
4=Aggressive cleanings done more often, possible
referral to a specialist
When should an asterisk be used with PSR?
Whenever furcation involvement is detected (bone loss where the roots branch)
What does a cosmetic evaluation involve?
Looking at a patients tooth color, shape, orthodontics, gum position, and a patient survey of these things
What is important when developing a treatment plan?
Prioritizing the work based on pain, significant deteriation chances (filling turning into a root canal treatment), any imminent health concern
What forms the foundation of all of your work?
The bone and gums
–Get those strong and healthy first if possible
What is a typical ordered treatment plan?
After the gums are stabilized we usually try to arrest all the decay, followed
by implants, crowns, bridges and any cosmetic concerns that haven’t been
addressed.
–In resolving the patient’s dental problems we normally work on an entire
quadrant at a time, when possible
Should you hold back a treatment option because you think an individual cannot afford it?
NO. Always recommend what is the best solution/treatment to ALL of your patients
- -Prioritize critical things first and in time patients will usually receive the rest of the recommended treatment
- -Don’t try to guess how much money your patient has
What questions should you ask when deciding whether or not you should get some new technology or change/begin a new procedure?
o Do I do what this tech allows me to do often enough to make it worth it?
o Is it something I can’t do without it?
o Can I do it better with it?
o Can I do it faster with it?
What is the foundation for building a healthy/thriving practice?
Doing thorough exams, and taking the time to LISTEN TO and TEACH the patients
