Lecture 7: Oral Diagnosis

Question 1

What is a full mouth series?

Answer 1

A radiograph set consisting of four bite-wings and 14 periapical films

Question 2

What are panoramic films used for?

Answer 2

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

Question 3

How are caries detected directly?

Answer 3

• -Check all un-restored grooves and pits
• -Check edges and condition of restorative work
• -Look for creaks and breakdown of teeth

Question 4

What to look for on a radiograph?

Answer 4

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

Question 5

But how much do radiographs normally underestimate the problem?

Answer 5

By up to 50%

Question 6

How quickly do most normal oral lesions resolve ?

Answer 6

In 2-3 weeks

–If a lesion persists beyond this point a biopsy should be sent to a histology lab for testing

Question 7

What structures are examined during the soft tissue exam intra-oral exam?

Answer 7

Lips, Facial Mucosa, Frenum, Gingival, Tonge, Floor of the mouth, throat, Hard and soft palate

Question 8

What structures are examined in the extra-oral exam?

Answer 8

Lymph glands
TMJ
Neck

Question 9

How are Periodontal Screening and Recordings (PSR) performed?

Answer 9

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

Question 10

How is the PSR score determined?

Answer 10

After probing all of the areas
you will give that section a score based on the worst symptom you detected in
the section

Question 11

What do the PSR scores mean?

Answer 11

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.

Question 12

What treatments correspond with each PSR score of 0?

Answer 12

0=No treatment

Question 13

What treatments correspond with each PSR score of 1?

Answer 13

1=Standard cleaning, education and improved

oral home care

Question 14

What treatments correspond with each PSR score of 2?

Answer 14

2=Normal cleaning to remove tartar or replacement of defective restorations

Question 15

What treatments correspond with each PSR score of 3?

Answer 15

3=Deep cleaning of pockets, medications and other procedures to resolve the infection

Question 16

What treatments correspond with each PSR score of 4?

Answer 16

4=Aggressive cleanings done more often, possible

referral to a specialist

Question 17

When should an asterisk be used with PSR?

Answer 17

Whenever furcation involvement is detected (bone loss where the roots branch)

Question 18

What does a cosmetic evaluation involve?

Answer 18

Looking at a patients tooth color, shape, orthodontics, gum position, and a patient survey of these things

Question 19

What is important when developing a treatment plan?

Answer 19

Prioritizing the work based on pain, significant deteriation chances (filling turning into a root canal treatment), any imminent health concern

Question 20

What forms the foundation of all of your work?

Answer 20

The bone and gums

–Get those strong and healthy first if possible

Question 21

What is a typical ordered treatment plan?

Answer 21

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

Question 22

Should you hold back a treatment option because you think an individual cannot afford it?

Answer 22

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

Question 23

What questions should you ask when deciding whether or not you should get some new technology or change/begin a new procedure?

Answer 23

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?

Question 24

What is the foundation for building a healthy/thriving practice?

Answer 24

Doing thorough exams, and taking the time to LISTEN TO and TEACH the patients

Question 25

What are the typical survival rates for oral cancer? Why are they this way?

Answer 25

50%

–Due to lack of detection early on

Question 26

What is Clinical Attachment Loss (CAL)?

Answer 26

The distance measured from the CEJ to the bottom of the sulcus
–CAL= Recession + pocket depth

Question 27

What is a better predictor of tooth loss danger than perio probe numbers alone?

Answer 27

Clinical Attachment Loss (CAL)

Question 28

What is the golden question when asking about soft tissue lesions?

Answer 28

How long has that been there?

Question 29

What does iatrogenic mean?

Answer 29

Of or related to illness caused by a medical examination or treatment
–Amalgam tattoo is an example

Question 30

What is geographic tongue?

Answer 30

White line surrounding edge of tongue due to loss of papillae
–May cause some pain, but is benign

Question 31

What types of questions are best to ask a patient in order to obtain information?

Answer 31

Open ended quesitons

Question 32

What is pericornitus?

Answer 32

The growth of the gum tissue above the tooth line (often found around wisdom teeth, or where wisdom once were)

Question 33

When in doubt….

Answer 33

Cut it out

Question 34

What does each code mean when perio-probing?

Answer 34

0=Colored band completely visible
1=Colored band completely visible
2=Colored band completely visible
3=Colored band only partly visible
4=Colored band no visible