Patient examination Flashcards
What happens during a dental patient appointment?
-The complaint – why the patient has attended
• HPC – history of the present(ing) complaint
• PDH – past dental history
• PMH – past medical history
• Clinical examination
• Special investigations
• Diagnosis and treatment (planning)
what do we need to know from the patient?
- That it’s the right patient in the chair!!
- Why your patient is attending (routine/emergency)
- Whether there is anything wrong
- How long the problem has been going on for (if there is one)
- Where/what is it (pain)
- Oral hygiene habits
- Appliances worn, fit and age
what additionally do we ask over and above taking a history?
- Whether regular attender
- Any problems with previous dental treatment
- Family history of gum disease & any teeth lost to gum disease
How can patients in pain behave?
- anxious
- aggressive
what are the dental pain questions?
- The type of pain/discomfort
- When and where it started
- Does the pain travel anywhere else?
- Does anything make it better or worse (hot/cold/sweet/biting)?
- Does the pain stop them doing anything?
- Does it keep the patient awake at night?
- Is it getting better or worse?
what condition is irreversible pulpits worse in?
hot
what other things can the patient mention (pain)?
- Swelling
- Bleeding
- Bad taste
- Loose teeth
- Difficulty eating
- Difficulty swallowing
- General malaise (looks unwell)
what happens if a patient has a difficulty with swallowing?
send to medical A and E
what is the extra-oral examination used for?
- diagnosis
- screening
what is screening used for?
-Oral cancer
• Only cancer which is increasing
• 7000+ new cases each year
• 2000 deaths (more than from RTAs, prostate or cervical cancer)
• 25% of cases have no risk factors- so must screen every patient
How do you carry out extra-oral examination?
• Explain to patient
• Get consent
• Remove prosthesis…(you may have to put it back in later if may be relevant to the diagnosis)
- check all nodes down to towards the clavicle
what do you look for during extra-oral examination?
- Symmetry/asymmetry
- Swelling
- Colour changes
- Ulceration
- Lesions
- Also note patient’s temperature and general ‘wellness’
how should you look at a patient when completing an extra oral exam?
Look face on when speaking to patient and from above when lying back (you may have to ask patient to remove safety glasses for a minute while you do this
what do you feel for in extra oral exam?
Palpate use pads of fingers and feel for:
• Tenderness
• Swellings: is it hard/soft or is there fluctuance. fixed/non-fixed
How do you carry out a methodical extra oral exam?
- Nodes
- Anterior cervical
- Posterior cervical
- Tonsillar
- Sub-mandibular
- Submental
- Supra-clavicular
what do you record if there is a positive finding?
- site
- size
- shape
- surface
- colour
- consistency
why do you carry out an intra-oral examination?
- diagnosis
- screening
How do you carry out an intra-oral examination?
Look and palpate: • Lips • Labial sulci • Buccal sulci • Buccal gingivae • Palatal and lingual gingivae • Tongue (hold with gauze and move about) dorsum, lateral borders, ventral • Floor of mouth (bilateral palpation required) • Hard palate • Soft palate • Throat/fauces/ tonsillar pillar region
what are you looking for in an intra oral examination?
- Looking for
- Swelling
- Ulceration
- Colour changes
- Texture changes
what do you record in intra oral examinations?
- Record positive and negative findings in notes
* Don’t alarm your patient
How do you know what is normal mucosa?
- Many variations on ‘normal’
- Build your knowledge through experience
- Ask staff (try to do this without alarming your patient!)
- You eventually develop an informed feeling for what’s suspicious
what is abnormal?
- Swelling
- Suppuration
- Ulceration that doesn’t heal
- Red patches
- White patches
- Lumps
- Unxplained loose teeth
- Numbness or altered sensation (in the absence of LA)
- Weight loss or unexplained hoarseness of throat
what is in patient records?
- Record everything in the notes, negative and positive findings
- Photos of lesions can be helpful
- Review lesions as required
- Refer suspicious lesions early
- Don’t alarm the patient!
what does the dental chart look like with a healthy tooth?
no marks on chart
what does the dental chart look like with a cavity?
draw hole on affected surface -represent caries
what does the dental chart look like with a restoration?
cavity is drawn and filled in
what tool is never used for charting?
sharp probe
what does the dental chart look like with an extraction?
horizontal line through the tooth
what does the dental chart look like with a very recent extraction?
cross through it
what does the dental chart look like with a crown?
vertical lines through it
what does the dental chart look like with a Pontic (false tooth as part of a bridge)?
horizontal lines through it
what does the dental chart look like with a bridge wing/veneer?
surfaces involved coloured in
what does the dental chart look like with an implant?
An “I” is drawn above tooth
what equipment is used in dental charting?
- Mirror
- Blunt ended probe (WHO probe ideal)
- 3:1
- Nurse or colleague to help
How do you start charting?
-Ensure tooth surfaces are clean and dry
• Have a general look and think about what’s present and missing
• Check for appliances!
• Communicate to your nurse where you are starting
what terms are used in charting?
- Upper/lower
- Left/right
- Tooth number
- Present/missing
- Sound
- Caries present: Surface (s)
- Restoration:Surface(s)
- Fracture
- Crown
- Pontic
- Partiallyerupted
- Root present
what do you need to remember when charting?
- Note a little ‘R’ and ‘L’ on the chart
- Always work systematically!
- Go round in a circle
- Consider tooth anatomy
- Look back at previous charts if available before you examine your patient
- Examine all surfaces of the tooth
- Look for shadowing and decalcification (caries)
- Teeth don’t grow back!
- Speak clearly
