Special Investigations Flashcards
Radiograph
x-ray image to aid diagnosis
OPG, periapical, bitewing, occlusal
assessing:
- interproximal caries
- extent of caries
- bone levels
- peri-apical status
- implant assessment
- dental development
- orthodontics
pulp sensibility testing
thermal
- cold - ethly chloride, endo-frost
- hot - heated GP rare
EPT tests primarily A-delta fibres
for endodontic diagnoses
normal response to pulp sensibility testing
short sharp pain
diminshes within seconds after stimulus removed
heightened response to pulp sensibilty testing
lingering response to stimulus
Reversible Pulpitis
- pronounced pain which subsides once stimulus is removed
Irreversible Pulpitis
- pain persists despite removal of stimulus
no response to pulp sensibility testing
tooth’s nerve supply has been affected (e.g. previous RCT, pulpal necrosis)
vitality testing
blood flow to the dental pulp is assessed
e.g. Laser doppler flowmetry, pulse oximetry, sepctophometry
endo dx
percussion
occlusal pressure is applied mimicking the pts masticatory forces using the back end of an instrument
listen to the sound and observe for pain response
identifying PDL involvement, locating source of pain, identifying number of teetn involved
lateral percussion tenderness on percussion indicates
periodontal cause
occlusal percussion tenderness on percussion indicates
endodontic cause
CBCT scans
multiple pictures taken to reconstruct a single 3D image
allows visualisation of nerve pathways, dental structures and soft tissues
used for:
- endodontics
- implants
- orthodontics
- TMJ disorders
- surgical planning for any impacted teeth
- treating jaw tumours
basic periodontal examination (BPE)
periodontal screening tool
each sextant is scored by ‘walking’ a WHO probe (0.5mm ball end) around each tooth, banded 3.5-5.5mm
all new pts, 6 monthly
6 point pocket chart
probe walked round and measurements recordeed MB, B, DB, MP, P, DP surfaces
measurements include:
- gingival margin level in relation to ACJ (mm), record a -ve value if the gingivae is abpve the ACJ (inflammed)
- bleeding on probing
- pocket depth
Indicated when BPE is 3 or 4 - more comprehensive perio chart needed
tooth mobility
observes the degree of crown displacement when bucco-lingual forces are appied using a finger and back end of an instrument
graded:
- <1mm
- 1-2mm
- >2mm and/or rotation or depression
indicated:
- BPE 3 or 4
- periodontiallly compromised tooth
- deep pocketing
- part of 6PPCC
furcation involvement
occurs when loss of connective tissue attachement and bone extends beyond the furcation of a multi-rooted tooth
degree of furcation involvement must be recorded
graded:
- up to 3mm horizontal attachement loss
- >3mm horizontal attachment loss, but not through and through
- through and through lesion
Indicated:
- periodontally compromised teeth
- part of 6PPC
plaque index
measures plaque and debris levels
recorded at the mesial, distal, buccal and palatal/lingual sites
Scored:
- 0 for nil plaque present
- 1 for plaque detected visually or by probe
% calculated for each arch
indicated:
- check OHI compliance
- motivation tool
bleeding index
measures bleeding and inflammation
recorded at mesial, distal, buccal and paltal/lingual sites
Scores
- 0 for nil bleeding or signs of inflammation present
- 1 for bleeding/inflammation detected visually or by gentle probing
indicated:
- OHI compliance
- gingivitis extent
- motivation tool
magnification
loupes or dental microscope
clincial photographs
introral cameras, digital SLR
indicated:
- visual aid for pt
- record keeping
- comparing outcomes
- portfolio
palpation
alveolar tenderness - retract mucosa and gently palpate the alveolus with finger
compare to healthy region of mouth
indicated:
- suspected root infection
- salivary stones
- swellings
- alveolar tenderness
- canine development
caries detection dye
inject onto occlusal sruface of teeth and shine light
study models
impressions of the dental arch followed by a bite registration if casts cannot be hand articulated
indicated:
- tx planning
- record keeping
- communicating diagnosis
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3in1
blow cold air onto tooth
dentine hypersensitivity
tooth slooth
pt bites down on tooth with indentation of the instrument over each cusp individual
note for pain when pt opens mouth
checking for underlying fractures
