Unit 304 - oral health assessment/diagnosis Flashcards
What are the 2 main purposes of carrying out the oral health assessment?
-prevention of disease by regular opportunities to reinforce oral health and general health messages.
-early detection and diagnosis when disease is already present.
What are the 3 main diseases that dentist look for during an assessment?
caries, gingivitis, periodontal disease
Within oral health assessments what are dentist there to do?
make the initial diagnosis, treatment plan and carry out treatments.
Within oral health assessments what are hygienist there to do?
works directly with patients or under the perscription from a dentist, maintain oral health and prevent it from worsening.
Within oral health assessments what are therapist there to do?
works directly with patients or under the perscription of a dentist to carry out certain treatments if necessary
Within oral health assessments what are dental nurses there to do?
assist the dentist, providing clinical and other support during the assessment/treatment, reinforce all oral hygiene messages given to the patient.
Why are vitality tests preformed?
Help to determine whether a tooth is vital or non - vital
Examples of materials/instruments the dentist will use to preform a vitality test- hot, cold and electrical.
Hot - greenstick compound - type of GP (vaseline should be applied to the tooth prior to prevent further pain)
Cold - ethyl chloride - produce ice crystals in room temperature
Electric - electric pulp tester
In regards to vitality testing what response would inidicate a healthy pulp?
Normal
In regards to vitality testing what response would inidicate early pulpitis?
increased response
In regards to vitality testing what response would inidicate that the pulp is dying?
reduced response
In regards to vitality testing what response would inidicate that the pulp tissue has died?
no response
Why is it necessary sometimes for a dentist to take study models?
consider a patients occlusion before deciding on any treatments.
What cases are study models useful?
occlusal analysis, ortho cases, tooth surface loss is present due to grinding/erosion so the dentist can monitor this, unwanted tooth movement is suspected.
Why are photographs taken during an oral health assessment?
record aspects of the dentition/soft tissues
- soft tissue lesions to aid diagnosis
-injury following trauma
-before and afters
How are photographs taken , what with?
conventional cameras, digital cameras or specialist intraoral digital cameras.
Where are extraoral soft tissues?
those outside the mouth
When a dentist is checking extraoral soft tissues, what will they be looking for with the external face signs?
skin colour, facial symmetry, presence of blemishes - moles/coldsores.
When a dentist is checking extraoral soft tissues, what will they be looking for with the lips?
change in colour or size, presence of blemishes and palpating for any abnormalities
When a dentist is checking extraoral soft tissues, what will they be looking for with the lymph nodes?
any swelling or abnormalities - indicate infection or a more sinister lesion.
Where are the lymph nodes located?
under the mandible and in the neck
If a patients skin colour was to change from pinky to pale/clammy what may this inidcate?
patient may faint
Why is checking facial asymmetry so important?
indicate the presence of swelling, issues with the nerve supply or muscular control.
What type of cancer is skin cancer?
Melanoma
Why is it important that the lips are examined?
to check for blemishes e.g. cold sores (herpes simplex type 1) or the presence of mucoceles.
What are mucoceles?
Minor salivary gland cysts
What colour lips indicate chronic heart failure?
tinged bluish-purple
Enlargement of lymph nodes could indicate:
the body is fighting infection or some other disease process
When a dentist is checking intraoral soft tissues, what will they be looking for with the labial, buccal and sulcus mucosa?
colour and texture, presence of any white patches (especially buccal) and moisture level
When a dentist is checking intraoral soft tissues, what will they be looking for with the palatal mucosa?
hard and soft palates, the oropharynx and tonsils
When a dentist is checking intraoral soft tissues, what will they be looking for with the tongue?
colour and texture, shape and movement, level of mobility.
Where is the most common place within the oral cavity for oral carcinoma to develop?
beneath the tongue
When a dentist is checking intraoral soft tissues, what will they be looking for with the floor of the mouth?
colour and texture, presence of any white or red patches and swellings.
Low moisture levels in the mouth can indicate what?
problems with the functioning of the salivary glands - age related or medication.
What are the 2 known risk factors of oral cancer?
smoking and alcohol
If a sinister lesion was suspected on a patient where would they be referred to?
local hospital maxillofacial department
what is teeth charting?
style “dental shorthand”
quickly and accurately record a patients dentition as it appears at the time of the oral health assessment
What is the palmer notation used to chart?
tooth charting
What is the international dental federation notation (FDI) used to chart?
tooth charting
What is the basic periodontal examination (BPE) used to chart?
periodontal charting
In what country is the univeral charting system mainly used?
USA
Numbers from UR8 as 1 to UL8 as 16 to LL8 as 17 to LR8 as 32
What system is used when charting the dentition of an actual patient?
Two-grid system - forensic notation
this seperates the current dental status from any treatment required.
Explain the two grid system - forensic notation
Outer grid and inner grid:
Inner grid - current dental status + restorations present
Outer grid - Dental treatment that needs to be carried out
With the forensic notation - 2 grid system a fractured tooth, can range from not needing treatment to needing treatment - only exception.
How is the palmer notation incorportating alphanumeric system shown?
All the 4 quadrants: UR UL LL LR
Letters - deciduous dentition
Numbers - permanent dentition
What does the two digit FDI notation replace?
quadrant symbol or use of UR etc, with a quadrant number as well as a tooth number.
How can we work out two digit FDI notation with permanent teeth:
UR1 11 - UR8 18
UL1 21 - UL8 28
LL1 31 - LL8 38
LR1 41 - LR8 48
How can we work out two digit FDI notation with deciduous teeth:
URA 51 - URE 55
ULA 61 - ULE 65
LLA 71 - LLE 75
LRA 81 - LRE 85
What 4 instruments are used during an oral health assessment?
Mirror
angled probe - detect soft tooth surfaces, margins on existing restorations
Tweezers
Briault probe - detect interproximal caries
What does the term occlusion mean?
Situation when the mouth is closed and the teeth of both jaws interlock together so that their occlusal surfaces are in contact.
What is a normal occlusion?
no crowding, no protuding teeth, no prominence of chin.
What is an overbite?
Vertical overlap - Upper arch covers the bottom arch
What is an overjet?
Horizontal overlap- distance between the upper and lower teeth
Class 1 occlusion =
normal bite
overjet between 2-4mm
overbite is 50%
Class II div 1 =
increased overjet more than 4mm
upper teeth protrude between their lips - open lip posture
mandible is too far behind its normal position - not because of the maxilla
Class II div 2 =
decreased overjet and increased overbite
Upper incisors become trapped behind the lower lip causing the teeth to erupt upright or pulled back = retroclined
mandible is not so far posterior
What does malloclusion mean?
normal occlusion is not present
What is crowding caused by?
insufficient room for all of the teeth to erupt in line and it also occurs in jaws which are too small to accomodate 32 permanent teeth.
Class III malloclusion:
Chin is prominent - lower jaw pertrudes forward
lowers infront of uppers
What are the main causes of malocclusion?
Genetic, inheritance of an abnormal jaw, or supernumerary teeth and missing teeth.
Common cause is early loss of teeth and thumb sucking habits
What is angles classification based on?
the relationship of the first molars to each other.
Incisor relationship can determine the classification
What is a supernumerary tooth?
An extra tooth
occurs mainly in the midline of the upper incisor region as a “mesiodens”, could prevent an incisor from erupting or make it erupt in an abnormal position.
What is congenitally missing teeth?
Absence of one or more permanent teeth
Upper lateral incisors are often missing - instead they can develop as tiny conical teeth = peg laterals.
Third molars and second pre molars are also common.
What is the correct word to use when several teeth are missing from a dentition?
Hypodontia - rare
What can thumb sucking cause?
displacement of anterior teeth = decreased overbite and increased overjet
How does a cross bite develop?
suction action causes excess pressure on the cheeks, so the upper buccal teeth are forced to develop inside the arch of the lowers.
What do periodontal tissues act as?
supporting tissues around the tooth
What are periodontal pockets?
presence and depth of any unnatural spaces down the side of the teeth.
What do healthy periodontal tissues look like?
Pink, firmly attached to the tooth with gingival crevice no deeper than 3mm, do not bleed.
What probe is used to record the BPE score?
BPE probe
What does code 0 mean?
healthy periodontal tissues, no bleeding, no calc or overhangs
What does code 1 mean?
pocket no more than 3.5mm, bleeding on probing, no calc or overhangs
What does code 2 mean?
pocket no more than 3.5mm, sub or supragingival calc present
What does code 3 mean?
pocket present up to 5.5mm deep
what does code 4 mean?
pocket present deeper than 5.5mm
what does code * mean?
furcation present
What does grade 1 mobility mean?
side to side tooth movement less than 2mm
What does grade 2 mobility mean?
side to side movement more than 2mm
What does grade 3 mobility mean?
vertical movement present
The standard of oral hygiene is graded as what during oral health assessments?
excellent, good, fair or poor
When code 3 is recorded on a BPE what should be done?
radiographs to check bone levels and oral hygiene instructions given and scale, 3 month recall
When greater than code 3 is recorded on BPE what should be done?
radiographs and full pocket depth recorded 6PPC, FULL debridement, 3 month check up
