SLWZ Chapter 12 The Dental Examination

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Cavity Classifications

Carious lesions are classified according to the surfaces of a tooth on which they occur (i.e. lingual, buccal, or occlusal), types of surface (i.e. pat, fissure or smooth surface), and numerical grouping. (12)

Diagnosis

To Identify or determine the nature and cause of a disease or injury through the evaluation of a patient's history and examination (12).

Treatment Plan

In dentistry, a schedule of procedures and appointments designed to restore, step by step the oral health of a patient. (12).

Components of the Dental Exam

The dentist will use a variety of techniques to accomplish a thorough examination. Table 12-1 pg 179 (12)
Radiographs
Impressions to create diagnostic casts
Photographs
Soft Tissue examination
Examination of the periodontal tissue
Examination of the teeth

Recording the Dental Examination

Dental recording, also referred to as "charting" can be described as "shorthand" for the dentist. The dentist will recite their findings , and the assistant will record these findings on the patient's dental record. Symbols and abbreviations and color coding are used to indicate various conditions. 12-2 pg 179 (12)
Tooth diagrams, numbering systems and color coding
Cavity Classifications
Charting symbols
Abbreviations of tooth surfacess
Abbreviations of treatment

Soft Tissue Examination

Involves a complete examination of the cheeks, mucosa, lips, palate, tonsil area tongue and floor of the mouth. This examination requires the use of visual examination and palpation. The purpose of this part of the examination is to detect any abnormalities in the head and neck area of a patient. (12)

Examination of the Periodontal Tissue

it is recommended that a periodontal examination be a part of every adult patient's dental exam. It is common practice for the dental hygienist to perform the periodontal examination for a patient.

Color Coding

Different color are used to chart on the diagram to provide visual information about each entry. Blue or Black represent dental treatment that has been completed. Red indicates dental treatment that is detected and needs to be completed at future dental appointments.

Cavity Classifications

Standard classifications are used to describe the types and locations of decay or restorations.

G.V. Black

(father of modern dentistry) developed the most commonly use system in the 1900's. Black's original classificaiton included Classes I through V. Class VI was added later.

Charting Symbols

A wide variety of symbols and abbreviations are used in dentistry.

Visual evaluation

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description: With the use of a mouth mirror, the dentist examines areas of the mouth and face that cannot be seen directly.

Palpation

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description: The examiner's hands are used to examine texture, size and consistency of hard and soft tissue around the mouth and facial area.

Instrumentation

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description: The examiner uses an instrument to exam hard tissue, such as teeth.

Radiography

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description: Radiographs provide a visual evaluation of areas that cannot be seen directly.

Intraoral imaging

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description: A miniature video camera projects and image on a screen. The magnification allows the dentist to better evaluate a specific tooth or area of the mouth, which makes it easier for the patient to understand what the dentist is discussing.

Photography

Examination Techniques, Visual Evaluation, Palpation and Instrument, Radiography, Intraoral Imagining Photography.
Description Photographs are an excellent tool for identification, treatment planning, case presentations and patient education.

Treatment Abbreviations

Abbreviations are used when recording dental treatment. Each dentist has his or her personal preferences

Single Surface Abbreviations

These and the other charting abbreviations involve the names of the tooth surfaces, such as "O" for occlusal.

Combination of Surfaces

When two tooth surfaces are involved, such as distal or occlusal, the combined surfaces, are referred to as "DO" for distal-occlusal. If three surfaces are combined, the same rule applies (e.g. "MOD" for mesial-occlusal-distal.)

Amalgam - Charting Symbol

Outline the surfaces that are involved and color in area (refer to teeth 2 and 14) pg 182

Composite

Outline the surfaces involved (refer to teeth 9 and 27) pg 182

Porcelain fused to metal

Outline the coronal portion of the tooth and either add diagonal lines to indicate gold or use abbreviations if another metal is used (refer to too 28) pg 182

Gold

Outline the crown of the tooth and place diagonal lines (refer to tooth 4) pg 182

Sealant

Place and "S" on the occlusal surface (refer to teeth 3 and 21) pg 182

Stainless steel crown

Outline crown of tooth and place "SS" on occlusal surface (refer to tooth 29) pg 182

To be extracted

Draw a red diagonal line through the tooth. An alternative method is to draw two red parallel line through the tooth (refer to tooth 1) pg 182

Missing tooth

Draw a black or blue "X" through the tooth. It does not matter if the tooth was extracted or ti never erupted, just as long as the tooth is not visible in the mouth. If a quadrant, or arch, is edentulous, make one "X" over all teeth (refer to tooth 32) pg 182

Impacted or unerupted

Draw a red circle around the whole tooth, including the root (refer to tooth 16). pg 182

Decay

Depending on the caries classification, outline and color the area for amalgam (refer to tooth 2), or outline the are for composite (refer to tooth 9) pg 182

Recurrent decay

Outline the existing restoration in red to indicate decay in the are (refer to tooth 14) pg 182

Root Canal

Draw a line through the center of each root involved (refer to tooth 22). pg 182

Periapical abscess

Draw a red circle in the apex of the root to indicate fection (refer to tooth 8) pg 182

Post and core

Draw a line through the root that requires a post; then continue the line into the gingival one third of the crown, making a triangle shape (refer to tooth 6) pg 182

Rotated Tooth

if a tooth has rotated in its position, indicate the direction the tooth has turned by placing a red arrow to the side of the tooth (refer to tooth 15) pg 182

Diastema

When there is more space than normal between two teeth, draw two red vertical lines between the areas (refer to teeth 24 and 25) pg 182

Fixed bridge

Draw an "X" through the roots of the missing tooth or teeth involved. Then draw a line to connect each of the teeth that make up the bridge. The type of material used to make the bridge will determine whether you outline the crowns for porcelain, use diagonal lines for gold, or use a combination of the two (refer to teeth 18 -20) pg 182

Full Crown

Outline the complete crown if it is to be a porcelain crown, or outline and place diagonal lines if it will be a gold crown (refer to tooth 4) pg 182

Drifting

Place a red arrow pointing in the direction a tooth is drifting (refer to tooth 31) pg 182

Implant

In red, draw horizontal lines through the root or roots of a tooth (refer to tooth 23) pg 182

Bonded veneer

Veneers cover only the facial aspect of a tooth. Outline the facial portion only (refer to tooth 26) pg 182

Fractured tooth or root

If a tooth or a root is fractured, draw a red zigzag line where the fracture occurs (refer to tooth 8) pg 182

Class I

Black's Classification of Cavities.Class I -VI.
Location Decay is diagnosed in the pits and fissures of the occlusal surface of molars and premolars, buccal or lingual pits of molars, and lingual pits of maxillary incisors. Because most of this type of decay is confined to a small area, the dentist will choose to restore these surfaces with composite (tooth-color) resins

Class II

Black's Classification of Cavities.Class I -VI.
Decay is diagnosed in the proximal (mesial or distal) surfaces of premolars and molars. Because this surface area is harder to detect visually, a radiograph is used to detect the decay. The design of the restoration will most commonly include the occlusal surface and may possibly involve more that tow surfaces. The type of dental material used to restore this classification is either silver amalgam (chosen for its strength) or newer composite (tooth-colored) resins designed for posterior teeth (chosen for esthetic appeal). If the tooth has extensive decay, the dentist may choose to crown the tooth with a gold or porcelain inlay, or crown.

Class III

Decay is diagnosed in the proximal (mesial or distal) surfaces of incisors and canines. This decay is similar to that of Class II, except it involves anterior teeth. It is easier for the dentist to access these surfaces with less tooth structure affected. The type of dental material used to restore this classification is composite (tooth-colored resins (for esthetic appearance).

Class IV

Decay is diagnosed in the proximal (mesial or distal) surfaces of incisors and canines. The difference between Class IV and Class III decay is that Class IV involves the incisal edge or angle of the tooth. The type of dental material used to restore this classification is composite (tooth-colored) resins (for esthetic appearance). If the tooth has extensive decay, the dentist may choose to crown the tooth with a porcelain crown.

Class V

Decay is diagnosed in the gingival third of facial or lingual surfaces of any tooth. This is also referred to as a smooth surface decay. This type of dental material used to restore this classification depends on which teeth are affected. If the decay occurs in posterior teeth, the dentist may choose silver amalgam; if anterior teeth are involved, composite (tooth-colored) resin will most likely be used.

Class VI

Decay is diagnosed on the incisal edge of anterior teeth and the cusp tips of posterior teeth. Class VI decay is caused by abrasion (wear) and defects. The dental material is chosen based on which teeth are involved.

Level I - Emergency Care

Types of Treatment Plans, Level I, Level II, and Level III.
The plan relieves immediate discomfort and provides relief to the patient.

Level II - Standard Care

Types of Treatment Plans, Level I, Level II, and Level III.
This plan restores the teeth to normal function. This includes permanent restorations, root canal therapy, periodontial therapy, and fixed and removable prosthetic.

Level III - Optimum Care

Types of Treatment Plans, Level I, Level II, and Level III.
this plan restores the teeth surrounding tissue to maximum function and esthetic acceptability. this includes cosmetic dentistry, orthodontics, periodontics, implants, and reconstructive surgery.

Assistant's Role in Collecting Information in a Dental Examination

1. Gathering all completed forms
2. Obtaining diagnostic aids, such as intraoral and extraoral radio-graphs, study casts, and photographs
3. Charting or recording the dentist's findings during the examination.

Elements that Make up a Dentist's preferred Charting System

1. Tooth diagrams, numbering systems and color coding
2. Cavity classification
3. Charting symbols
4. Abbreviations of tooth surfaces
5. Abbreviation of treatments.

Anatomic Diagram

The illustration resembles actual teeth. In some styles, the roots of the teeth are also included. (12-1)

Geometric Diagram

A circle represents each tooth. The circle is divided to present each tooth surface (12-2)

Color Coding

Different colors are used to chart on the diagram to provide visual information about each entry. Blue or black represents dental treatment that has been completed. Red indicates dental treatment that is detected and needs to be completed at future dental appointments.

Treatment Information included on a Patient's Chart

1. Medical history update including vital signs
2. Anesthetic used
3. Types of moisture control
4. The tooth treated and surfaces involved.
5. Types of dental materials used
6. How well the patient tolerated the procedure

Perio Disease

Breakdown of the bone

Scalers

are Dental hygienist

Prophy Paste

Smooth and removes stains

Polishing on Children

Children 5 years and older the dental assistant can polish their teeth. This is an expanded function.

Supra Gingival

Above the gum line

Disclosing agents

Shows plaque in colors, If it changes color you need to rebrush.

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