Professional Documents
Culture Documents
Diagnosis
Diagnosis
1 Introduction.
1 Patient assessment.
a) General data.
b) Medical review.
c) Dental history.
1 Examination and diagnosis.
1 Diagnosis of dental caries.
a) Determination of risk factors:
b) Clinical examination of caries:
1. Visual.
2. Tactile.
3. Radiographic.
4. Transillumination.
5. Digitizers.
6. Laser topography.
1. Examination of caries in pits and
fissures.
2. Examination of caries in smooth
proximal surfaces.
3. Examination of caries in smooth
cervical surfaces.
1 Clinical examination of amalgam
restoration.
1. Amalgam blues.
2. Amalgam overhangs.
1
1
1
3. Ditching.
4. Voids.
5. Fracture line.
6. Improper anatomical contour.
7. Marginal ridge discrepancy.
8. Proximal contact defect.
9. Recurrent caries.
Clinical examination of cast restoration.
Clinical examination of esthetic
restoration.
Adjunctive aids for examining teeth and
restorations.
1. Percussion.
2. Palpation.
3. Vitality test.
4. Cavity test.
5. Study cast.
6. Additional aids.
Treatment planning.
Types: 1. Ideal treatment planning.
2. Optional treatment planning.
Sequence of treatment plan:
1. Control phase.
2. Holding phase.
3. Defintive phase.
4. Maintenance phase.
Introduction
Patient assessment
a) General data:
1. Patient full name.
2. Address and telephone number: To postpone the appointment if needed and to send him a bill
of fees.
3. Age: Gives an idea about:
a) Size of the pulp.
b) The position of the gingival attachment.
c) The depth of the cavity and the biological principles.
4. Sex: Certain diseases are related to specific sex, e.g. gingival enlargement during pregnancy
and menstruation.
5. Occupation: Gives an idea about certain occupational defects, e.g. notches in anterior teeth of
dressmakers and carpenters.
Gives an idea about the material of choice for restoring a tooth.
b) Medical review:
This helps in identification of any condition that may alter, complicate or contraindicate the
proposed dental procedures.
Certain systemic diseases may need consultation with specialist before starting treatment, e.g.
cardiac patient.
c) Dental history:
1) Past dental history:
Frequency of dental treatment and problems were met during past interference, should be
recorded.
Past dental experience for the same problem (Chief complaint) should be discussed with the
patient in order to not to repeat disagreeable procedures.
The patients present problem (chief complaint) should be recorded in the chart.
The onset, duration and the related factors of the chief complaint should be recorded.
The date and type of available radiographs should be recorded to determine the need for
additional radiograph and to minimize the patient exposure to necessary ionizing radiation.
Clinical examination procedures should be proceeded by review of the general oral condition
and the type of occlusion using examination rubber gloves for all steps.
1) Non-oral factors including: Age. Sex, medical condition and general health, fluoride and
genetic role.
2) Oral factors including: Tooth anatomy, oral flora, oral hygiene, previous restorations and
reduced salivation.
Caries risk assessment:
2.
3.
4.
Transillumination: Dark area appeared when the tooth is subjected to fiber-optic light.
5.
6.
Caries has increased water and carbon contents and decreased minerals,
so it is very sensitive to CO2 gas laser.
When caries is exposed to CO2 gas laser, its water contents will be
evaporated leaving black carbonized residue.
Caries tends to occur bilaterally and adjacent proximal surfaces may be affected, i.e. if the
caries is found in the occlusal or proximal surface in one tooth on one side, then the changes
increased for the same location.
These are the most caries susceptible areas where the developmental lobes of calcification fail
to coalesce.
Tactile examination: By passing dental floss along side the proximal surface, tearing of
dental floss fibers indicating caries.
Transillumination: Dark cone in proximal surface in bite wing film is a true indicator for
proximal caries.
Visual examination: Chalky appearance of the cervical 1/3 may denote caries.
Disappearing-reappearing phenomenon, the chalky white appearance of
carious lesion disappears with wetting and appears with dryness.
2. Amalgam overhangs:
Could be diagnosed by:
1.
2.
3.
4.
3. Ditching:
4. Voids:
If more than 0.2 mm the restoration should be considered as defective one and should be
replaced.
5. Fracture line:
Using visual and tactile method, careful examination should be done to locate fracture line.
When inadequate embrasure or misplaced contact area should consider the restoration is
defective and should be replaced.
The proper position and height of marginal ridge should be inspected and compared with the
neighboring tooth, other wise the restoration should be considered defective and replaced.
Using dental floss or passing light between the teeth may indicate the contact area relation of
amalgam restoration.
Open contact or tight contact may lead to gingival and periodontal problems.
9. Recurrent caries:
Done by gentle tapping the occlusal or incisal surface of the teeth by the use of mirror handle to
determine the presence of tenderness indicating periapical involvement.
Care must be taken with maxillary teeth due to close relation to maxillary sinus.
Percussion should be done out of sequence to avoid patient concentration with the affected
tooth.
2) Palpation:
Done with teeth tender to percussion to determine the presence of periapical or periodontal
abscess.
It is performed by rubbing any swelling between index finger and bone to feel fluctuation.
3) Vitality test:
4) Cavity test:
Using round bur without anesthesia, a cavity is made through the restoration into dentin.
5) Study casts:
They are helpful in providing an understanding of the occlusion and planning of treatment.
They are also useful for explaining the treatment for the patient.
6) Additional aids:
Transillumination.
Treatment planning
Types:
1) Ideal treatment plan:
It is the plan where the best forms of treatment are done irrespective to the patient and dentist
limitations.
It is the plan where the maximum form of treatment is done in relation to the patient general
and oral conditions as well as the dentist knowledge and experience.
1.
Elimination of pain.
2.
3.
4.
5.
2) Holding phase:
The holding phase is a time between the control and definitive phase that allows for resolution
2.
3.
3) Definitive phase:
After reassessment of the initial treatment the need for further care should be determined.
This includes some forms of endodontics, periodontics, orthodontics, oral surgery, and
operative procedures prior to fixed or removable prosthetic treatment.
4) Maintenance phase:
Regular recalls examinations that may reveal the need for further adjustment.