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Text Book of Pediatric Dentistry-81-86
Text Book of Pediatric Dentistry-81-86
Chapter outline
)) Recording the History )) Specialized Examination
)) Clinical Examination )) Final Diagnosis
)) Provisional Diagnosis )) Comprehensive Treatment Plan
Successful dental treatment for children can be achieved Emphasis on preventive dental care has taken the lead
by recording a detailed history, a complete clinical over the direct restorative intervention. Furthermore,
examination, appropriate investigations, a thoughtful recent information suggests that there is a more intimate
diagnosis, and an appropriate treatment plan. It is very relationship between oral and systemic health. Thus, the
essential to obtain all relevant information about the challenge dentists are facing in the 21st century is a rapidly
patient and family along with an informed consent before growing population of patients who have chronic medical
embarking upon the comprehensive treatment program for conditions, take multiple medications, yet still require
a child patient. In some circumstances, the diagnosis (i.e., routine, safe, and appropriate oral health care. This chapter
an explanation for the patient’s symptoms and identification addresses the rationale and method for gathering relevant
of other significant disease process) may be self-evident.
medical and dental information (including the examination
When clinical data are more complex, the diagnosis may
of the patient) and the use of this information for dental
be established by:
treatment.
Reviewing the patient’s histor y and physical,
radiographic, and laboratory examination data
Listing those items that either clearly indicate an RECORDING THE HISTORY
abnormality or that suggest the possibility of a significant
This can be further categorized for descriptive purposes
health problem requiring further evaluation
into:
Grouping these items into primary versus secondary
Vital statistics
symptoms, acute versus chronic problems, and high
versus low priority for treatment Chief complaint
Categorizing and labeling these grouped items according History of present illness
to a standardized system for the classification of disease Family (social) history
Medical history
Components of oral examination and diagnosis Drug history
Recording the history Dental history
Examination of the patient
Provisional diagnosis Natal, Pre- and postnatal history
Special examination Behavioral history
Final diagnosis Growth and development
Treatment plan (including medical referrals)
Diet history
46 Section 2 Diagnosis in Pediatric Dentistry
A B C
Figs. 6.1A to C: Head shapes: (A) Mesocephalic; (B) dolichocephalic; (C) Brachycephalic.
A B C
Figs. 6.2A to C: Facial forms: (A) Mesoprosopic; (B) Euryprosopic; (C) Leptoprosopic.
Chapter 6 Oral Examination and Diagnosis 49
History and oral examination play a major role in
Examination of skin:
the diagnosis of any swelling of the face. The skin of the face should be evaluated for the
Examination of eyes: presence of primary and secondary skin lesions
Eyes should be observed for any inflammation, Any scars, bruising, laceration, pallor, and birth
swelling, or puffiness around the eye marks should also be documented.
Inflammation of maxillary teeth can cause swelling Examination of chin:
of the eyelids Prominence of chin and mentalist activity can
Children with upper respiratory tract infection, indicate habits and malocclusion.
sinusitis, and allergy have puffiness of eyelids. Examination of lips (Figs. 6.4A and B):
Examination of nose: Lips should be examined for the presence of cold
Nose should be examined for any abnormalities in sores, swelling, or abnormal coloring
size, shape, or color Competent—lips are in contact when musculature
Children who encounter nasal discharge indicate is relaxed
upper respiratory tract infection Incompetent—lip seal is not formed in normal
Children with chronic upper respiratory tract circumstances, only hyperactivity of oral musculature
infection will develop mouth breathing habit. can help in forming closure.
A B C
Figs. 6.3A to C: Facial profiles: (A) Straight; (B) Convex; (C) Concave.
A B
Figs. 6.4A and B: Competency of lips.
50 Section 2 Diagnosis in Pediatric Dentistry
A B
Figs. 6.5A and B: Method of examination of TMJ.
Examination of TMJ (Figs. 6.5A and B): Lymphadenopathy is not uncommon in children
Functional examination should include due to frequent viral infections
palpation and auscultation of TMJ and associated Ask the patient to bend his neck in forward and
musculature downward position to palpate the lymph nodes
The patient should be examined for any clicking on the side and to bend it forward to palpate the
sound, crepitus, pain, deviation, and restricted submandibular area.
opening
Intraoral examination: Intraoral examination for a young
Mouth opening is also related to TMJ function and
child should begin with the “tell-show-do” approach, that
should also be examined. Normal mouth opening
is, by explaining the child what are you going to do; show
is 40–45 mm.
him the examination instruments followed by intraoral
examination. During and after the intraoral examination,
TMJ examination
explain the parents about the intraoral findings and discuss
The function of TMJ is examined by palpating the head of the treatment plan. This includes the examination of hard
mandibular condyle and observing the patient with mouth closed,
open and during random movements. as well as soft tissues.
Soft tissue: It includes examination of the oral mucosa
Lymph nodes examination (Figs. 6.6A and B): and examination of periodontal tissues. Complete
A complete examination of neck region including inspection and palpation of all soft tissue oral structures
the lymph nodes is mandatory is needed
A B
Figs. 6.6A and B: Examination of lymph nodes.