DIAGNOSIS &TREATMENTDIAGNOSIS &TREATMENT
3 Major Steps3 Major Steps
Data gatheringData gathering
Examination of PatientExamination of Patient
Preparing & PresentingPreparing & Presenting
Treatment PlanTreatment Plan
ASSISTANTS ROLEASSISTANTS ROLE
Aid patients in completing formsAid patients in completing forms Generating diagnostic aidsGenerating diagnostic aids RadiographsRadiographs
Diagnostic castsDiagnostic casts
Recording Dentists findings during Recording Dentists findings during exam exam ACCURATELYACCURATELY
METHODSMETHODS
Manual: Manual: Assistant records data Assistant records data
on patient charton patient chartColor coded pencils Color coded pencils
indicate condition indicate condition of teethof teeth
BLUE = Existing/comp.BLUE = Existing/comp.RED = Needs to be RED = Needs to be
donedone
ComputerizedComputerizedPatients charts arePatients charts are stored on computerstored on computer some are voice some are voice
activatedactivated Others require Asst. Others require Asst.
or Hygienist to enteror Hygienist to enter
CLINICAL EXAMCLINICAL EXAM
Dentist looks for:Dentist looks for:
Oral lesionsOral lesions
Dental decayDental decay
Fractured teethFractured teeth
Periodontal diseasePeriodontal disease
Other dental anomaliesOther dental anomalies
CLINICAL EXAM cont.CLINICAL EXAM cont.
Intra oral imaging or camera assistIntra oral imaging or camera assist
dentist’s explanation with visualdentist’s explanation with visual
Computers may show enlarged x-rays for Computers may show enlarged x-rays for easy viewingeasy viewing
CLINICAL EXAM cont.CLINICAL EXAM cont.
Detailed scrutiny each toothDetailed scrutiny each tooth Mal-positioned teethMal-positioned teeth Structural defects, stains, fracturesStructural defects, stains, fractures Decalcified areas & small breaks in enamelDecalcified areas & small breaks in enamel Carious lesions/indications recurrent decayCarious lesions/indications recurrent decay Overhangs of Amalgam or Cast RestorationOverhangs of Amalgam or Cast Restoration Poor fitting prosthesisPoor fitting prosthesis Abnormal wear patterns of teethAbnormal wear patterns of teeth
CLINICAL EXAM cont.CLINICAL EXAM cont.
Dental caries is a disease initiated by Dental caries is a disease initiated by microbial activity involving hard portions microbial activity involving hard portions of teethof teeth
Caries is a disintegration of enamel, Caries is a disintegration of enamel, dentin, cementum, forming open lesions, dentin, cementum, forming open lesions, commonly known as: commonly known as:
CAVITIES & DECAYCAVITIES & DECAY
PREREQUISITES / DECAYPREREQUISITES / DECAY
Plaque on tooth surfacesPlaque on tooth surfaces Shelter areas between teeth: interproximal Shelter areas between teeth: interproximal
surfaces, embrasures, or defects in teeth surfaces, embrasures, or defects in teeth such as pits and fissures are a breeding such as pits and fissures are a breeding groundground
Microorganism in plaque ferment Microorganism in plaque ferment carbohydrates form food to produce acid.carbohydrates form food to produce acid.
Acid attacks enamel = demineralization = Acid attacks enamel = demineralization = destructiondestruction
RATE OF DECAYRATE OF DECAY
Depends on Depends on Abundance of plaqueAbundance of plaque TypeType Number of organismsNumber of organisms Amount of carbohydrates available for Amount of carbohydrates available for
conversionconversion Resistance of the tooth structureResistance of the tooth structure
DECALCIFICATIONDECALCIFICATION
First step in decay- loss of calcium salts from First step in decay- loss of calcium salts from enamelenamel
Enamel is weakened / eventually destroyedEnamel is weakened / eventually destroyed INCIPIENT caries have not progressedINCIPIENT caries have not progressed
Appear slightly chalky or opaqueAppear slightly chalky or opaque Surface is rough and granularSurface is rough and granular Pits & Fissure may be a darkened, shaded outlinePits & Fissure may be a darkened, shaded outline
CARIOUS PROCESSCARIOUS PROCESS
Reaches the dentin:Reaches the dentin: Spreads rapidlySpreads rapidly Spreads laterallySpreads laterally Undermines the enamel (often not visible Undermines the enamel (often not visible
until extensive destruction occurs)until extensive destruction occurs) Unless arrested will continue to pulpUnless arrested will continue to pulp
ARRESTED caries: shows no tendency for ARRESTED caries: shows no tendency for further progress into toothfurther progress into tooth
CARIOUS PROCESSCARIOUS PROCESS
Recurrent caries: occur beneath existing Recurrent caries: occur beneath existing restorations due to restorations due to Improper cavity prepImproper cavity prep Inadequate cavity restorationInadequate cavity restoration Faulty sealing of the restoration, “leaky Faulty sealing of the restoration, “leaky
margin” margin”
CARIOUS PROCESSCARIOUS PROCESS
Rampant decay:Rampant decay: Wide spread decayWide spread decay Usually found in high risk patientsUsually found in high risk patients Baby bottle syndromeBaby bottle syndrome
Nursing bottle syndromeNursing bottle syndrome Babies put to bed + bottle + sugary liquidsBabies put to bed + bottle + sugary liquids Saliva production slows while sleepingSaliva production slows while sleeping Sugar + bacteria + dental plaque = AcidSugar + bacteria + dental plaque = Acid Acid attacks enamelAcid attacks enamel
CARIOUS PROCESSCARIOUS PROCESS
Root caries:Root caries: CEJ exposed = very susceptible to decayCEJ exposed = very susceptible to decay
Cervical abrasion or erosion: not caused by Cervical abrasion or erosion: not caused by bacteria, but by chemical or mechanical bacteria, but by chemical or mechanical influencesinfluences Tooth brushingTooth brushing BulimiaBulimia AttritionAttrition Sucking lemonsSucking lemons
DENTAL CHARTINGDENTAL CHARTING
Dental charting:Dental charting: Part of Patient legal recordPart of Patient legal record Initial charting done on first visitInitial charting done on first visit Indicate existing first, what has been done Indicate existing first, what has been done
and what needs to be done.and what needs to be done. Record used for diagnosis, consults w/other Record used for diagnosis, consults w/other
Drs., accounting purposesDrs., accounting purposes ForensicsForensics
TYPES OF CHARTSTYPES OF CHARTS
AnatomicalAnatomical Shows complete tooth buccal or facialShows complete tooth buccal or facial Crown or incisal edgeCrown or incisal edge Crown only of lingual surfaceCrown only of lingual surface Includes primary dentitions in some formIncludes primary dentitions in some form
GeometricGeometric Shows circle:each circle section into 5 areasShows circle:each circle section into 5 areas Generally includes primary dentition Generally includes primary dentition
NUMBERING SYSTEMSNUMBERING SYSTEMS
Universal / National systemUniversal / National system What we use 1-32, A-TWhat we use 1-32, A-T
InternationalInternational Used in Europe and CanadaUsed in Europe and Canada
PalmerPalmer Used in orthodonticsUsed in orthodontics
CAVITY CLASSIFICATIONCAVITY CLASSIFICATION
Developed by GV BlackDeveloped by GV Black Class I : pits & fissuresClass I : pits & fissures Class II : posterior only, involves a proximal Class II : posterior only, involves a proximal
surface, usually 2 or moresurface, usually 2 or more Class III:anterior only, involving interproximal Class III:anterior only, involving interproximal Class IV:anterior only, interproximal & incisalClass IV:anterior only, interproximal & incisal Class V: occur cervical or gingival third both Class V: occur cervical or gingival third both
lingual & facial/buccal all teethlingual & facial/buccal all teeth Class VI: w/o Black, worn areas by abrasionClass VI: w/o Black, worn areas by abrasion
ABBREV. TOOTH SURF.ABBREV. TOOTH SURF.
Simple: one tooth surfaceSimple: one tooth surface Compound: two surfacesCompound: two surfaces Complex: more than twoComplex: more than two Use first letter of word: ex. Mesial = MUse first letter of word: ex. Mesial = M More than one: combine/drop al, add oMore than one: combine/drop al, add o
Ex: mesio-occlusal, distolingualEx: mesio-occlusal, distolingual Mesial = first if present, lingual & facial Mesial = first if present, lingual & facial
lastlast
ABBREV. TOOTH SURF.ABBREV. TOOTH SURF. Facial replaces labial when referring to Facial replaces labial when referring to
anterior teethanterior teeth Basic terms:Basic terms:
Abscess: localized infectionAbscess: localized infection Bridge: abutments, pontics, maryland bridgeBridge: abutments, pontics, maryland bridge
An appliance that replaces 1 or more missingAn appliance that replaces 1 or more missing
Crown: “cap” SSC, FGC (Full Gold Crown), Crown: “cap” SSC, FGC (Full Gold Crown), PFM (Porcelain Fused to Metal) FPC (Full PFM (Porcelain Fused to Metal) FPC (Full Porcelain Crown)Porcelain Crown)
Denture: FUD (Full Upper Denture) FLD Denture: FUD (Full Upper Denture) FLD (Full Lower Denture)(Full Lower Denture)
ABBREV. TOOTH SURF.ABBREV. TOOTH SURF. Basic terms cont.:Basic terms cont.:
Incipient: beginning decay- “watch”Incipient: beginning decay- “watch” Overhang: excessive materialOverhang: excessive material Partial denture: removable prosthesis Partial denture: removable prosthesis
replacing one or more but less than all replacing one or more but less than all missing teethmissing teeth
Restoration: amalgam or composite filling, Restoration: amalgam or composite filling, crown or inlaycrown or inlay
Root canal therapy: pulp in removed and Root canal therapy: pulp in removed and replaced with filling materialreplaced with filling material
Sealant: material placed into pits & fissures Sealant: material placed into pits & fissures to PREVENT cariesto PREVENT caries
CHARTINGCHARTING
Charting Colors:Charting Colors: RED: represent work that need to be doneRED: represent work that need to be done BLUE: work that has been completedBLUE: work that has been completed
Periodontal charting:Periodontal charting: Perio screening & recording part of examPerio screening & recording part of exam Tip of probe marked in 3mm incrementsTip of probe marked in 3mm increments Six surfaces probed: mesiofacial, buccal, Six surfaces probed: mesiofacial, buccal,
distofacial, mesiolingual, lingual, distolingualdistofacial, mesiolingual, lingual, distolingual
CHARTING cont.CHARTING cont.
Periodontal cont.Periodontal cont. Readings of 3mm or less is normal sulcus Readings of 3mm or less is normal sulcus
depth, charted in Bluedepth, charted in Blue Readings over 3mm considered periodontal Readings over 3mm considered periodontal
pockets & abnormal, charted in Redpockets & abnormal, charted in Red Other considerations during perio exam:Other considerations during perio exam:
Mobility: Roman numerals 0-3Mobility: Roman numerals 0-3 RecessionRecession Furcations, & Mucogingival problemsFurcations, & Mucogingival problems