Clinical examination of a patient in conservative dentistry
- Patient reception:
At the office level, we install the patient in a semi-seated position, and we try to establish a relationship with the patient so that there is trust, and to prepare him psychologically (case of children or old people).
- Anamnesis: (the assistant notes the information while the dentist questions the patient)
- Civil status: name, first name, age, profession, telephone number, etc.
- Reason for consultation: aesthetic, functional (pain), or as part of checks (prevention) or referrals from other services.
- History of the disease: date of onset of the lesion, type of pain, provoked or spontaneous, if provoked, by what stimuli, continuous or discontinuous, taking of analgesics (does it relieve the pain or not) which allows a distinction to be made between pulpopathies (discontinuous pain) and periodontopathies (continuous pain resistant to taking analgesics).
- The exo-oral clinical examination:
- At the inspection: this is already done at the same time as the reception and the anamnesis.
- On palpation:
- ATM: looking for joint noise (popping, cracking and crepitation), pain, condylar play
- Muscles: masseter, temporalis, external and internal pterygoids. Looking for pain, hyper/hypotonicity
- Lymph node chains: clinically detectable adenopathy, fixed or mobile in relation to the superficial plane, hot or cold, painful or not and its size. Its palpation is done by hand in a hook shape and by asking the patient to tilt the head towards the side where we are going to palpate.
We only note what is abnormal or pathological.
- Mouth opening:
3 spans of the patient’s fingers (4cm), without asking the patient to do so, we note whether he speaks normally or not, his pronunciation. If not, we think of DAM, DDS, periodontal disease…
- The endo-oral examination: inspection and palpation
- Oral hygiene
- Gingival examination: height, color, volume (edema), contour, texture… and the conclusion is the presence or absence of inflammation of the gum.
- Condition of the mucous membranes: palate, floor, cheek or lip… looking for ulceration, discoloration, dental imprint, scars, fistulas, noting the location, color, pain…
- The dental formula: the CAD index, we note decayed, missing and filled teeth
- Occlusal examination: dental class, group or canine function, interferences, etc.
- Examination of the causative tooth:
- The inspection:
Color: grayish, blackish, brown, varnish, clove, white spot, pink spot, fluorosis…
Degree of tooth destruction: single-walled, four-walled cavity, etc.
Enamel abnormalities…
- Palpation: is done using the consultation tray
Tooth mobility : in case of fractures or periodontal disease
Percussions: carried out on a control tooth (preferably healthy and at a distance from the lesion)
We have horizontal percussions (pulp state = cameral region) and vertical (axial = periapex) in search of sensitivity.
The vitality test: thermal, electrical or milling variations
Cold: using a cotton ball soaked in Friljet and held with tweezers, applied first to a control tooth at the cervical neck after drying the latter.
During milling: after manual curettage, a round bur is mounted on a blue contra-angle without preparing the patient, and the milling is carried out on the axial wall and it is noted whether the patient reacts or not.
Warm, using gutta percha in the same manner as the cold test.
Pressure test, to know if you are close to the pulp (not a vitality test).
These tests are judged either positive or negative and for the vitality test it is noted whether the pain subsides when the stimuli are stopped (pulpo-dentin damage) or whether it continues.
Patient with old filling: the previous filling must be removed to make a diagnosis.
Clinical examination of a patient in conservative dentistry
- Additional examinations:
The additional examination makes it possible to decide and identify the disease in case of doubt, it makes it possible to confirm or deny the diagnosis.
We have the biological, serological examination, the ultrasound, the panoramic but the most used in OC is the retro-alveolar.
What do we look for on retroalveolar radiography?
- If we have a caries cavity, we estimate its proximity to the pulp.
- Root canal treatment, if the patient is a child.
- The desmodontal space, preserved or widened.
- Presence of a periapical, latero-radicular or furcation lesion (reaction ) .
- Periodontal bone resorption (endoperiodontal lesion).
- The shape, length and curvature of the roots.
- The presence of proximal caries.
- Existing fillings and restorations, their proximity to the pulp chamber, their sealing.
- The presence of debris or fractures of instruments in the canal.
- Internal resorptions, does the canal lumen develop uniformly towards the apical foramen or are there radiolucent images at the level of the canal.
- External resorptions, objectified on the mesial and distal external canal walls.
- Coronal fractures in the follow-up case, and the diagnosis of radicular and coronoradicular fractures.
- Tumors, cysts and granulomas.
*For septum syndrome, it is the clinical examination which contrasts with a clinical picture similar to total or partial acute pulpitis but the pathognomonic sign of pain which appears during chewing makes the difference.
Then we move on to the stage of making the diagnosis based on the information deduced from the clinical and complementary examinations: “According to the history of the disease, the endo-oral exo examinations, and the examination of the causal tooth, the subjective signs agree with the objective signs and have been confirmed by the complementary examination which highlights the presence of such and such lesions.”
Then we make an etiological diagnosis , citing all the etiologies. For example, in the case of septum syndrome, if we do not eliminate the etiology (proximal caries due to an overflowing restoration, etc.), we will have a relapse even after periodontal curettage.
Then the differential diagnosis, citing the cause which decides between the different diagnoses.
For example, we speak of chronic apical periodontitis and not chronic pulpitis, because the pulp vitality was not preserved, the clinical examination reveals a deposit of tartar all around the tooth, we also see in the X-ray a periapical lesion, a thickening of the lamina dura and a widening of the desmodontal space. The patient also confirmed that taking analgesics did not stop the pain.
Then we go to the treatment plan , we start from the most general to the most specific.
- If there are missing teeth, we will replace them with a prosthesis.
- If there is an overlap, it is part of the etiological treatment, we take care of eliminating tartar deposits and food debris between the teeth and then we move on to ODF treatment.
- If there are gingival inflammations, if there are recessions, we move on to periodontology.
- If there are teeth that are deemed unsalvageable, we move on to tooth extraction.
- Then we return to the treatment of the pathology that we have diagnosed.
Then we estimate the prognosis , according to age, the material used, the lifestyle, the presence of general diseases, etc.
Clinical examination of a patient in conservative dentistry
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.