The clinical examination
The interrogation (anamnesis)
Patient reception
Questioning:
- A very important step which precedes our actual clinical examination, and which brings out elements necessary for making the diagnosis.
The clinical examination
Marital status :
Name and Surname: to identify the patient on the one hand and on the other hand to ensure a psychological approach to the patient
Age: Certain periodontal diseases affect certain age groups more than others.
Sex:
Profession: some professions are related to certain periodontal diseases e.g. patients with high responsibilities often develop DAM, also students due to stress.
Address and telephone number: To contact the patient and summon the family in case of emergency
Reason for consultation and history of the disease:
The reason for consultation is usually clearly expressed and should be noted in the patient’s own words.
- Aesthetic :
– Recessions
– Dental staining
– Appearance of new spaces between the teeth.
– Change in gingival shape or volume
– Presence of tartar.
- functional :
Pain: location, intensity, circumstances of occurrence, rhythm, frequency, time
– Gingivorrhagia: spontaneous or induced.
– Bad breath sensation.
– Bad taste sensation.
– Dental mobility.
– Gingival pruritus.
History of the disease: Corresponds to a chronological account of the problem indicated by the main complaint, emphasizing the date of appearance of the first signs and the duration of their evolution.
General background:
Dental history:
1-Staff
- visits to the dentist, their frequency, date of first and last visit, nature of treatment:
- Dental care.
- Extractions: causes (cavities or mobility)
- Prosthetic or orthodontic treatment.
- Scaling or any other periodontal treatment
2-Family
- Look for conditions in different generations and the frequency of periodontal disease in other family members.
Risk factor assessment:
Stress tobacco
Exo-oral examination
Inspection
- Facial symmetry: in relation to the midsagittal plane, any asymmetry due to swelling should be noted (and its characteristics (volume, consistency, mobility) described if necessary); facial paralysis, fracture, periodontal abscess or salivary gland diseases
- Coloring of skin: pallor: anemia, fatigue, dermatological problem, scars.
- The lips: Note the different lesions and assess the volume and the presence or absence of the stomion.
Palpation
Muscles:
Palpation of the muscles and their insertions allows us to note: muscle tone, pain, contraction, hypertrophy
The Temporomandibular Joints
Condylar play: Symmetrical or asymmetrical. Subluxation, Dislocation
Pain:
Joint noises:
Cracking : is a brief noise; comparable to a branch breaking, observed when opening or closing
Snap : This is a sharper, audible noise, comparable to a whip snapping, observed during closing and opening movements,
Crepitation : is a series of low noises repeated throughout the opening path.
The lymph node chains:
The submental chains between the anterior bellies of digastrics.
The submaxillary chains: along the lower edges of the mandible
The sub-angular maxillary chains: behind the mandibular angle
Endo-oral examination:
- Mouth opening:
Assessed at three finger spans from the patient, it can be:
Insufficient : Exaggerated:
– Temporary limitation: trismus Sign of a dislocation
– Permanent limitation: Permanent mandibular constriction
- Oral hygiene:
Good, average or bad, it is necessary to note the presence of PB, food debris, tartar, pigmentation
- Halitosis : gastrointestinal, renal, hormonal, drug-induced, metabolic or broncho-respiratory
- Salivary flow:
1- The interrogation:
- Specify difficulty swallowing or frequent thirst.
- Reveals the need to soak food to facilitate swallowing.
2- the appearance of the mucous membranes: In the case of a dry mouth the mucous membranes are red, dry, associated with angular cheilitis.
3-sugar test: place a piece of sugar under the tongue, note the time needed for it to melt: – Normal 1mm.
– Hyposialia + 3 min.
– Hypersialia – 1 min.
4-Salivary PH: The test is carried out using a PH meter placed under the tongue.
5- viscosity: assessed between 2 fingers by the appearance of a salivary filament.
- The state of the mucous membranes: Any changes in the oral mucosa should be noted in search of an infectious or tumoral focus, so the labial, jugal, palatine, lingual floor and peripharyngeal mucosa should be systematically examined.
Lips: note the indentations caused by the occlusion,
The jugal mucosa:
The lingual mucosa:
The palatine mucosa:
The floor of the mouth:
Inserting brakes and bridles: chaput test
Examination of the superficial periodontium: See TD
The survey:
- Why probe?
- How to probe?
- When to probe? See TD
- What to probe?
Dental examination:
Teeth are examined to detect:
- Missing teeth: dental formula
- Treated teeth and iatrogenic restoration
- Dental lesion: all dental lesions must be looked for; fracture, cracks, cavities, enamel dysplasia, and the pulp vitality test, dental discoloration must be done.
- Hypersensitivity: it is felt by the patient during physical, chemical and thermal changes on the exposed root surfaces
- Pathological or secondary dental migration: Secondary dental movement resulting from bone lysis or dental extraction is frequently observed on teeth in the horizontal direction “diastema” and in the axial direction “egression”
- Abrasions: encountered mainly in bruxism, tension, or in nervous subjects, these abrasions are evaluated using indices according to AGUEL
- Mobility: Using two dental instrument handles
“Tweezers” apply alternating pressure to the vestibular and lingual surfaces of each tooth, this mobility is assessed with a coded index from 0 to 4 according to ARPA
Occlusal Examination:
| Incisors | Canines | Molars | |
| Vertical direction | Overbite 2 to 3mm | Recovery | recovery |
| Antero-posterior | Over jet 2 to 3mm | Angle Dog Class | Angle molar class |
| Transverse | PII Coincidence | Canine overhang | Molar gearing |
Prematurities: defined by anterior or posterior occlusal contacts, occurring before the PIM during closing movements, these prematurities are avoided by a reflex deviation of the closing path, the examination is done using articulating paper or wax calibrated in PIM
Propulsion movement
The clinical examination
Laterality movement
The clinical examination
Group function
Anterolateral function
The clinical examination
The closing path: It is appropriate not only to measure the mouth opening in maximum amplitude, but also to check this opening path
The path of the mandible is observed during opening, carefully observing the movement of the tip of the chin or the lower inter-incisal point , from the maximum inter-cuspation occlusion to the opening.
Review of functions : see TD
Chewing, swallowing, phonation, breathing
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.