IN THE NAME OF GOD

EXAMINATION of the TEETH

TECHNIQUES and MATERIALS The primary examination techniques for evaluating the teeth include visual inspection,transillumination,probing,palpation,percussion and the evaluation of finction.

REQUIRED TOOLS A good light source, a mirror, a sharp explorer, and an air syringe are the most basic tools required.

VISUAL INSPECTION It should begin prior to cleaning the teeth and prior to instrumentation. The visual inspection, the systemic observation of the entire dentition as a unit , can be performed with a dental mirror and a good light source.

INFLAMMATION If the distribution is generalized, the patient’s home care and need to be addressed. Localized area of gingivitis may be the result of existing caries or of a tooth that is out of its normal alignment and therefore has surfaces that are difficult to reach with normal

Localized gingivitis near to restoration may be because of :deficiency in contact, an overhanging restoration, recurrent caries, or a poorly contoured restoration.

CARIES PATTERN Caries usually occurs in pit and fissures. Any unusual pattern of caries should be explored to determine the cause. Important : if the caries involves multiple cervical surfaces and perhaps even incisive surfaces, an unidentified cause of xerostomia must be investigated.

Missing teeth Clinically missing teeth require investigation through questioning the patient regarding the history of removal, through radiographs to locate unerupted or impacted teeth, or through the missing teeth as an oral manifestation of a systemic disease or genetic abnormality. The sequela of missing teeth : supraeruption,tilting,drifting, or rotation,all of which may have an impact on the treatment plan.

Size,color,and structural changes Changes from the normal appearance of teeth are based on color, size, or structural defects and are important to recognize. These changes can be: Localized generalized

ERUPTION PATTERN A retained anterior primary tooth while the remaining maxillary teeth are erupting normally, a radiograph is indicated to rule out an impacted mesiodens. It is also helpful to know when calcification of enamel occurs because many defects of enamel are the result of an interruption of that process.

DETECTION OF CARIES The completion of the visual inspection as well as the instrumentation of the teeth for caries is more reliable in a clean mouth with the teeth dried

PROBING Caries in the pits and fissures of teeth may be detected with a sharp explorer that is pressed into the pit perpendicular to the occlusal plane. All pits and fissures must be examined carefully because only one spot may exist in which the enamel is no longer intact.

Signs of decay: Softening at the base of the pit or fissure. Opacity surrounding the pit or fissure indicating undermining or demineralization of the enamel. Softened enamel that may be flaked away by the explorer.

Caries develop on the smooth surface Smooth surfaces caries on buccal or lingual surfaces usually begins with white decalcification in the enamel along cervical margins and can be seen when the teeth are dried. These decalcified areas may have surface breaks where the enamel has eroded but may still be caries free.

Controlling the explorer is especially important in this area( on surface) because it has a tendency to slide over the smooth curve surfaces of the teeth and injure the gingiva. Using the third to fourth fingers as fulcrum rest near the tooth examined helps one to exert enough pressure without losing control.

ROOT CARIES Root caries may be found below the CEJ or involving both the root and the cervical enamel. Root caries is often discolored, but discoloration alone does not indicate existing caries. Radiographs are excellent for detecting root caries interproximally.

As more eldery patients seek dental care, root caries will be seen more often.Xerostomia must also be ruled out and managed if several root caries exist.

INTERPROXIMAL SMOOTH LESIONS Interproximal smooth lesions in the posterior teeth are difficult to explore because one must distinguish between the explorer wedged by contact area. Radiographic evidence of caries should be relied on for early lesions. In advanced lesions , a white chalkiness opalescent discoloration appears beneath the enamel of the marginal ridge.

When the light source is moved from side to side , this discoloration may seem to move as well and is evidence of cries penetrating the dentine. If the adjacent tooth has been lost , the interproximal surface may show evidence of some enamel involvement.

Transillumination Detecting ant. interproximal caries lesions. By viewing the lingual or palatal surface of the patient’s teeth with a mirror and strong light shining on the labial surfaces, minor defects in enamel can be seen. Some times it’s more reliable than ant.periapical radiographs. When the teeth is overlaped both clinical and radiographic methods are compromised.

RECURRENT CARIES/defective restorations Evaluation for recurrent caries involves techniques similar to those for detecting new caries. Methods: Probbing margins of restorations Transillumination of class III and IV restorations. radiographs

Restorations may be considered defective if they no longer perform the function for which they were placed , if they are unaesthetic,or if they cause harm. Ditches and voids in restoration have ability to retain food and plaque that could lead to recurrent caries.

Occlusal restorations may have a wider tolerance for rough margins because the occlusal surfaces are readily cleanable , whereas the same roughness on n interproximal margin may result in an undesired gingival response. Dental floss passed interproximally can detect interproximal caries lesions, overhanging restorations, and contact areas that are too tight or inadequate.

A restoration also must be evaluated for: Anatomic contour Marginal ridge compatibility Proximal contact Added to what said before: Recurrent caries Defectiveness of restorations

Treatment planning considerations You must consider: Patient’s age Systemic health Diet Clinical findings The location of caries, the amount of enamel, dentinal and or cemental involvement , and the length of time can determine the type of restorative material to be used

DETECTION OF PULPAL DISEASE

PULP TESTING Pulpal evaluation through the electrical pulp test, application of heat and ice, or preparation of a test cavity may be indicated to determine the pulpal status of teeth. Usually all three means of determining pulpal vitality are used.

ELECTERICAL METHOD: Switch button must be presses as the control is slowly increased until the patient reports slight pain. Important: it’s best to tart with a tooth believed to be normal and to observe the patient’s response.

In early pulpitis: pain persists when the stimulus has been removed, whereas in healthy pulp, the sensation disappears within 5 seconds.

Identifying a cracked tooth Identifying an individual tooth with a crack requires selective pressure on individual cusps by: Rubber polishing wheels Orange wood stick Tongue blades Light reflected from various directions, specially once a deep restoration has been removed And also disclosing can be useful

PERCUSSION A tooth with a large carious lesion should be checked for percussion sensitivity by tapping the tooth lightly with mirror handle. What can cause pain on percussion? Inflammation in the PDL and pulp Incomplete fracture in dentine (cracked tooth) Presence ankylosis Sinusitis (positive response to several posterior maxillary teeth)

MOBILITY TESTING Mobility can be checked by attempting to move the tooth with two rigid instruments such as mirror handles. Mobility is measured from 0-3 What causes mobility? Recent removal of orthodontic appliances Loss of periodontal support Trauma from blow or malocclusion Periapical disease

Evaluation of the occlusion It involves how the teeth fit together and functional occlusion, and the position of the teeth in relation to the TMJ and muscles of mastication. The practitioner also assesses the relationship of the anterior teeth, specifically, the amount of overjet , over bite, the vertical overlap.

Angle classification Class l Class ll Class lll Important:class ll has 2 division: The maxillary interior teeth protrude labially The maxillary central incisors are lingually inclined

Functional occlusion Centric occlusion:teeth are in intercusspation,when patient swallows. Centric relation: the position that condyles are in the most post. & sup. position in glanoid fossa. Protrusive excursion: mandible protruded,ant. teeth touch & the post. Teeth disocclude Lateral excursion: moving the jaw laterally when teeth are in c.o Mounted diagnosis casts, articulating paper, waxes are used in evaluating the occlusion.

Diagnostic casts Moreover , many features are more easily seen on casts than in the mouth. Diagnostic casts allow the study of th occlusion , specifically , The shape of the dentition the architecture of the supporting structures, the presence or absence of occlusal facets, the denture space, and much more, even in the absence of patient.

Radiographs Exposed radiographs are an indispensable aid to the diagnosis of periodontal disease, caries, periapical disease, and other disorders.

Recording of findings A perfect examination of the teeth is meaningless unless the findings are recorded in such a way that the examiner nd others to whom the patient may be referred can understand them. The numbering system used in one’s dental training is not universal. therefore , when corresponding or writing articles, the name of the tooth is best used.

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