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Intra oral examination- 1. Soft tissue examination 2
Intra oral examination- 1. Soft tissue examination 2 . Hard tissue examination
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Examination of soft tissues
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Mucosa Gingiva Frenal attachments Floor of the mouth Tonsils Duct orifices
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Manifestations of systemic diseases
Mucosa- ulcerations Growths Discoloration Manifestations of systemic diseases
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Gingiva - Color Contour Stippling Size
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Frenal attachments Maxillary labial frenum at times can be thick and may cause midline diastema Blanch test can be used for confirmation Short lingual frenum can cause ankyloglossia
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Floor of the mouth Important structures seen are submandibular
gland and duct, sublingual gland and duct
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Color changes are seen in hyperkeratotic changes, inflammatory conditions, retention cysts
Enlargement of floor of mouth usually occurs due to cystic lesions, cellulitis
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Tonsils Size and degree of inflammation if present should be examined
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Duct orifices Parotid gland – Stenson’s duct – opens in to vestibule apposite to second maxillary permanent molar Submandibular gland- Wharton’s duct-lateral to lingual frenum Sublingual gland- Rivinus duct- opens in to floor of the oral cavity
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Oral hygiene appraisal
Stains Calculus Gingival enlargement /recession Periodontal pocket Bleeding on probing
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Hard and soft palate Palatal depth Presence of swelling
Mucosal ulcerations Color Clefts
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Examination of hard tissues
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No of teeth Type of teeth Type of dentition Dental caries with pulpal involvement
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Attrition Mobility of teeth ( physiological/pathological)
Grade of mobility
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Angle’s classification
Occlusion Angle’s classification Class 1 Class 11 Class 111 Canine relationship Deciduous occlusion Flush terminal plane Mesial step distal step
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Fracture teeth Type of fracture Fluorosis Grade
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Provisional diagnosis
A general diagnosis based on the clinical impression without doing any laboratory investigations
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Investigations Radiographic investigation
Hematological investigations- Bacteriological culture and sensitivity test Vitality tests Biopsy Photographs Study models
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1) intraoral Intra oral periapical
Radiographs are of two types- 1) intraoral Intra oral periapical Bitewing Occlusal 2) extraoral
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Intraoral radiographs
Intraoral Periapical radiographs- Indications- 1)status of periapical region in deciduous and young permanent teeth 2)evaluation of pulp and endodontic treatment 3)detection of developmental anomalies
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4) to determine pathology involving primary teeth 5)evaluation of status of periodontal ligament
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Bitewing radiograph- Detection of inter proximal caries with respect to depth and with relation to pulp Observation of boundaries of pulp chamber and height of pulp horn
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Location of retained primary roots
Observation of relationship of apposing tooth Observation of location and position of permanent tooth bud and its relationship to primary root
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Occlusal radiograph
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Occlusal radiograph Evaluation of entire maxillary or mandibular arch evaluation of cortical plate expansion location of maxillary sinus or sub mandibular salivary gland calculi
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Extra oral films- Ortho pantomographs – Visualization of both maxilla and mandible is possible in one film Useful in dental age evaluation eruption status of the teeth
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Identification of location of the lesion in the jaws
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Cephalographs Establishment of skeletal and dental anomalies
Evaluation of orthodontic treatment results Useful in the study of skeletal, dental and soft tissue structures in craniofacial region
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Hematological investigations-
RBC count Hemoglobin determination Hemocrit count
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Bleeding disorders- Platelet count Bleeding time Clotting time. ...>Prothrombin time Torniquet test
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Associated with infections-
White cell count (WBC). Differential count
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Bacteriological culture and sensitivity test
Wound, abscess or surgical lesion cultures Caries activity tests Root canal cultures Fresh moist preparations and smears
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Vitality tests Biopsy photographs Study models
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Investigation findings
Positive and negative findings of various investigations should be mentioned
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Differential diagnosis
“The process of listing out two or more diseases having similar signs and symptoms out of which only one could be attributed to patient’s suffering”
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Final diagnosis- “a confirmed diagnosis based on all available data”
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Treatment planning It is a complex process, like solving
Abuzzal. Good and provisional treatment planning is very essential for providing an effective , and efficient treatment with minimum energy ,time and cost.
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Treatment planning Objective of planning treatment:
a. Insures the most effective treatment for the individual patient. b. Insures the most effective sequences of treatment provided . i.e., preventive or, therapeutic.
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Treatment planning….cont
C. Allows the dentist to follow objectives in each phase of the treatment. d. Allows periodic reevaluation of treatment progress and the necessary revision of the treatment plan.
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Treatment planning….cont
c. It Increases patient confidence in the dentist. d. It minimize , energy , time , and cost.
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Phases of the treatment plan
includes:, * Emergency care through ,control of chief complaint. * Medical consultation…, if the patient having any medical problem, which may require the refer of the patient to the specialists. Dental consultation.
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Phases of the treatment plan….cont
* Introduction….The patient introduced to the Dentistry , it is include management of child’s behavioral problems. * collecting all necessary information ( by History, Examination, investigations and Consultation).
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Phases of the treatment plan….cont
* preventive therapy….include, - oral hygiene, diet consoling, prophylaxis, fluoride and fissure sealants appl. phase (3) * surgical & corective phase…. includes * Excavation and temporary filling. * Extraction of hopeless teeth.
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Phases of treatment plan…cont.
* corrective therapy, includes restoration,. amalgam, G.I, and composite ,st .steel .crown, sp. maintainer ,any advanced periodontal therapy and endo- dontic treatment.
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Phases of the treatment plan…cont
- Rehabilitating phase….this involve full mouth rehabilitation i.e, final occlusal adjustment, polishing of the restoration, oral habit appliances, re-evaluation of the oral health, and referral for ortho- dontic treatment.
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Phases of the treatment plan
- Recall phase. -Establishment of recall visits or intervals.
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