Treatment Planning The Comprehensive Exam

Flashcards covering key topics from a dental treatment planning lecture, including extraoral and intraoral exams, periodontal and radiographic assessments, hard tissue and caries exams, endodontics, orthodontics, occlusion, and diagnostic tools.

What are some key observations during an Extra Oral Exam?

Unusual gait or habits, localized swelling, bruises/abrasions/scars, signs of trauma, asymmetrical facial swelling, anxious patient.

Key Steps of a TMJ Exam

Palpate temporalis, condyle, and masseter; measure opening; notice deviations; listen for clicks/crepitus; ask about discomfort.

What are the main components of the Intraoral Exam?

Soft tissue exam (oral cancer screening), missing teeth, periodontium, existing restorations, endodontics, occlusion, tooth malposition.

Anatomic Locations for Soft Tissue Exam

Lips, labial mucosa, frenum, parotid gland duct, palatine tonsils, floor of mouth, submandibular/submental glands, hard/soft palate, uvula, oropharynx, lateral/base of tongue.

Characteristics of a Sinus Tract

Yellow, red, or raised bump intraorally; may have purulence when pushed; can track with gutta percha point radiographically.

Components of the Periodontal Exam

Probing depths and recession, mobility/fremitus, attached gingiva, inflammation, alveolar bone defects, furcation involvement.

When to Refer to a Periodontist or Extract

Deep pockets not responding to SRP, mobility (stage 1, 2, or 3), restorative needs, opposing dentition, furcation involvement.

Types of Dental Radiographs

Panoramic, full mouth series, periapical, bitewings, occlusal, TMJ, CBCT.

Factors to Consider When Determining Which Radiographs to Take

Chief complaint, caries risk, previous radiographs, FMX/pano within 5 years. Radiograph needs are NOT based on insurance coverage.

Radiographic Assessment (Periodontal)

Lamina dura, crown/root ratio, interproximal bone, hypercementosis, furcation, calculus

Radiographic Assessment (Caries/Endo)

Periapical pathology, caries, existing restorations (recurrent decay, overhang).

Radiographic Assessment (Osseous)

Pathology, opacities/radiolucencies, root morphology (for oral surgery or endo), retained roots, supernumerary/unerupted teeth.

Radiographic Signs of Periapical Lesions of Endodontic Origin

Loss of lamina dura; radiolucency at apex; check lesion size compared to older radiographs.

What to Look for on a Panoramic Radiograph

Impacted teeth, abnormal pathology, periapical radiolucency, TMJ.

Key Steps in Hard Tissue/Caries Exam

Visual/tactile senses, review radiographs, dry teeth.

Definition of Cavitation

Break in tooth surface.

Probes Used for Caries Assessment

Perio probes or ball-ended probes are used due to Sharp explores may lead to false‐ positive findings, especially in pits and fissures, and may damage fragile enamel surfaces associated with early caries lesions.

Evaluating Existing Restorations

Proximal overhangs, recurrent decay, marginal gap, fractures.

Components of Endodontic Exam

Use cold test, EPT, percussion, palpation; assess perio depths, tooth slooth, clinical exam, and radiographic findings.

Cold Test Materials

Cotton pellet (#2) held by stainless steel cotton forceps produces colder temperatures in the pulp.

What to say to your patient during the Endo Exam

Mutter a phrase similar to “When you feel the cold on the tooth, even if it isn’t painful raise your left hand.”

Electric Pulp Testing (EPT)

Uses gradual electrical current to excite pulpal tissue; positive result indicates vitality, no response indicates non-vital pulp.

Signs of Vertical Root Fracture

Pain on biting/release, percussion sensitivity, sinus tract, J-shaped radiolucency, narrow increase in probing depth.

Assessment in Orthodontic Exam

Malocclusion, Angle classification, dentofacial esthetics, function, individual tooth rotations, overjet/overbite/crossbite, lip competency.

Principles of Ideal Ortho-Occlusion

Mutually protected occlusion, cusp-to-fossa occlusal scheme, minimum one contact per tooth, cuspid rise/group function, no posterior contacts in protrusive, no cross-tooth balancing contacts, eliminate fremitus, obtain neurological release.

Uses of Diagnostic Casts

3D record of occlusion; shows space constraints/plans; used for diagnostic wax-ups, RPD design, surgical stents, essix retainers.

Standard Diagnostic Photos

Full face, smile, at-rest anterior, open from anterior, R/L buccal, Mx/Mn occlusal with mirror.