diagnosis and treatment planning in partially edentulous arches

purpose and uniqueness of rx, shared decision making

what to do during patient interview

general examination, oral examination

what to do during clinical examination

interpretation of examination data, development and phases of rx plan

what to do during treatment planning

diagnosis

the determination of the nature of disease

treatment plan

the sequence of procedures planned for the treatment of a patient after diagnosis

chief complaint

a subjective statement made by a patient describing the most significant or serious symptoms or signs of illness or dysfunction. it is stated in the patient’s own words

history of present illness

a description of the development of the patient’s present illness. it is a chronological description of the progression of the patient’s present illness from th first sign and symptom to the present

chief complaint and its history, medical history review, dental history review especially related to previous prosthetic experiences, patient expectations

patient interview

• the dentist should follow a sequence that includes:

medical examination, oral examination

clinical examination involves 2 stages:

systemic disorders, medical history, diets, habits

a comprehensive medical history includes:

visual examination-intra oral and extra oral, pain relief and temporary restorations, radiographs, evaluation of abutment and periodontium, vitality test of individual teeth, determination of the floor of the mouth position, oral prophylaxis and impression of each arch

an oral examination should be accomplished in the following sequence

tmj tenderness, mouth opening deviation and clicking

extra oral examination

ausculation, lateral palpation of tmj, posterior palpation of tmj

temporo mandibular joint examination

number of teeth present with their clinical evaluation, malposed teeth, caarious teeth, existing restoration-sensitivity to percussion, periodontium, residual ridges, saliva, occlusion and occlusal plane, oral hygiene index

intraoral examination

inspection, palpation, percussion, probing, auscultation, olfaction, aspiration

methods of clinical examination

inspection

methods of clinical examination

• uses the visual sense

contour, color, surface texture, inspection by magnifying lens, transillumination

by inspection, many findings could be noticed as:

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transillumination

a visual diagnostic method that relies on the passage of light through relatively thin

proper positioning of the patient on the dental chair, adequate light source as room light, dental unit light and sometime mirror light, complete dryness using compressed air, manual chip syringe, suction tips and cotton or gauze pieces, retraction could be done by plastic retractors, mirror top, wooden tongue depressor or even the examiner fingers, special materials as disclosing tablets could be used to detect bacterial plaque

proper and successful inspection requires the following:

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palpation

methods of clinical examination

• is the examination method that relies on the sense of touch

bimanual

palpation techniques

• it is the manipulation of the tissues using two hands or two fingers of both hands. it is used for examination of cheeks, floor of the mouth and to detect the presence of salivary gland stones

bidigital

palpation techniques

• using two fingers of one hand. used usually for lips and buccal mucosa

bilateral

palpation techniques

• used to compare symmetrical structures such as tmj, muscles of mastication, lymph nodes, two lobes of thyroid gland

consistency, mobility, extent, size and shape, fluctuance, surface temperature, vibrational sensation, diascopic examination

features that can be revealed by palpation include:

percussion

methods of clinical examination

• it is the striking of the tissues (soft or hard) with fingers or an instrument

tenderness, pain

percussion is used to evaluate — and —

listens to the resulting sound or watches the patient’s reaction

percussion

• striking the tissues with the fingers on an instrument, the examiner —

acute

percussion

• localize tenderness and pain more exaggerated in — rather than chronic cases

tenderness to percussion, tooth movement and sound

percussion

• three characteristics are noted

apical peridontitis

greater tenderness to percussion in an apical direction suggests —

lateral peridontitis of gingival origin

greater tenderness to percussions in a lateral direction suggests —

probing

methods of clinical examination

• is the use of a slender device to identify or determine the extent of a narrow tract or cavity

explorer which is sharp ended, curved or angulated or periodontal graduated probe with blunt end

the dental probe may be:

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auscultation

methods of clinical examination

• is the diagnostic process of listening to sounds made by various body parts

olfaction

methods of clinical examination

• the sense of smell occasionally contributes to diagnostic information

aspiration

methods of clinical examination

• withdrawal of fluids from body cavity. it is used for cultures and sensitivity tests to identify the pathogen

fetid

odor of bacterial infection ANUG

garlic or bad

odor of chronic periodontitid

acetone

odor in diabetes

urine smell

odor in renal failure

collection and evaluation of data, pain, infection control, biopsy, patient motivation

development of treatment plan

• phase I

removal of deep caries, extirpation of necrotic pulp, extraction of non-retainable teeth, periodontal treatment, interim prosthesis, occlusal equilibrium, patient education

development of treatment plan

• phase II

pre-prosthetic surgical procedures, definitive endodontic procedures, definitive restoration of teeth, fixed partial denture construction, reinforcement of education and motivation of the patient

development of treatment plan

• phase III