 Initial intake interview

 Introduction to dental procedure

 Oral examination, indices, oral hygiene
instruction
 Diagnosis and treatment planning
 Do the treatment
 Evaluation
• GOOD HISTORY
• ACCURATE DIAGNOSIS
• APROPRIATE TREATMENT PLANNING
• STANDARD FORM (DENTAL/MEDICAL
RECORD)
 COMMUNICATION
VERBAL OR NON VERBAL
 EMPATY
 REMEMBER- GUARDIAN- DENTIST -
CHILDREN – RELATIONSHIP
 BEHAVIOR ASSESMENT
 HOW TO COMMUNICATE WITH
CHILDREN OR GUARDIAN IS THE KEY OF
SUCCESFULL TREATMENT
 CHILDREN ARE BAD HISTORIAN
 SOCIAL ( NAME, AGED, ADDRES,
PARENTAL OCCUPATION ETC)
 MEDICAL HISTORY
 DENTAL HISTORY
 CLINICAL EXAMINATION
 EXTRA ORAL
 INTRA ORAL
 RADIOGRAPHIC
 HISTORY OF PREGNANCY, DELIVERY
 SYSTEMIC REVIEW (CARDIAC,
HAEMATOLOGICAL, HEPATITIS, EPILEPSY
ETC)
 HOSPITALIZATION
 MEDICATION
 GENERAL APPEARANCE
 HEAD AND NECK
 SOFT TISSUE
 PERIODONTAL TISSUE
 OCCLUSION
 TEETH
 Early Childhood
caries
 Multiple
interproximal and
smooth surface
lesions
 Multiple incipient
lesions
 THE DETERMINATION OF THE NATURE OF
A CASE OF DISEASE (DORLAND’S)
 Diagnosis is the determination of the nature of
a diseased condition by careful investigation of
its symptoms and history
 Medical History Review
 Subjective History
 Objective Testing
 Analysis of data collected – Clinical
diagnosis
 Plan of Action
 Review/update written medical questionnaire
 Medications
 Allergies
 Need for SBE prophylaxis
 Diabetes
 Pregnancy
 Written consultation with physician as required
 CLINICAL EXAMINATION
 - CHIEF COMPLAINT
MEDICAL HISTORY
DENTAL HISTORY
EXTRA ORAL EXAMINATION
INTRA ORAL EXAMINATION
• VITALITY TEST
• RADIOGRAPHIC
• BLOOD TEST
• SALIVA TEST
• STUDY MODELS
Chief complaint
 In patient’s own words
 “My tooth hurts when I chew hard foods”
 “I can’t drink cold soda”
Pain History
 Location
 Intensity
 Duration
 Stimulus
 Relief
 Spontaneity
Very poorly localized
 Intermittent
 Throbbing
 Intensified by heat, cold and sometimes chewing
 May be relieved by cold
 Usually severe
 May be well localized
 Deep pain
 Intensified by chewing
 Moderate to severe in intensity
 May be well localized
 Intensified by chewing
 Moderate to severe in intensity
 Gives rise to tentative diagnosis
 Determines urgency of treatment
 Confirmed by examination and special tests
 Visual Examination
 Radiographs
 Percussion
 Palpation
 Mobility
 Thermal tests
 Electric Pulp Test
 Periodontal probing
 Selective anesthesia
 Test cavity
 Transillumination
 Occlusion
 Electric Pulp Test
 Periodontal probing
 Selective anesthesia
 Test cavity
 Transillumination
 Occlusion
 Extra-oral examination
 Facial asymmetry
 Swelling
 Extra oral sinus tract
 TMJ
Extra oral sinus tracts
associated with
necrotic teeth
Intra-oral examination
 Soft tissue lesions
 Swelling
 Redness
 Sinus tract
Acute apical abscess Incision and drainage
A sinus tract should
be traced with a
gutta-percha cone
Hard tissues
 Caries
 Large or defective restorations
 Discolored/chipped teeth
 Always take your own pre-operative
radiograph
 Never make a diagnosis based on
radiographic evidence alone
 Consider taking a bitewing film of
posterior teeth
 Note characteristic appearance of
fractured root
Characteristic J-shaped or halo lesion associated with
fractured root
 A very significant test
 Always compare suspect tooth with adjacent and
contralateral teeth
 Tenderness indicates inflammation in the PDL
 Cause of inflammation may be pulpal or
periodontal
Vertical percussion Horizontal percussion
 Extraoral
 To detect swollen or tender lymph nodes
 Intraoral
 May detect early periapical tenderness
 Identifies soft tissue swelling
 Must compare with other areas
 Reflects the extent of inflammation in the PDL
 Compare with adjacent and contralateral teeth
 There are many causes of mobility besides
pulpal inflammation extending into the PDL
 Cold always used
 Heat rarely used
 Compare reaction with adjacent and
contralateral teeth
 Refractory period of at least 10 minutes
before pulp can be retested accurately
 CO2 Snow

Ice stick
 A direct test of nerve elements of pulpal
tissue
 Vitality versus non-vitality only – not
whether vital pulp is normal or inflamed
 In multi-rooted teeth, where one canal is
vital – tooth usually tests vital
 False positives and false negatives may
occur
False positive reading:
 Electrode contact with metal restoration or gingiva
 Patient anxiety
 Liquefaction necrosis
 Failure to isolate and dry teeth prior to testing
 Periodontal probing pocket depths must be
measured and recorded
 A significant pocket, in the absence of
periodontal disease may indicate root
fracture
 Poor periodontal prognosis may be a
contraindication to root canal therapy
 Initiation of cavity preparation without
anesthesia
 Test of last resort
 Helps to identify vertical crown fracture
 Produces light and dark shadows at
fracture site
A crack will block and reflect the light when transilluminated
 Hyperocclusion – a possible cause of
percussion sensitivity
 Analyze the data gathered via:
 History
 Examination
 Special tests

 Arrive at a clinical (not histologic) diagnosis:

 Pulpal diagnosis
 Periapical diagnosis
 Normal
 Reversible pulpitis
 Irreversible pulpitis
 Necrosis
 Previous endodontic treatment
 Symptoms None
 Radiograph No periapical change
 Pulp tests Responds normally
 Periapical tests Not tender to percussion or
palpation
 Symptoms May have thermal
sensitivity
 Radiograph No periapical change
 Pulp tests Responds – sensitivity not
lingering
 Periapical tests Not tender to percussion or
palpation
 Symptoms May have spontaneous pain
 Radiograph No periapical change
 Pulp Tests Pain that lingers
 Periapical tests Generally not tender to
percussion or palpation
 Symptoms No thermal sensitivity
 Radiograph Dependent on
periapical status
 Pulp tests No response
 Periapical testsDependent on
periapical status
 Normal
 Acute apical periodontitis
 Chronic apical periodontitis
 Chronic apical periodontitis with symptoms
 Acute apical abscess
 Chronic apical abscess
 Condensing osteitis
 Symptoms None
 Radiograph No periapical change
 Pulp tests Responds normally
 Periapical testsNot tender to
percussion or palpation
 Symptoms Pain on pressure
 Radiograph No periapical change
 Pulp tests +/- depending on pulp
status
 Periapical tests Tender to percussion and/or
palpation
High restorations, traumatic occlusion, orthodontic treatment, cracked
teeth, vertical root fractures, periodontal disease and maxillary sinusitis
may also produce this response
 Symptoms None
 Radiograph Periapical radiolucency
 Pulp tests No response
 Periapical testsNot tender to
percussion or palpation
 Treatment decisions are based on:
 Pulpal diagnosis
 Periapical diagnosis
 Restorability of tooth
 Periodontal considerations
 Difficulty of case
 Financial considerations
 RECOGNIZING THE PROBLEM

FORMULATING THE PROBLEM

CARRYING OUT NECESSARY EXAMINATION

INTERPRETATION OF THE RESULT DIAGNOSIS

• PROBLEM LIST
• SYNTHESIS AND DIAGNOSIS
• TREATMENT OBJECTIVE
• TREATMENT
WHAT IS THE IMPORTANT OF SYSTEMIC
CONDITION IN DENTAL TREATMENT?
 THE MEDICAL HISTORY GIVES PERTINENT
INFORMATION AS TO PHYSICAL WELL
BEING OF THE PATIENT
 EXAMPLE CARDIAC MALFORMATION OR
ANOMALY  INDICATION FOR
PREMEDICATION BEFORE TOOTH
EXTRACTION
 ALLERGIC
 7 Year old girl
 Chief complaint, the first primary mandibular
molar hurts when eating , and during night
especially at bed time
 Clinical examination, very large caries, pulpal
exposure
 Radiographic periapical areas not normal,
there is furcation involment
 Not restorable
 DIAGNOSIS ?
 TREATMENT PLANNING?
• Pulp necrosis
• Extraction
• Space maintainer