Examination and Methods of Diagnosis and Treatment Planning

 

Examination

• Clinical examination

  • Inspection/ Visual

    • Extraoral
      • facial asymmetry or
      • distention of tissues.
      • localized swelling,
      • presence of bruises, abrasions, scars or any other signs of trauma
      • size of pupils which may signify systemic disease, premeditation or fear
    • Intraoral
      • Oral hygiene status
      • Amount and quality of restorative work
      • Prevalence of caries
      • Missing tooth
      • Presence of soft or hard swelling
      • Periodontal status
      • Presence of any sinus tracts
      • Discolored teeth
      • Tooth wear and facets.

  • Palpation

    • Extraoral

      • localized swelling (salivary gland, submandibular)

        • look for
          • Local rise in temperature
          • Tenderness
          • Extent of lesion
          • Induration
          • Fixation to underlying tissues, etc

      • TMJ

        e patient is asked to open the mouth and

        perform lateral excursion to notice (Fig. 8.5).

        • Any restricted movement
        • Deviation in movement
        • Jerky movement
        • Clicking
        • Locking or crepitus.

      • Lymph Nodes

        lymph node enlargement, tenderness, mobility and consistency

      

    • Intraoral

      digital pressure tocheck any tenderness in soft tissue overlying suspected tooth

      • Sensitivity may indicate inflammation in periodontal ligament surrounding the affected tooth.

  • Percussion

    • Periodontal status

    • Percussion of tooth indicates inflammation in periodontal ligament which could be due to trauma, sinusitis and/or PDL disease.

    • How?

      gentle tapping with gloved finger or blunt handle of mouth mirror

      Each tooth should be percussed on all the surfaces of tooth until the patient is able to localize the tooth with pain. Degree of response to percussion is directly proportional to degree of inflammation.

      

  • Auscultation

    Daerah TMJ terdengar suara clicking

  • Exploration

    Menggunakan alat eksplorer/ probe

Intraoral examination

Pemeriksaan

• Anamnesis- dari pasien

  • Data diri
  • Onset (kapan
  • Location (setempat, menjalar)
  • Duration
  • Characteristic (tajam, spontan, berdenyut)
  • Aggravating (memperburuk)
  • Relieve (meredakan, meringankan)
  • Treatment (sudah dirawat apa saja
  • Keluhan Utama
  • Riwayat Medis
  • Riwayat Dental

• Periodontal Evaluation

  • Assessed by?
  • Change?

• Carious Lesions Evaluation

  • Diagnosed by?

    • Visual changes in tooth surface
    • Tactile sensation while using explorer
    • Radiography—Definite radiolucency indicating a break in the continuity of enamel is carious enamel
    • Transillumination.

  • Presence

    A translucency producing a characteristic shadow on the proximal surface indicates presence of caries.

• Evaluation of Existing Restorations

  • Assessed?
    • visual examination,
    • tactile and
    • clinical examination using radiographs.
  • Presence?

    • Proximal overhangs:

      Proximal restoration is evaluated by moving the explorer back and forth across it. If the explorer stops at the junction and then moves onto the restoration, an overhang is present. This should be corrected, as it can result in the inflammation of the adjacent soft tissues.

    • Marginal gap or ditching:

      It is the deterioration of the restoration-tooth interface on occlusal surfaces as a result of wear or fracture. Shallow ditching, less than 0.5 mm deep usually requires patchwork repair. If ditch is too deep, restoration should be completely replaced.

    • Amalgam blues:

      These are the discolored areas seen through the enamel in teeth. The bluish hue results either

• Pulp VItality Test

  • Pulp vitality tests attempt to examine the presence of pulp blood flow, as this is viewed as a better measure of true health than sensibility.

  • Thermal test

    • Cold test → ethyl chloride / dry ice
    • Heat test → gutap/compound stick yang dipanaskan
    • Tahapan
      1. Isolasi tanpa frenulum (11)
      2. Spray keringkan (11,21)
      3. Chloe Ethyl ke cotton pellet→ semprot salju
      4. Gigi Sehat (kontrol) dingin? VITAL
      5. Ulangi 3,4
      6. Tes kavitas terdalam mengarah pulpa. SAkit? VITAL
      7. Tes jarum K file→ pasang rubber stop masukkan perlahan, hitung brapa mm
      • Sakit di ruang pulpa= VITAL
      • di saluran akar? (setelah orifice)= NON VITAL

  • Electrical pulp testing

    A positive response indicates the vitality of pulp.

    No response indicates nonvital pulp or pulpal necrosis.

  • Test cavity

    A positive response indicates the vitality of pulp. No

    response indicates nonvital pulp or pulpal necrosis.

  • Anesthesia testing

  • Bite test.

    This test helps if patient complains of pain on mastication.

    Tooth is sensitive to biting if pulpal necrosis has extended

    to the periodontal ligament space or if a crack is present

    in a tooth

• Objektif

  • Klinis

    • Visual dan taktil
    • Colour
    • Contour
    • Consistency

  • Tes Termal

  • Electrical Pulp Testing

  • Radiografik

    lesi radiolusen→ Nekrosis pulpa, kecuali periodontitis

Methods of Diagnosis

• Metode Konvensional

  • Visual
  • Transluminasi
  • Sondasi
  • Dental Flosh

• Metode Alternatif

  • Digital radiography
  • DIAGNOdent
  • Quantitative Light-Induced Fluorescene (QLF)
  • Fiber Optic Transillumination (FOTI)
  • Electronic Caries Monitor (ECM)

• Visual-Tactile Method

  • Konvensional
    • Tactile →perceptible by touch
    • Visual
  • Advances
    • Ultrasonic Illumination
    • Ultrasonic Imaging
    • Fiberoptic Transillumination (FOTI)
    • Wavelength dependent FOTI
    • Digital-Imaging FOTI (DIFOTI)

• Radiographic Method

  • Conventional
    • Intraoral Periapikal
    • Bitewing radiographs
    • Panorex radiographs
    • Xeroradiographs
  • Advance
    • Digital Imaging
    • Computerized image analysis
    • Magnetic resonance microimaging (MRMI)

• Electrical Conductance Measurement

• Lasers

  • Argon laser
  • Diode laser
  • Qualitative laser fluorescence
  • Diagnodent

Treatment Planning

• Urgent Phase
• Control Phase
• Holding Phase
• Definitive Phase
• Maintenance Phase