Oral Diagnosis and Treatment Planning Chapter 28 Copyright

Chapter 28 Lesson 28. 1 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Pronounce, define, and spell the Key Terms. List and describe the examination

Learning Objectives (Cont’d) Differentiate between anatomic and geometric diagrams for charting. Chart the correct

Introduction Sound dental care begins with a thorough examination of the head and neck

Reasons a Patient Seeks Dental Care As a new patient For an emergency or

Techniques Used for Assessment Visual evaluation provides an overall assessment of existing conditions. Soft

Techniques Used for Assessment (Cont’d) In palpation, the examiner uses the fingers and hands

Techniques Used for Assessment (Cont’d) Radiography, both intraoral and extraoral, provides indispensable tools for

Fig. 28 -3 (left) Example of an intraoral bite-wing radiograph. Fig. 28 -4 (right)

Techniques Used for Assessment (Cont’d) Intraoral imaging allows the use of a video system:

Fig. 28 -5 An intraoral imaging system is used to make a diagnosis and

Techniques Used for Assessment (Cont’d) Intraoral and extraoral photography Ø Provides a visual means

Fig. 28 -6 Photographs are taken to provide a visual evaluation of the patient.

Recording the Dental Examination Specific criteria that must be known before charting: Black classification

Fig. 28 -7 Black classification of cavities Copyright © 2009, 2006 by Saunders, an

Fig. 28 -8 Example of a geometric diagram for charting conditions of the mouth.

Fig. 28 -9 A, Universal numbering system. Copyright © 2009, 2006 by Saunders, an

Fig. 28 -9 B, International Standards Organization System/Fédération Dentaire International System. Copyright © 2009,

Fig. 28 -9 C, Palmer notation system Copyright © 2009, 2006 by Saunders, an

Fig. 28 -10 Example of color coding, with red used for existing problems and

Fig. 28 -11 Example of charting conditions of the mouth. Copyright © 2009, 2006

Chapter 28 Lesson 28. 2 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Describe the need for a soft-tissue examination. Describe the pocket depth and

Soft-Tissue Examination Extraoral features Face, neck, tissue changes, skin abrasions, lips Ø Cervical lymph

Examination and Charting of the Periodontium Specific periodontal findings to be recorded: Overall health

Dental Mobility Scale Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc.

Description of Probing Scores Copyright © 2009, 2006 by Saunders, an imprint of Elsevier

The Treatment Plan Levels of care Level I, emergency care, relieves immediate discomfort. Ø

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Learning Objectives Pronounce, define, and spell the Key Terms. List and describe the examination and diagnostic techniques used in patient assessment. Discuss the role of the dental assistant in the clinical examination. List the six categories of the Black classification of cavities. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives (Cont’d) Differentiate between anatomic and geometric diagrams for charting. Chart the correct restorative material for either an existing restoration or a required treatment. Chart the correct symbol for either an existing restoration or a required treatment. Explain the color coding of a chart diagram. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Reasons a Patient Seeks Dental Care As a new patient For an emergency or a specific problem For consultation with a specialist As a returning patient for continued care Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Techniques Used for Assessment Visual evaluation provides an overall assessment of existing conditions. Soft tissue Ø Tooth structure Ø Restorations Ø Missing teeth Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Techniques Used for Assessment (Cont’d) In palpation, the examiner uses the fingers and hands to evaluate hard and soft tissue. Instrumentation is the use of instruments to examine the teeth and surrounding tissues. Detection Ø Probing Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Techniques Used for Assessment (Cont’d) Radiography, both intraoral and extraoral, provides indispensable tools for identifying: Decay Ø Defective restorations Ø Advanced periodontal conditions Ø Pathologic conditions Ø Developmental conditions Ø Abnormalities Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 28 -3 (left) Example of an intraoral bite-wing radiograph. Fig. 28 -4 (right) Example of an extraoral panoramic radiograph. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Techniques Used for Assessment (Cont’d) Intraoral imaging allows the use of a video system: To magnify an image for better evaluation Ø For easier access to difficult areas Ø For photocopying images for insurance purposes Ø For case simulation or presentation Ø For medical and legal documentation Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Techniques Used for Assessment (Cont’d) Intraoral and extraoral photography Ø Provides a visual means of identifying and understanding specific problems. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Recording the Dental Examination Specific criteria that must be known before charting: Black classification of cavities Ø Tooth diagrams Ø Tooth-numbering systems Ø Color coding Ø Charting Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 28 -8 Example of a geometric diagram for charting conditions of the mouth. (From Gaylor LJ: The administrative dental assistant, ed 2, St Louis, 2007, Saunders. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 28 -10 Example of color coding, with red used for existing problems and black or blue for treatment that is completed. (From Gaylor LJ: The administrative dental assistant, ed 2, St Louis, 2007 Saunders. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives Describe the need for a soft-tissue examination. Describe the pocket depth and bleeding index of the gingival tissues and how to record them. Discuss the importance of a treatment plan. Chart the findings of the periodontal examination correctly. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Soft-Tissue Examination Extraoral features Face, neck, tissue changes, skin abrasions, lips Ø Cervical lymph nodes Ø Temporomandibular joint Ø Oral habits Ø Intraoral features Interior of the lips Ø Oral mucosa Ø Tongue Ø Floor of the mouth Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Examination and Charting of the Periodontium Specific periodontal findings to be recorded: Overall health condition of gingiva Ø Signs and location of inflammation Ø Location and amount of plaque and calculus Ø Areas of unattached gingiva Ø Areas of periodontal pockets larger than 3 mm Ø Presence of furcation involvement Ø Dental mobility scale Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Treatment Plan Levels of care Level I, emergency care, relieves immediate discomfort. Ø Level II, standard care, restores the patient to normal function. Ø Level III, optimum care, restores the patient to maximum function Ø Presentation of treatment plan Recording of dental treatment Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.