Examination of Patients

By Dr. Vishaal Bhat on Sunday 30 December 2007 with 0 comments

An examination should be conducted under a proper lighting, with a patient sitting at the chair of the stomatological unit, by examination tools (dental mirror, dental probe, dental forceps). Results of an examination should be entered into a patient’s medical record which serves for preparing a treatment plan. The first part of an examination is the anamnesis (case history). This part collects data that are related to a patients current illness and could influence a way of patient’s treatment.

Social anamnesis. Some data may indicate professional risks: e.g. higher cariousness at bakers or confectioners. Data about a patient’s habits may also be significant (smoking, drinking hard spirits), in relation to pre-cancerous states and malignant tumors.

Family anamnesis collects data on previous illnesses, surgeries and injuries. Data on cardiovascular diseases, metabolic disorders (diabetes, thyropathy), blood or hemocoagulation changes, allergic or paroxysmal states etc. Sometimes it is necessary to request a written report on a patient’s condition from a specialist. This report must state a proposed extent of a surgical treatment to be conducted.

Stomatologic anamnesis focuses on previous illnesses, surgeries or injuries of the orofacial area, about previous orthodontic, prosthetic treatments or dental surgeries, and about hygiene habits.

Extra-oral examination uses methods that are common in medicine, e.g. aspection, palpation, and also auscultation in the mandibular joint area. Careful examination and a qualified evaluation of its results may suggest a lot on the nature of a patient’s illness.

During an intra-oral examination, an attention is paid to the whole oral cavity. Not only the teeth should be examined, but also the mucosa of alveolar ridges, the tongue, the oral cavity base and the cheeks. Attention should also be paid to the ducts of large salivary glands and the appearance of saliva. Individual teeth are examined with the aid of the dental mirror and the probe so that all tooth surfaces can be inspected. The teeth of the permanent dentition are labeled with Arabic numbers from 1 to 8, milk dentition teeth are labeled by roman numerals from I to V. At present, the most frequently used numbering is that recommended by the international stomatology organization FDI (Féderation Dentaire Internationale). The quadrants of upper and lower jaws are labeled with numbers both for milk and permanent teeth. The permanent dentition quadrants are labeled as follows:

upper jaw right side left side

1 2

lower jaw 4 3

The milk dentition quadrant labeling is the following:

upper jaw right side left side

5 6

lower jaw 8 7

The quadrant number precedes a number that marks an individual tooth. For instance, the upper right canine tooth of the permanent dentition will be marked as 13, the same tooth of the milk dentition will be marked as 53.

Auxiliary examination methods complement the basic clinical examination. Besides some specialized methods (sonography, thermography), the most important is the X-ray examination. The intra-oral X-ray examination provides for an image of teeth and alveolar ridges, the extra-oral X-ray examination renders an image of the facial skeleton or the mandibular joint. Tomography provides for more detailed data by imaging a pre-selected layer of an object in a certain depth. Computer tomography (CT) is utilized in surgical dentistry mainly for imaging of the orofacial area tumors or during some injuries of the upper or middle third of the facial skeleton. The panoramic examination on the Status X instrument yields a surveying X-ray of teeth, e.g. when examining for a focal infection. Concurrent imaging of both jaws, nasal and maxillar sinuses and mandibular joints can be achieved by the orthopantomographic examination, e.g. using the AVANTEX instrument (Chirana). An X-ray exam with the use of contrast compounds is also frequently used. These compounds (e.g. iodinated oils - Lipiodol, or the barium suspension) absorb more X-rays than the surrounding tissues thus creating a positive contrast. This means of examination enables to follow morphological and functional manifestations of normal or pathologically altered organs, especially the large salivary glands (sialography), changes of the maxillar sinuses epithelium (antrography), eventually localization of cysts at the orofacial area (cystography).

Results of these examination methods can help significantly with determination of the correct diagnosis of an illness.

Category: Oral Medicine Notes



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