Professional Documents
Culture Documents
Presented by-
Dr Surbhi Singh
Advantage :-
1) it takes little of the dentist’s time
2) it offers a standardized approach for each patient.
Disadvantage :-
1) Little time to build rapport with the patient
2) The questions or their format may be interpreted inaccurately
by some patient.
3)Combination
1. The combined method is considered by the authors to be
the best appropriate technique for history taking in the
routine practice of Dentistry.
2. This approach uses the advantages of both techniques and
reduces the disadvantages after reviewing a completed
health questionnaires, the dentist discusses the response
with the patient.
8
COMPONENTS-
Statistics Provisional diagnosis
Chief complaint Investigations
History of present illness Final diagnosis
Medical history Treatment plan
Past dental history
Personal history
General examination
Extraoral examination
Intraoral examination
STATISTICS
Patient registration number
Date
Name
Age
Sex
Address
Occupation
Marital status
Patient registration number
Useful for-
1. maintaining a record,
2. billing purposes,
3. medico legal aspects.
Date
Useful for-
1. Time of admission
2. reference during follow up visits
3. Record maintenance.
NAME
to communicate with the patient
to establish a rapport with the patient
Record maintenance
Psychological benefits
AGE
For diagnosis
Treatment planning
Behavioral management techniques
DISEASE MORE DISEASE PRESENT IN
COMMONLY PRESENT CHILDREN & YOUNG
AT BIRTH ADULTS
- Micrognathia - Benign migratory glossitis
- Cleft lip & cleft plate - Juvenile periodontitis
- Ankyloglossia - Pemphigus
- Predecidous dentition - Recurrent apthous
- Teratoma stomatitis
- Hemophilia - Dental caries
- Dentigerous cyst
- Diptheria
- Rickets
- Infectious mononucleosis
DISEASE PRESENT IN ADULTS & OLDER PATIENTS
- Attrision
- Abrasion
- Gingival recession
- Periodontitis
- Lichen planus
- Ameloblastoma ( 30 – 50)
- Trigeminal neuralgia
- Fibroma
- Verrucous carcinoma
- Iron deficiency anemia
- Diabetes
- Hypertension
- Asthma
AGE
used to calculate the dose of the drug.
CHILD DOSE
1) YOUNG RULE = child’s age adult dose
age + 12
2) CLARK RULE
.
OCCUPATION
To asses the socioeconomic status.
Predilection of diseases in different occupations for eg:
hepatitis B is common in dentists & surgeons.
MARITAL STATUS
To see any history of consanguineous marriages.
The high consanguinity rates, coupled by the large
family size in some communities, could induce the
expression of autosomal recessive diseases.
CHIEF COMPLAINT
The chief complaint is usually the reason for the
patient’s visit.
It is stated in patient’s own words in chronological
order of their appearance & their severity.
The chief complaint aids in diagnosis & treatment
therefore should be given utmost priority.
HISTORY OF PRESENT ILLNESS
Elaborate on the chief complaint in detail
Ask relevant associated symptoms
The symptoms can be elaborated in terms of:-
Mode & cause of onset
Duration
Location-localized ,diffuse ,referred, radiating.
Progression- continous or intermittent.
Aggravating & relieving factors
Treatment taken
COMMON CHIEF COMPLAINTS
Pain
Swelling
Ulcer
PAIN
Original Site of pain
Origin & mode of onset
Severity
Nature of pain
Progression of pain
Duration of pain
Movement of pain
Periodicity of pain
Effect of functional activity
Precipitating factors
Relieving factors
Associated symptoms
Treatment taken
a) Anatomical location where the pain felt ?
b) Origin & mode of onset :- activity which inducing the pain should
be taken in consideration.
c) Intensity of pain :- whether the pain is mild , moderate or severe.
d) Nature of the pain :- it can be throbbing , shooting , stabbing, dull
, aching, lancinating, boring, griping, sharp, gnawing, squeezing.
e) Progression of pain:-The patient should be asked ‘how is it
progressing?
The pain may begin on a weak note & gradually reach a peak &
then gradually declines.
It may begin at its maximum intensity & remains at this level this
disappears.
f)Duration of pain-Duration of pain means the period from the time of
onset to the time of pain disappearance.
Temperature
normal temp is 98.6 degree F or 37 degree celsius.
Measured by thermometer.
Respiratory rate
Adult rate–16-24 breaths per minute
Observe
Feel for chest movement
Auscultate
Blood pressure
Systolic- 110-140 mm Hg
Diastolic-60-90 mm of Hg
Measured by Sphygmomanometer.
List of systems reviewed:-
1. Cardiovascular system
2. Respiratory system
3. Central nervous system
4. Gastrointestinal system
5. Genitourinary system
6. Musculoskeletal system
7. Endocrine system
Every system will be examined under the following
headings:-
Inspection
Palpation
Percussion
Auscultation
INSPECTION
Visual assessment of the patient.
Make sure good lighting is available.
Position and expose body parts so that all surface can
be viewed.
Inspect each area of
size, shape, colour, symmetry, position and
abnormalities.
If possible, compare each area inspected with the same
area on the opposite side of the body.
Use additional light to inspect body cavities.
PALPATION
A technique in which the hands and fingers are used to
gather information by touch.
Light Palpation
Apply tactile pressure slowly, gently and deliberately.
The clinician’s hand is placed on the part to be
examined and depressed about 1-2cm.
Deep Palpation
It is done after light palpation.
It is used to detect abdominal masses.
Technique is similar to light palpation except that the
finger are held at a greater angle to the body surface and
the skin is depressed about 4-5 cm.
Bimanual Palpation
It involve using both hand to trap a structure between
them. This technique can be used to evaluate spleen,
kidney, breast, uterus and ovary.
Sensing hand –Relax & place lightly over the skin.
Active hand –Apply pressure to the sensing hand.
Bidigital palpation
It is done by pressing the structure to be examined
between examiner’s thumb & index finger.
Done for evaluation of nodules, lip etc
PERCUSSION
Percussion involve tapping the body with the
fingertips to evaluate the size, border and consistency
of body organs and to discover fluid in body cavity.
Used to evaluate for presence of air or fluid in body
tissues
Sound waves heard as percussion tones (resonance)
Methods of Percussion:-
Mediate or Indirect Percussion
Immediate Percussion
Fist Percussion
Mediate or Indirect Percussion
It can be performed by using the finger on one hand as
a plexor (Striking finger) and the middle finger of the
other hand as a pleximeter (the finger being struck).
Used mainly to evaluate the abdomen or thorax.
Immediate Percussion
Used mainly to evaluate the sinus or an infant thorax.
It can be performed by striking the surface directly
with the fingers of the hand.
Fist Percussion
Used to evaluate the back and kidney for tenderness.
It involves placing one hand flat against the body
surface and striking the back of the hand with a
clenched fist of the other hand.
ASCULTATION
Auscultation is listening to sound produce by the
body.
The following characteristics of sound are noted:-
Frequency or the number of oscillation generated per
second by a vibrating object.
Loudness –Loud or soft
Duration –Length of time that sound vibration last.
Short / medium / long.
Done by stethoscope.
CARDIOVASCULAR SYSTEM
Cardinal symptoms noted during history taking are:-
Dyspnea
Chest pain
Cough
Expectoration
Hemoptysis
Palpitation
Syncopal attacks.
PERCODIUM
It is the anterior aspect of chest that overlies the
heart.
Normally it has smooth contour, slightly convex &
symmetrical.
Bulging Flattened
1. Enlarged heart fibrosis of lung
2. Pericardial effusion congenital deformity
3. Mediastinal tumor
4. Pleural effusion
5. Scoliosis
APEX IMPULSE
Apex is lowermost & outermost cardiac impulse.
It is in 5th left intercoastal space just inside the
midclavicular line.
It is nt visible in the case of emphysema & pericaedial
effusion.
DILATED VEINS
Seen over the chest wall in conditions like intrathoracic
obstruction, superior & inferior vena cava obtruction &
right sided heart failure.
APEX BEAT
the lowest and outermost point of definite cardiac
pulsations can be usually palpated in the 5th intercostal
space within the midclavicular line.
Apex beat absent on left side can be due to:-
1. Dextrocardia
2. Pericardial effusion
3. Thick chest wall
4. obesity
PERCUSSION
It is done to determine the boundaries of heart.
Left border
Patient must be percussed in fourth & fifth space in
mid axillary line & then medially towards the left
border of heart.
The resonant note of lung becomes dull.
Normally the left border is present along the apex
beat.
If it is present outside then it suggests pericardial
effusion.
Upper border
S2( DUB)
The 2nd heart sound, marks the end of systole
(beginning of diastole).
From closure vibrations of aortic and pulmonary valves
Loudest at the base.
Abnormal S2
Loud Second Heart Sound (aortic)
Systemic hypertension
Vocal fremitus
Vocal fremitus is the vibration detected by palpation
with the palm of the hand on the chest, when the
patient is asked to repeat “ninety nine”
-
Added sounds
These are abnormal sounds that arise in the pleura
or lungs
Visual field
Done by confrontation by wiggling fingers 1 foot from
patient ears, asking which they see move.
Color
Ishihara chart
CN III, IV, VI
Look at pupils: shape, relative size and ptosis.
Shine light in from the side to see pupils’s light
reaction.
Ask the patient to follow finger with eyes without
moving head.
CN V
Corneal reflex
Touch cotton wool to other side
Look for blink in both eyes.
Facial sensation
Sterile sharp item on forehead, cheek & jaw; then repeat it with dull object & ask the
patient to differentiate.
If abnormal, then test temperature [water-heated/cooled
tuning fork], light touch [cotton].
Motor sensation
Palpation of the muscle of mastication.
CN VII
First look at the patient's face. It should appear symmetric. That is:
There should be the same amount of wrinkles apparent on either side of the
forehead.
The nasolabial folds (lines coming down from either side of the nose towards the
corners of the mouth) should be equal
The corners of the mouth should be at the same height
Ask the patient to smile. The corners of the mouth should rise to the same height and
equal amounts of teeth should be visible on either side.
Ask the patient to puff out their cheeks. Both sides should puff equally and air should not
leak from the mouth.
CN VIII
Auditory acuity
Rub hands with noise on side of ear.
Weber’s test
Rinne’s test
Vestibular function
Romberg test
Weber Test:
1. Grasp the 512 Hz tuning fork by the stem and strike it against the
bony edge of your palm, generating a continuous tone. Alternatively
you can get the fork to vibrate by "snapping" the ends between your
thumb and index finger.
2. Hold the stem against the patient's skull, along an imaginary line
that is equidistant from either ear.
3. The bones of the skull will carry the sound equally to both the right
and left CN 8. Both CN 8s, in turn, will transmit the impulse to the
brain.
4. The patient should report whether the sound was heard equally in
both ears or better on one side than other (referred to as lateralizing
to a side).
5. The vibrations are normally perceived equally in both ears because
bone conduction is equal. In conductive hearing loss, the sound is
louder in the abnormal ear than in the normal ear. In sensorineural
hearing loss, lateralization occurs to the normal ear.
Rinne Test:
1. Grasp the 512 Hz tuning fork by the stem and strike it
against the bony edge of your palm, generating a
continuous tone.
2. Place the stem of the tuning fork on the mastoid bone.
3. The vibrations travel via the bones of the skull to CN 8,
allowing the patient to hear the sound.
4. Ask the patient to inform you when they can no longer
appreciate the sound. When this occurs, move the tuning
fork such that the tines are placed right next to (but not
touching) the opening of the ear. At this point, the
patient should be able to again hear the sound. This is
because air is a better conducting medium then bone.
CN IX
Examine the palate for uvular displacement
Check for gag reflex.
CN X
Check for gag reflex
Check for taste alteration in posterior part of tongue.
Ask the patient to open their mouth and say, "ahhhh," causing the soft palate to rise
upward.
CN XI
Check for shrugging of shoulders.
Place your hands on top of either shoulder and ask the patient to shrug while you provide
resistance. Dysfunction will cause weakness/absence of movement on the affected side.
CN XII
Inspect tongue for deviations.
EXTRAORAL EXAMINATION
SKIN – is looked for
Appearance-any rashes, sores or itching
Color-anemia patients have pale skin color, yellow tint is
seen in jaundice patients.
Pigmentation
Edema
Temperature
FACIAL SYMMETRY–bilaterally
symmetrical/asymmetrical
LIP COMPETENCY-competent/incompetent
EYE
Inspect external eye structure for-
Position and alignment
Exophthalmoses
Strabismus
Eye lashes : sty.
Indicator of anemia & jaundice.
infection of maxillary teeth may extend to orbital region
causing swelling of eyelid & conjunctivitis.
NOSE
Size-should be 1/3rd of total facial height.
Deviated nasal septum in mouth breathers.
Saddle nose in congenital syphilis.
JAWS
Any deviation in path of closure and opening lateral
movements of mandible.
Tenderness over the joint and muscles of mastication.
Any injuries trauma to the facial bones and jaws should
be examined.
TMJ
clicking or popping
Deviation or deflection while opening
pain or tenderness over joint or masticatory muscles.
Maximal interincisal opening (normal is 35-50 mm)
Range of vertical & lateral movements.
PALPATION OF PRE TRAGUS AREA:
The examiner can be positioned either in front of or behind
the patient.
Palpation
The muscle can be seen and readily
palpated throughout its entire
length and breadth when the
patients teeth are firmly clenched.
The masseter muscle
Origin: from lower portion of the
zygomatic arch .
Insertion: on the lateral surface of
the angle and coronoid process of the
mandible.
ANY ULCER:
Site of ulcer is usually
characteristic
Carcinomatous ulcers and
traumatic ulcers are common
along lateral border of the
tongue.
PALPATION:
While palpating for indurations on
the base of an ulcer, tongue should be
relaxed and at rest within the mouth.
If it is kept protruded the contracted
muscles may give false impression to
induration and lead to error in
diagnosis.
Induration is an important sign in
epithelioma, gummatous ulcers
which is absent in tuberculous ulcer.
Note whether ulcer bleeds on
palpation usually seen in malignant
ulcers.
Palpate the back of the tongue
for any ulcer or swelling.
123
Gingiva
COLOR:
Coral Pink,
Physiological pigmentation may be seen (melanin).
CONTOUR:
Depends on the shape of the teeth and their alignment in the arch,
location and size of the area of proximal contact and dimensions of
facial and lingual embrasures. Scalloped outline on the facial and
lingual surface.
SHAPE:
Is governed by the contour of the proximal tooth surface and the
location and shape of the gingival embrasures.
SIZE: Corresponds to the sum total of the bulk of cellular and
intercellular elements and their vascular supply.
CONSISTENCY:
gingiva is firm and resilient with exception of free gingival margin
gingival fibers contribute to the firmness of the gingival margin.
SURFACE TEXTURE:
“orange peel” referred to as being stippled
it can be viewed by drying the gingiva .
STIPPLING:
will be absent in infancy and old age increases in adulthood.
attached gingiva and central portion of interdental gingiva are stippled;
where as marginal gingiva is not.
stippling is produced by alternate rounded protuberances and
depressions in the gingival surfaces.
POSITION:
refers to the level at which gingival margin is attached to the tooth.
RECESSION:
is exposure of root surface by an apical shift in the position of the
gingiva .
126
CAUSES: Faulty tooth brushing technique
Tooth malposition
High frenal attachment
Trauma from occlusion
Orthodontic movement of teeth
127
Salivary glands
PAROTID GLAND
POSITION: Located below, behind and slightly
in front of the ear.
Swelling of parotid gland obliterates the normal
hollow just below the lobule of the ear.
INSPECTION
Wharton’s duct is inspected by means of torch on the floor of the
mouth which is situated on either side of lingual frenum.
If the gland is infected, slight pressure on the gland will exude pus
through the orifice.
If stone is suspected in one duct saliva will be soon coming out with
normal flow from other orifice while affected duct orifice remains dry.
TEST:
Tested by putting dry sweets on each orifice and
some lemon juice on dorsum of the tongue, 2
minutes after sweets on one side are taken out.
One finger of one hand is placed on the floor of mouth medial to the alveolus and lateral
to the tongue, and pressed on the floor of the mouth as far as possible.
The finger of the other hand on the exterior is placed just medial to the inferior margin
of the mandible.
These fingers are pushed upward as this will help to palpate both the superficial and
deep lobes of submandibular salivary glands.
This also differentiates the enlarged salivary gland from enlarged submandibular lymph
nodes.
Submandibular salivary gland enlargement is a single swelling where as nodular swelling
suggests lymph node enlargement .
131
EXAMINATION OF
SWELLING:
INSPECTION:
SHAPE:
Shape of the swelling should be noted whether it is
ovoid, pear shaped, and kidney shaped, spherical /
irregular.
SIZE:
Always the vertical and horizontal dimensions should
be noted
133
SURFACE:
mucosa will be smooth, ulcerated papillomatous, eroded, keratinized, necrotic.
EDGE:
edges may be clearly defined or indistinct, sessile or pedunculated.
NUMBER:
Some swellings are always multiple e.g. neurofibromatosis, multiple glandular
swelling.
SOLITARY SWELLINGS: Lipoma, Dermoid Cyst.
134
MOVEMENT WITH RESPIRATION:
Swellings that arise from upper abdominal viscera move with respiration
(liver, spleen, stomach, gall bladder).
IMPULSE ON COUGHING:
Swellings which are in continuity with abdominal cavity, pleural
cavity, spinal cavity, or cranial cavity give rise to impulse on coughing.
MOVEMENT WITH DEGLUTITION:
A few swellings which are fixed to larynx or trachea move during
deglutition
Eg thyroid swellings, thyroglossal cyst, pre or para tracheal lymph node
enlargement.
MOVEMENT WITH PROTRUSION OF TONGUE:
Thyroglossal cyst moves with protrusion of tongue.
135
SKIN OVER THE SWELLING:
ANY PRESSURE EFFECT: an axillary swelling with edema of the upper limb
means swelling arising from lymph node .
TENDERNESS:
INFLAMMATORY SWELLINGS: TENDER
NEOPLASTIC SWELLINGS: NON-TENDER
SIZE
DEEPER DIMENSIONS OF THE SWELLINGS REMAIN UNKNOWN DURING
INSPECTION.
SHAPE
VERTICAL AND HORIZONTAL DIMENSIONS ARE BETTER CLARIFIED BY
PALPATION.
EXTENT:
WHETHER MASS IS WELL DEFINED, MODERATELY, POORLY DEFINED.
137
SURFACE:
with palmer surface of the fingers the clinician should palpate the surface of
the swelling .
SMOOTH: cyst
LOBULAR: smooth bumps – lipoma
NODULAR: a mass of matted ln
IRREGULAR AND ROUGH : carcinoma
EDGES OR BORDERS: margins are palpated with the help of tip of the finger.
SMOOTH MARGINS : benign swellings
IRREGULAR MARGINS:malignant swellings
CHEESY: indicates finer tissue that has granular sensation but no rebound
RUBBERY: tissue that is firm but can be compressed slightly and rebound to
normal contour as soon as pressure is withdrawn
139
FLUCTUATION:
swelling fluctuates when it contains liquid or gas .
TEST: is carried out by one finger of each hand. Sudden pressure is applied on
one pole of swelling.
This will increase pressure within the cavity of the swelling and will be
transmitted equally at right angle to every part of its wall.
If another finger is placed on other side of swelling the finger will raise
passively due to increased pressure within the swelling. This means swelling is
fluctuant.
Test is performed in two planes at right angle to each other. Two fingers are
kept as far as possible as size of swelling will allow.
The swelling containing fluid will be softer at the center than its periphery
while solid swelling will be firmer at center than at its periphery (pagets test)
140
FLUID THRILL:
In big swellings demonstrated by tapping the swelling on one side with two finger
while percussion wave is felt on the other side of swelling with palmer aspect of the
hand.
In case of small swellings three fingers are placed over other hand, percussion wave
felt by other two fingers on each side.
141
TRANSLUCENCY:
swelling can transmit light through it for this it should contain fluid like
water,
serum,
lymph or plasma.
for this test, darkness is required
during day time, this can be done by using roll of paper which is held on side
of the swelling while a torch light is held on the other side of the swelling.
the swelling will transmit light if it is translucent.
142
REDUCIBILITY:
the swelling can be reduced and ultimately disappear as soon as it is pressed
upon. Eg) hernia
COMPRESSIBILITY:
swelling can be compressed, but could not disappear completely like arterial,
capillary, venous hemangioma.
143
PULSATALITY:
A SWELLING MAY BE PULSATILE IF IT
ARISES FROM THE WALL OF AN ARTERY
or
LIES CLOSE TO AN ARTERY
or
IF THE SWELLING IS A VASCULAR ONE.
PULSATILE ONE: two fingers are raised with each throb of the artery
EXPANSILE ONE: two fingers are raised and separated from each other
TRANSMITTED ONE: two fingers are raised but not separated, called
transmitted pulsation.
144
FIXITY TO THE OVERLYING SKIN:
For this, skin is made to move over the swelling ,
145
ASPIRATION:
146
5. LYMPH FLUID: color less with high lipid content, appears
cloudy and frothy. it is seen in hygroma and
lymphoma.
147
PERCUSSION:
To elicit slight tenderness like brodies abscess.
AUSCULTATION:
all pulsatile swellings are auscultated to exclude presence
of any bruit or murmur.
148
EXAMINATION OF ULCER
Ulcer is a break in the continuity of the skin and
epithelium.
INSPECTION:
Size and shape:
Tuberculous ulcers are oval in shape but coalesce to form
irregular crescentric borders.
Syphilitic ulcer is circular or semicircular to start with but
unites to form serpiginous ulcer where we call it is as
“WEEPING ULCERS”.
Carcinomatous ulcers are irregular in shape and size.
To record exact size and shape of ulcer, a sterile gauze is
pressed on to the ulcers to get measurement.
149
Number: tuberculosis, granulomatous, varicose and soft
chancre may be more than one in number.
150
EDGES:
IN SPREADING ULCER: the edges are inflamed and edematous
151
RAISED AND PEARLY WHITE BEADED EDGE: it’s a feature of rodent
ulcer which develops in invasive
Cellular diseases and become necrotic at the centre.
FLOOR:
Exposed surface of the ulcer .
When floor covered with red granulation tissue, ulcer seems to be healthy
and healing.
PALE AND SMOOTH GRANULATION TISSUE: HEALING ULCER
WASH LEATHER SLOUGH ON THE FLOOR: GRANULATION ULCER
A BLACK MASS AT THE FLOOR: MALIGNANT MELANOMA. 152
DISCHARGE:
character of discharge its amount and smell.
HEALING ULCER: shows scanty serous discharge
SPREADING AND INFLAMED ULCER: shows purulent discharge
TUBERCULOSIS AND MALIGNANT ULCER: serosanguineous discharge.
SURROUNDING AREA:
If surrounding area of an ulcer is glossy red and edematous, ulcer is actually
inflamed.
VARICOSE ULCER: surrounding skin is pigmented.
SCAR OR WRINKLING IN THE SURROUNDING SKIN OF ULCER: old case
of tuberculosis.
153
PALPATION:
TENDERNESS:
Acutely inflamed ulcer – always very tender
Chronic ulcers -slightly tender
Neoplastic ulcer –never tender
EDGE: in palpation different types of edges are confirmed which are seen
in inspection.
Marked induration of edge is the characteristic feature of
carcinoma.
BASE: on which the ulcer rests, whereas floor is exposed surface of ulcer.
155
HARD TISSUE
TEETH PRESENT
Size
Color
structural changes of teeth
Eruption status of teeth
Retained deciduous teeth
Any trauma to tooth
TEETH MISSING
Reason for missing teeth/tooth
History of removal
Visual inspection,
Probing
Percussion
Transillumination
DISADVANTAGES:
A. To be radiographically visible, mineral
loss should be more than 20-30%
OTHER METHODS:
Fibro Optic Transilluminator.
ETIOLOGY:
use of abrasive dentifrice, tooth floss, tooth picks etc.
EROSION:
defined as irreversible loss of dental hard tissue by a chemical
process that does not involve bacteria.
TYPES:
PATHOLOGIC MOVEMENT: it results from inflammatory
process, para functional habits.
165
GRADES OF MOBILITY: (GLICKMAN’S
CLASSIFICATION)
CLASS-II:
Distobuccal cusp of upper first molar
occludes in the buccal groove of lower first
permanent molar.
CLASS-III:
mesiobuccal cusp of maxillary first
permanent molar occludes in interdental
space between mandibular first & second
molar.
PROVISIONAL DIAGNOSIS
It is also called tentative diagnosis or working diagnosis.
It is formed after evaluating the case history & performing
the physical examination.
DIFFERENTIAL DIAGNOSIS
The process of listing out of 2 or more diseases having
similar signs and symptoms of which only one could be
attributed to the patient’s suffering
A final diagnosis is only possible after carrying out
further investigations.
INVESTIGATIONS:
CHAIR SIDE INVESTIGATIONS: ROUTINE COMPLETE
HEMOGRAM-
TYPES:
VERTICAL PERCUSSION TEST –
positive indicates periapical
pathology
HORIZONTAL PERCUSSION
TEST – positive indicates
periodontium associated problems.
170
RADIOLOGICAL INVESTIGATIONS
INTRAORAL PROJECTIONS;
-Intra-Oral Periapical,
Occlusal,
Bitewing views.
EXTRAORAL PROJECTIONS;-
OPG,
PA view of skull and jaws,
AP view
PNS view,
SUBMENTOVERTEX view,
TMJ views.
171
OTHER INVESTIGATIONS:-
URINE EXAMINATION
Special investigations like:-
Sialography
MRI
CT Scan
FINAL DIAGNOSIS:
173
TREATMENT PLAN
The formulation of treatment plan will depend on both
knowledge & experience of a competent clinician and
nature and extent of treatment facilities available.
175
1.Preliminary phase
Treatment of emergencies:
Dental or periapical
Periodontal
Other
176
2.Nonsurgical phase
Plaque control and patient education:
diet control (in patients with rampant caries)
Removal of calculas and root planing
Correction of restorative and prosthetic irritational
factors.
Excavation of caries and restoration (temporary or
final,depending whether a definitive prognosis for
the tooth has been determind and on the location
of caries)
177
3.Surgical phase
Periodontal therapy including placement of implants
Endodontic therapy
4.Restorative phase
Final restorations
Fixed and removable prothodontic appliances
Evaluation of response to restorative procedures
Periodontal examination
178
5.Maintenance phase
periodic rechecking:
179
PRESCRIPTION WRITING
180
PROGNOSIS
It is defined as act of foretelling the course of disease
that is the prospect of survival & recovery from a
disease as anticipated from the usual course of that
disease or indicated by special features of the case.
REFERENCES: