Hard Tissue ChartingHard Tissue Charting

Dental Hygiene TheoryDental Hygiene Theory

Instructor: Nickee dela Cruz R.R.D.H.

Hard Tissue Charting• Is completed & documented at the

ASSESSMENT appointment

• Is updated at each maintenance appointment

• Should follow a routine so that nothing is missed (sequencing)

• Do not use erasers or white out, if you make a mistake stroke 1 line through it & date & initial the change

Charting• Conditions which exist or are present in the

oral cavity are recorded in BLUE

• Carious lesions, teeth requiring treatment (extractions & other pathologic conditions, such as abcesses) are recorded in RED

• SUSPECTED carious lesions are charted in GREEN, but if they are diagnosed by the DDS as being decay, they are changed to RED

Normal, Atypical, & Abnormal Findings to Observe during Hard

Tissue Exams

The dental hygienist should be able to …

• Recognize signs of development anomalies & acquired tooth damage & bring them to the DDS’s attention

• Be able to properly document in the odontogram (hard tissue) in the client’s chart

Anomalies of the Teeth

• HyperdontiaHyperdontia – or supernumary teeth, extra teeth such as mesiodens which will occur between the maxillary anterior teeth

• HypodontiaHypodontia – absence of 1 or 2 teeth or anodontia, congenitally missing teeth most common are 3rd molars than maxillary lateral incisors, than mandibular premolars

Mesiodens

Mesiodens (arrow). A, Radiographic

appearance. B, Clinical appearance

Hypodontia

 Microdontia (arrow)

Supernumary Teeth

Anomalies of the Dental Tissue

• Macrodontia – larger than normal teeth, they tend to be wider, longer, & higher than normal teeth, may affect several or all teeth in the dentition

Anomalies of the Dental Tissue

• GeminationGemination – a tooth tries to split or twin

Gemination

Gemination (arrow)

Anomalies of the Dental Tissue

• Dens in denteDens in dente – a tooth within a tooth usually the lingual of maxillary incisors

Dens in dente

Anomalies of the Dental Tissue

• DilacerationsDilacerations – severe distortion or crown or root by trauma during formation

Dilaceration

Definition of DYSPLASIA

• medically abnormal development or growth of a part of the body, for example, an organ, bone, or cell, including the total absence of such a part

Intrinsic StainingIntrinsic StainingStain or discoloration within the toothStain or discoloration within the tooth

Enamel Enamel dysplasia HYPOPLASIAHYPOPLASIA – (rough, pitted enamel surface,

ameloblasts disrupted during the matrix formation of the tooth)

• Interruption of the enamel developmental Interruption of the enamel developmental process results in irregular enamel process results in irregular enamel formation or lack of enamel formation. formation or lack of enamel formation. Restorative treatment may be required Restorative treatment may be required because of susceptibility to decay and to because of susceptibility to decay and to improve appearance.improve appearance.

Enamel Hypoplasia

Enamel hypoplasia

Syphilitic enamel hypoplasia.

• A, Hutchinson's incisors.

• B, Mulberry molars.

Enamel Dysplasia

HYPOCALCIFICATIONHYPOCALCIFICATION – defect in enamel during mineralization, spotted surface is generally smooth, may be from trauma, nutritional deficiencies, excess fluoride intake

Enamel Hypocalcification

Enamel DysplasiaAMELOGENESIS IMPERFECTA – AMELOGENESIS IMPERFECTA – hereditary

condition where dentin & pulp develop normally but enamel is easily chipped or worn away

• A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only.

• teeth vary in color from white opaque to yellow to brown   

• all teeth are affected, smaller and pitted

Amelogenesis Imperfecta

Enamel Dysplasia

Dentinogenesis Imperfecta

• The bluish color and translucent features of this dentition are very suggestive of dentinogenesis imperfecta.

• Unlike amelogenesis imperfecta, the enamel in dentinogenesis imperfecta is normal; it is the underlying dentindentin that is structurally deficient.

Dentinogenesis Imperfecta

Dentinogenesis Imperfecta

Here is another example of the clinical features of dentinogenesis imperfecta.

Dentin Dysplasia (Rootless Tooth)

• A hereditary defect in dentin formation in which the coronal dentin and tooth color is normal; the root dentin is abnormal with a gnarled pattern and associated shortened and tapered roots

Taurodontism

• A malformed multirooted tooth characterized by an altered crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and the pulp chamber being abnormally large.

• Observed on radiographs – shows enlarged pulp chamber resulting in thinner dentin

Taurodontism

Talon Cusp• Lingual of maxillary & mandibular

anterior teeth

Acquired Anomalies• Attrition – wear from tooth on tooth

Attrition of the mandibular anterior teeth

Abrasion• Mechanical tooth wear caused by a

foreign substance

Erosion

• Loss to tooth surface due to a chemical agent

• Erosion from sucking on lemons (arrow) NEXT SLIDE

Tooth Fracture• Small to large chips or breaks in the enamel

Surfaces of the Teeth

Quadrants Primary vs. Permanent

Charting Symbols for Oxford Dental Hygiene Clinic

Chapter 13 Chapter 13 pg 247pg 247

Missing Teeth M

• Teeth that are not present because of extraction or are congenitally missing

• Charting procedurePlace a vertical line or

X through the facial, occlusal & lingual surfaces

• Chart in BLUE ink

Unerupted Teeth U

• Teeth that have not yet erupted or are impacted

Circle facial, occlusal, & lingual surfaces of tooth

Chart in RED ink

Teeth to be extracted Ex

• Teeth to be extracted because of pathologic or orthodontic reasons

• Draw a RED diagonal line through the tooth, or an alternative method is to draw 2 RED parallel lines through the tooth

Amalgam Restorations A

• Alloy of silver/mercury; silver or dark grey in color; widely used as a restorative material

• Chart surfaces where the restorations appear

• Outline the shade in BLUE for precise notation use Black’s classification

Tooth Colored Restorations R = resin CR = Composite resin

• Outline exact size & shape of restoration

• Shade with BLUE ink

• Chart surfaces involved

• Use Black’s Classification

Temporary Restorations Temp, T

• Temporary filling cements; zinc oxide-eugenol cement

• Chart temporary restorations the same as amalgam or resins in BLUE ink, but distinguish from amalgams with the abbreviation

Veneer Ven

• Veneer or layer of resin that is used to cover the unsightly area of tooth

• Outline & shade in surface of tooth where veneer is found

• Chart in BLUE ink

Full Gold Crown FGC

• Can be onlays or inlays or crowns

• Outline & fill in with diagonal lines covering all surfaces

• Chart in BLUE ink

¾ Gold Crown ¾ GC

• Covers less than ¾ of tooth surfaces

• Outline & fill with diagonal lines places on all surfaces or portion of surfaces covered by crown

• Chart in BLUE ink

Ceramic to Metal CrownsGCFP = crown, GCFP = crown,

porcelain faceporcelain faceGCAF = gold crown, GCAF = gold crown,

acrylic faceacrylic face

Chart similarly to gold Chart similarly to gold crowns crowns

Abbreviation can be Abbreviation can be used to distinguish it used to distinguish it from full gold or ¾ from full gold or ¾ crownscrowns

Chart in Chart in BLUEBLUE ink ink

Gold Inlay GI

• Does not cover the cusps

• Outline the shape of the restoration on the surfaces where it appears

• Chart in BLUE ink

Gold Onlay GO• Restoration which

involves the cusp tips• Outline & color the

shape of the restoration on the surfaces where it appears

• Chart in BLUE ink

Fixed Bridges• Each tooth may be

labeled with the appropriate abbreviations FGC, GCPF, ¾ GC

• Outline abutment & pontic teeth in BLUE ink & fill in with diagonal lines on occlusal, facial, & lingual surfaces

• Chart the pontic teeth as extracted

• Place 2 horizontal lines between the occlusal surfaces of the teeth to represent the splinted unit

Dental Implants IMPL

• Make a written comment under the teeth involved

Dental Caries C

• Outline the SUSPECTED carious area(s) in GREEN

• Once diagnosed as caries by DDS, outline in RED

• On completion of the restoration, fill in the RED areas with BLUE

Black’s Classification

Black’s Classification

Black’s Classification

Recurrent Decay RD

• Outline the area of recurrent decay in RED

• Recurring caries around the margin of an existing restoration

Appliances – Partial or Complete Dentures

PUD = partial upper PUD = partial upper denturedenture

PLD = partial lower PLD = partial lower denturedenture

CUD = complete upper CUD = complete upper denturedenture

CLD = complete lower CLD = complete lower denturedenture

Chart the missing teeth with Chart the missing teeth with vertical lines or X’s vertical lines or X’s through all surfacesthrough all surfaces

Join vertical lines or X’s Join vertical lines or X’s with horizontal line at with horizontal line at root apex & label to root apex & label to indicated upper or lower indicated upper or lower & partial or complete & partial or complete denturedenture

Overhanging Restorations OH

• Chart with triangular symbols in the interproximal area

• Chart in BLUE ink

Dental Sealants S

• Encircle & place abbreviation inside the circle

• Chart on occlusal surface in GREEN

Root Tip RT

• Chart tooth as missing & place abbreviation symbol near root apex

• Chart in BLUE ink

Root Canal RC

• Place vertical line through pulpal area of root

• Label with abbreviation

• Chart in BLUE ink

Decalcification or Hypocalcification Decal

• Outline the area & label with abbreviation

• Chart in BLUE ink

Erosion Ero

• Shade area in BLUE & place symbol

Hypoplasia Hypoplas

• Chart using wavy lines to denote the irregularity of enamel with symbol

• Indicate with abbreviation

Attrition Att

• Place a horizontal line over the affected surfaces

• Chart in BLUE ink

Abrasion Abr

• Chart 2 horizontal lines in BLUE ink

• Caused by mechanical wear caused by improper toothbrushing or other habits such as chewing on pencils, pipe smoking

Supernumary Teeth Su

• Draw additional tooth in location found

• Chart in BLUE ink• Label with

abbreviation

Other Dental Anomalies

• Other anatomic variations such as dens in dente, should be clearly indicated in the record section of the dental chart

TMJ Evaluation

• Detecting or noting any noises while bilaterally palpating the TMJ

• Noises include

- CREPITUS (cracking/grinding of the CREPITUS (cracking/grinding of the bones rubbing together)bones rubbing together)

- POPPING or CLICKING POPPING or CLICKING

Tenderness & pain/muscle tension should also be noted

Percussion

Is done on each tooth to check for sensitivity, by gently tapping the dental mirror handle tip on each tooth & recording the finding’s noted as:

• Normal = WNL

• Sensitive = +P

• Very Sensitive = ++P

• Extremely Sensitive = +++P

Open Bite

Crossbite

Overbite

Occlusal relationship of primary molars

Reviewing Radiographic Findings

Relevant to the Clinical Assessment

Found on the back of the Hard Tissue

Radiographic Findings

• Review normal or pathological findings

• Is part of the ASSESSMENT phase & can be used in the IMPLEMENTATION phase

• Radiographs are also required for documentation & record keeping of client’s dentition ( ie. Forensic dentistry often uses radiographs)

Periodontal Conditions Observed in Radiographs

1. Normal anatomy & the tooth crown to root ratio2. Confirmation of clinical findings & topography of

root surfaces3. Status of the lamina dura4. Changes in the PDL5. Remaining bone height6. Local irritants such as calculus & overhanging

restorations7. Patterns or extent of disease8. Possible furcation areas9. Disease progression or remission by serial

radiography