Ch 28

Oral Diagnosis And

Treatment Planning

Exam and Dx Techniques

• Visual Evaluation• Overall assessment of previous dental care

and existing conditions• Soft tissue—pink and uniform in color• Tooth structure—uniform in color and

morphologically sound and intact• Dentist uses mouth mirror and dental light

• Restorations—evaluate for discrepancies and complete coverage of tooth structure

• Missing teeth

• Palpation• Examination technique

• Use fingers and hands to feel for texture, size and consistency of hard and soft tissue

.

• Instrumentation• The type of instruments selected

should accomplish the following• Detection

− Use of a sharp pointed explorer, to detect imperfections in enamel surfaces--decay

• Probing− To measure the sulcus for loss of gingival

attachment or bone loss

Radiography

• Used in the examination:• Identify

• Decay• Defective restorations• Advanced periodontal conditions• Pathology• Developmental conditions• Other abnormalities

Intraoral Imaging

• Used like a miniature video camera• Allows the dentist to use computer

monitor• Provides

• Magnification of an image for evaluation• Easier access for areas that are difficult to

view• Access to photocopy for insurance

verification• Case simulation or case presentation• Medical and legal documentation

Photography

• Intraoral • Extraoral• Provides visual means of ID and

understanding of specific problems

Black’s Classification of Cavities• Class I

• Pits and fissures posterior teeth• Class II

• Proximal surfaces of posterior teeth• Class III

• Proximal surfaces of anterior teeth• Class IV

• Proximal surfaces of anterior teeth including incisal edges• Class V

• Gingival 1/3 of facial or lingual surfaces of all any tooth• Class VI

• Incisal edge of anteriors and/or cusp tips of posterior teeth

Tooth Numbering Systems

• Universal Numbering System• 1-32 , right to left

• International Standards Organization system• Two-digit number to each tooth, UR 1,

UL 2, LL 3 and LR 4

• Palmer Notation System• Brackets for four quads

Color Coding

• Red• Condition that needs to be done

• Blue• Condition that has already been done

• Black• Existing may not need any treatment

Charting Symbol

• Know how to chart each type of condition• Refer to your complete in class charts

Abbreviations

• Know each abbreviation for single surfaces

• Know each abbreviation for multiple surfaces

Soft tissue examination

• Complete examination of• Cheeks• Mucosa• Lips• Lingual and facial alveolar bone• Palate• Tonsil area• Tongue• Floor of mouth

• Visual and palpation

Examination and charting teeth

• Thorough assessment of each tooth

• Using instruments, check each surface of each tooth and detect findings

Examination and Charting of Periodontium

• Assess tissue that support the teeth• Gingiva• Cementum• Periodontal ligament• Alveolar • Supporting bone structures

• Using radiographs

Types of Treatment Plans

• Level I: Emergency Care• Relieves immediate discomfort

• Level II: Standard Care• Restores the dentition to normal function

• Level III: Optimum Care• Restores the dentition to maximum function

and an esthetically pleasing result.• KNOW these in detail

Treatment Plan Presentation• Case presentation is done in private setting,

such as a conference room or office• Items to have available

• Before and after photos• Diagnosis cast of similar cases and patient cast• Models of proposed appliances, ie dentures,

implants, crowns, etc• Patient chart• X-rays• Treatment plans

• Treatment plans as well as patient charts are legal documents

• Must be done in blue or black ink• Must be clear, concise and legible