ORAL DIAGNOSISORAL DIAGNOSIS

Dena 320Dena 320

Deborah BellDeborah Bell

DiagnosisDiagnosis

To identify or determine the nature To identify or determine the nature and cause of a disease or injury and cause of a disease or injury through evaluation of the medical through evaluation of the medical and dental history.and dental history.

The dentist only can diagnosisThe dentist only can diagnosis

AssessmentAssessment

Assess is to evaluate or concludeAssess is to evaluate or conclude

Assistant’s ResponsibilityAssistant’s Responsibility

Data gathering to bring together all of Data gathering to bring together all of the information required by the the information required by the dentist to make and accurate dentist to make and accurate diagnosis of the patient’s conditiondiagnosis of the patient’s condition

accomplished by asking the new accomplished by asking the new patient to complete printed forms - patient to complete printed forms - reviewing these forms with the reviewing these forms with the patient in interview form to clarify and patient in interview form to clarify and gain more information.gain more information.

Patient RecordPatient Record

Result of overall process of Result of overall process of delivering patient caredelivering patient care

permanent document which reflects permanent document which reflects the patientthe patient

primary source of information to primary source of information to assess the quality of care given a assess the quality of care given a patientpatient

source of data for research purposessource of data for research purposes

Provides documentation regarding Provides documentation regarding the patientsthe patients– conditioncondition– diagnosisdiagnosis– treatmenttreatment– responses to treatmentresponses to treatment

risk management for teamrisk management for team

Components of the Patient Components of the Patient RecordRecord

Patient informationPatient information– demographicsdemographics– financial responsibilityfinancial responsibility

medical historymedical history– alerts to possible medical conditionsalerts to possible medical conditions– medicationsmedications– special treatments needs to avoid special treatments needs to avoid

emergenciesemergencies– patients signature patients signature

Make sure there is a signatured Make sure there is a signatured release form to allow release of release form to allow release of informationinformation– consultations with physician if needed consultations with physician if needed

Continue Medical HistoryContinue Medical History

Update history at each visit Update history at each visit – patient and assistant reviewspatient and assistant reviews– patients signs and datespatients signs and dates

health changes/ no changeshealth changes/ no changes surgery surgery conditionsconditions MedicationsMedications

Medical alert informationMedical alert information

Vital SignsVital Signs

PulsePulse respiration raterespiration rate body temperaturebody temperature blood pressureblood pressure

PulsePulse

Expansion of the artery as the Expansion of the artery as the heartbeatsheartbeats

slight finger pressure used to slight finger pressure used to identifyidentify

normal pulse rate in resting adultsnormal pulse rate in resting adults– 60 - 100 beats per minute60 - 100 beats per minute

normal pulse rate in resting childnormal pulse rate in resting child– 70 - 110 beats per minute70 - 110 beats per minute

Recording techniqueRecording technique– radial arteryradial artery– count for 30 seconds and multiply by count for 30 seconds and multiply by

22– Or count for 1 minuteOr count for 1 minute– IMMEDIATELY RECORD ON RECORDIMMEDIATELY RECORD ON RECORD– Note any arrhythmia'sNote any arrhythmia's

RespirationsRespirations

Normal respiration rate for relaxed Normal respiration rate for relaxed adultsadults– 10 - 20 breaths10 - 20 breaths

Normal respiration rate for relaxed Normal respiration rate for relaxed childchild– 20 - 2620 - 26

observe patients chest rise and fall observe patients chest rise and fall for30 seconds and multiply by 2for30 seconds and multiply by 2

Body TemperatureBody Temperature

Average normal 98.6 degreesAverage normal 98.6 degrees normal range 96.4 - 99.1 degrees normal range 96.4 - 99.1 degrees

FahrenheitFahrenheit

Blood PressureBlood Pressure

The amount of labor the heart has The amount of labor the heart has to exert to pump blood throughout to exert to pump blood throughout the bodythe body

Systolic pressureSystolic pressure– first recording (higher number)first recording (higher number)– pressure it takes for left ventricle to pressure it takes for left ventricle to

push oxygenated blood out into the push oxygenated blood out into the blood vesselsblood vessels

Diastolic pressureDiastolic pressure– second number (lower number)second number (lower number)– reflects the hear muscle at restreflects the hear muscle at rest

both pressures are measured in both pressures are measured in millimeters of mercury (mm HG)millimeters of mercury (mm HG)

BP classifications for BP classifications for adultsadults

NormalNormal– 120/80 120/80 – range less than 130/less that 85range less than 130/less that 85

high normalhigh normal 130 - 139/ 85 - 90130 - 139/ 85 - 90

HypertensionHypertension– stage 1(mild)stage 1(mild)

140-159/91-99140-159/91-99

– stage 2 (moderate)stage 2 (moderate) 160-179/100-109160-179/100-109

– stage 3 (severe)stage 3 (severe) 180-209/110-119180-209/110-119

– stage 4 (very severe)stage 4 (very severe) 210 & above/120 & above210 & above/120 & above

Types of BP MetersTypes of BP Meters

Automated electronic blood Automated electronic blood pressure devicepressure device

sphygmomanometer & sphygmomanometer & StethoscopeStethoscope

BP technique GuidelinesBP technique Guidelines

Extend the patients arm at same Extend the patients arm at same level as heartlevel as heart

cuff approximately 1 inch above cuff approximately 1 inch above the antecubital spacethe antecubital space

secure cuff around arm with all air secure cuff around arm with all air expelledexpelled

Korotkoff sounds phasesKorotkoff sounds phases

Phase IPhase I– first distinct thumping sound and first distinct thumping sound and

becomes louderbecomes louder SYSTOLIC READINGSYSTOLIC READING

Phase IIPhase II– sound softenssound softens

Phase IIIPhase III– becomes crisper and intensifiesbecomes crisper and intensifies

Phase IVPhase IV– distinct abrupt mufflingdistinct abrupt muffling

Phase VPhase V– artery is fully open and sound artery is fully open and sound

disappearsdisappears– DIASTOLIC READINGDIASTOLIC READING

Record immediately and verbalize Record immediately and verbalize your reading results to the patientyour reading results to the patient

guidelinesguidelines

If more than one reading needed If more than one reading needed allow 10 minutes between ideallyallow 10 minutes between ideally

If somewhat high before procedure If somewhat high before procedure take again at end of appointmenttake again at end of appointment

If reading is extremely highIf reading is extremely high– choose not to begin procedurechoose not to begin procedure– refer to physicianrefer to physician

Components of a Dental Components of a Dental ExaminationExamination

Oral ExaminationOral Examination

Takes place after the patient has Takes place after the patient has completed the medical history and completed the medical history and vital signs have been recordedvital signs have been recorded

ComponentsComponents

General overall appearanceGeneral overall appearance facial areafacial area temporomandibular jointtemporomandibular joint oral mucosaoral mucosa lipslips tonguetongue floor of mouthfloor of mouth

PalatePalate gingival tissuegingival tissue occlusionocclusion teethteeth structures maintaining the teeth in structures maintaining the teeth in

positionposition

Techniques for Techniques for examinationexamination

Visual examinationVisual examination– whole patient not just oral areawhole patient not just oral area

palpationpalpation– feeling for abnormal changesfeeling for abnormal changes

instrumentationinstrumentation– caries detectioncaries detection

intraoral/extraoral radiographyintraoral/extraoral radiography

Intraoral imagingIntraoral imaging– provide better visibilityprovide better visibility– better evaluationbetter evaluation– case presentationscase presentations– risk managementrisk management– photocopy for insurance purposesphotocopy for insurance purposes

Intraoral/extraoral photographyIntraoral/extraoral photography– treatment planningtreatment planning– case presentationcase presentation

Oral Cancer examOral Cancer exam– neckneck– facial areasfacial areas– intraoral tissuesintraoral tissues– by touching and visual evaluationby touching and visual evaluation

RememberRemember

Check for crepitus (popping of TMJ Check for crepitus (popping of TMJ at tragus of the ear) when you at tragus of the ear) when you complete the oral cancer examcomplete the oral cancer exam

Note Bruxism habit (grinding)Note Bruxism habit (grinding)

Oral Hygiene IndiciesOral Hygiene IndiciesEvaluation and RecordingEvaluation and Recording

A systematic assessment of plaque A systematic assessment of plaque debris and calculusdebris and calculus

Use of 6 tooth surfaces: 4 post / 2 Use of 6 tooth surfaces: 4 post / 2 ant.ant.

Division of tooth into thirds used as Division of tooth into thirds used as principleprinciple

Scoring of IndiciesScoring of Indicies

0 – no plaque0 – no plaque 1 – no more than 1/3 of surface1 – no more than 1/3 of surface 2 - 2/3 or more that 1/3 but not 2 - 2/3 or more that 1/3 but not

more than 2/3more than 2/3 3 – more that 2/3 covered3 – more that 2/3 covered Total points each category and Total points each category and

divide by number of surfaces ( 6 or divide by number of surfaces ( 6 or both 12)both 12)

Perio ChartingPerio Charting

Each tooth has 6 readingsEach tooth has 6 readings– MfMf– MM– DfDf– MlMl– LiLi– dldl

Results of ScoringResults of Scoring

.6 – good.6 – good .7 to 1.8 – fair.7 to 1.8 – fair 1.9 to 3.0 – poor1.9 to 3.0 – poor Higher score – BAD!Higher score – BAD!

Assistants RoleAssistants Role

Acquiring diagnostic aidsAcquiring diagnostic aids interviewing the patientinterviewing the patient accurate charting and recordingaccurate charting and recording

Treatment PlanTreatment Plan

A written treatment plan is A written treatment plan is presented to the patient after the presented to the patient after the dentist has reviewed and dentist has reviewed and evaluated all patient information evaluated all patient information gathered.gathered.

Types of Treatment PlansTypes of Treatment Plans

Level ILevel I– emergency careemergency care– relieves immediate discomfortrelieves immediate discomfort

Level IILevel II– Standard careStandard care– restores dentition to normal functionrestores dentition to normal function

Charting The DentitionCharting The Dentition

Charting componentsCharting components

Charting abbreviationsCharting abbreviations– BO BO MOMO– DIDI MODMOD– DLDL MODBLMODBL– DODO– LOLO Connect by adding “o”Connect by adding “o”– MIMI exception: buccal-occlusalexception: buccal-occlusal

charting symbolscharting symbols choose charting system for tooth choose charting system for tooth

identificationidentification Measuring tissue levelsMeasuring tissue levels

Procedures SampleProcedures Sample

BondingBonding

BridgeBridge

Maryland BridgeMaryland Bridge

CariesCaries

RestorationRestoration

ImplantImplant

Inlays and OnlaysInlays and Onlays

SealantsSealants

VeneersVeneers

Let’s chart!Let’s chart!