IN THE NAME OF GODIN THE NAME OF GOD

EXAMINATION of the EXAMINATION of the TEETHTEETH

TECHNIQUES and TECHNIQUES and MATERIALSMATERIALS

The primary examination techniques for The primary examination techniques for evaluating the teeth include visual evaluating the teeth include visual

inspection,transillumination,probing,palpation,inspection,transillumination,probing,palpation,percussion and the evaluation of finctionpercussion and the evaluation of finction..

REQUIRED TOOLSREQUIRED TOOLS

A good light source, a mirror, a sharp explorer, A good light source, a mirror, a sharp explorer, and an air syringe are the most basic tools and an air syringe are the most basic tools

requiredrequired..

VISUAL INSPECTIONVISUAL INSPECTION

It should begin prior to cleaning the teeth and It should begin prior to cleaning the teeth and prior to instrumentationprior to instrumentation..

The visual inspection, the systemic The visual inspection, the systemic observation of the entire dentition as a unit , observation of the entire dentition as a unit , can be performed with a dental mirror and a can be performed with a dental mirror and a

good light sourcegood light source..

INFLAMMATIONINFLAMMATION•If the distribution is generalized, the

patient’s home care and need to be addressed.

•Localized area of gingivitis may be the result of existing caries or of a

tooth that is out of its normal alignment and therefore has surfaces that are difficult to reach with normal

•Localized gingivitis near to restoration may be because of :deficiency in contact, an

overhanging restoration, recurrent caries, or a poorly contoured

restoration.

CARIES PATTERNCARIES PATTERN•Caries usually occurs in pit and

fissures.•Any unusual pattern of caries should

be explored to determine the cause.•Important : if the caries involves

multiple cervical surfaces and perhaps even incisive surfaces, an unidentified

cause of xerostomia must be investigated.

Missing teethMissing teeth

•Clinically missing teeth require investigation through questioning the patient regarding the

history of removal, through radiographs to locate unerupted or impacted teeth, or

through the missing teeth as an oral manifestation of a systemic disease or

genetic abnormality.•The sequela of missing teeth :

supraeruption,tilting,drifting, or rotation,all of which may have an impact on the treatment

plan.

Size,color,and structural Size,color,and structural changeschanges

•Changes from the normal appearance of teeth are based on

color, size, or structural defects and are important to recognize.

•These changes can be:

•Localized•generalized

ERUPTION PATTERNERUPTION PATTERN•A retained anterior primary tooth

while the remaining maxillary teeth are erupting normally, a radiograph is indicated to rule out an impacted

mesiodens.•It is also helpful to know when

calcification of enamel occurs because many defects of enamel are

the result of an interruption of that process.

DETECTION OF CARIESDETECTION OF CARIES•The completion of the visual

inspection as well as the instrumentation of the teeth for caries is more reliable in a clean

mouth with the teeth dried

PROBINGPROBING•Caries in the pits and fissures of

teeth may be detected with a sharp explorer that is pressed into the pit perpendicular to the occlusal plane.

•All pits and fissures must be examined carefully because only one spot may exist in which the enamel is

no longer intact.

•Signs of decay:

•Softening at the base of the pit or fissure.

•Opacity surrounding the pit or fissure indicating undermining or

demineralization of the enamel.

•Softened enamel that may be flaked away by the explorer.

•Caries develop on the smooth surface•Smooth surfaces caries on buccal or

lingual surfaces usually begins with white decalcification in the enamel along cervical margins and can be

seen when the teeth are dried. These decalcified areas may have surface

breaks where the enamel has eroded but may still be caries free.

•Controlling the explorer is especially important in this area( on surface) because it has a tendency to slide over the smooth curve surfaces of

the teeth and injure the gingiva.

•Using the third to fourth fingers as fulcrum rest near the tooth examined

helps one to exert enough pressure without losing control.

ROOT CARIESROOT CARIES

•Root caries may be found below the CEJ or involving both the root and the

cervical enamel.•Root caries is often discolored, but

discoloration alone does not indicate existing caries. Radiographs are

excellent for detecting root caries interproximally.

As more eldery patients seek dental care, root caries will be seen more

often.Xerostomia must also be ruled out and managed if several root

caries exist.

INTERPROXIMAL SMOOTH INTERPROXIMAL SMOOTH LESIONSLESIONS

•Interproximal smooth lesions in the posterior teeth are difficult to explore

because one must distinguish between the explorer wedged by contact area.

•Radiographic evidence of caries should be relied on for early lesions. In advanced lesions , a white chalkiness

opalescent discoloration appears beneath the enamel of the marginal

ridge.

•When the light source is moved from side to side , this discoloration may

seem to move as well and is evidence of cries penetrating the

dentine.

•If the adjacent tooth has been lost , the interproximal surface may show

evidence of some enamel involvement.

TransilluminationTransilluminationDetecting ant. interproximal caries lesions.

• By viewing the lingual or palatal surface of the patient’s teeth with a mirror and

strong light shining on the labial surfaces, minor defects in enamel can be seen.

•Some times it’s more reliable than ant.periapical radiographs.

•When the teeth is overlaped both clinical and radiographic methods are

compromised.

RECURRENT CARIES/defective RECURRENT CARIES/defective restorationsrestorations

•Evaluation for recurrent caries involves techniques similar to those

for detecting new caries.

•Methods:

•Probbing margins of restorations•Transillumination of class III and IV

restorations.

•radiographs

•Restorations may be considered defective if they no longer perform

the function for which they were placed , if they are unaesthetic,or if

they cause harm.

•Ditches and voids in restoration have ability to retain food and plaque that

could lead to recurrent caries.

•Occlusal restorations may have a wider tolerance for rough margins because the occlusal surfaces are readily cleanable ,

whereas the same roughness on n interproximal margin may result in an

undesired gingival response.•Dental floss passed interproximally can

detect interproximal caries lesions, overhanging restorations, and contact areas that are too tight or inadequate.

•A restoration also must be evaluated for:

•Anatomic contour•Marginal ridge compatibility•Proximal contact•Added to what said before:•Recurrent caries•Defectiveness of restorations

Treatment planning Treatment planning considerationsconsiderations

•You must consider:•Patient’s age•Systemic health•Diet•Clinical findings• The location of caries, the amount of

enamel, dentinal and or cemental involvement , and the length of time can

determine the type of restorative material to be used

PULP TESTINGPULP TESTING•Pulpal evaluation through the

electrical pulp test, application of heat and ice, or preparation of a test

cavity may be indicated to determine the pulpal status of teeth.

•Usually all three means of determining pulpal vitality are used.

•ELECTERICAL METHOD:

•Switch button must be presses as the control is slowly increased until the

patient reports slight pain.

•Important: it’s best to tart with a tooth believed to be normal and to

observe the patient’s response.

•In early pulpitis:

•pain persists when the stimulus has been removed, whereas in healthy

pulp, the sensation disappears within 5 seconds.

Identifying a cracked toothIdentifying a cracked tooth•Identifying an individual tooth with a crack

requires selective pressure on individual cusps by:

•Rubber polishing wheels•Orange wood stick•Tongue blades•Light reflected from various directions,

specially once a deep restoration has been removed

•And also disclosing can be useful

PERCUSSIONPERCUSSION

•A tooth with a large carious lesion should be checked for percussion sensitivity by

tapping the tooth lightly with mirror handle.

•What can cause pain on percussion?•Inflammation in the PDL and pulp•Incomplete fracture in dentine (cracked

tooth)•Presence ankylosis•Sinusitis (positive response to several

posterior maxillary teeth)

MOBILITY TESTINGMOBILITY TESTING•Mobility can be checked by attempting to

move the tooth with two rigid instruments such as mirror handles.

•Mobility is measured from 0-3•What causes mobility?•Recent removal of orthodontic appliances•Loss of periodontal support•Trauma from blow or malocclusion•Periapical disease

Evaluation of the occlusionEvaluation of the occlusion•It involves how the teeth fit together

and functional occlusion, and the position of the teeth in relation to the

TMJ and muscles of mastication.

•The practitioner also assesses the relationship of the anterior teeth,

specifically, the amount of overjet , over bite, the vertical overlap.

Angle classificationAngle classification•Class l•Class ll•Class lll•Important:class ll has 2 division:•The maxillary interior teeth protrude

labially•The maxillary central incisors are

lingually inclined

Functional occlusionFunctional occlusion•Centric occlusion:teeth are in

intercusspation,when patient swallows.•Centric relation: the position that condyles are in

the most post. & sup. position in glanoid fossa.•Protrusive excursion: mandible protruded,ant.

teeth touch & the post. Teeth disocclude•Lateral excursion: moving the jaw laterally when

teeth are in c.o•Mounted diagnosis casts, articulating paper,

waxes are used in evaluating the occlusion.

Diagnostic castsDiagnostic casts•Moreover , many features are more easily

seen on casts than in the mouth.•Diagnostic casts allow the study of th

occlusion , specifically, •The shape of the dentition the architecture

of the supporting structures, the presence or absence of occlusal facets, the denture

space, and much more, even in the absence of patient.

RadiographsRadiographs•Exposed radiographs are an

indispensable aid to the diagnosis of periodontal disease, caries,

periapical disease, and other disorders.

Recording of findingsRecording of findings•A perfect examination of the teeth is

meaningless unless the findings are recorded in such a way that the examiner

nd others to whom the patient may be referred can understand them.

•The numbering system used in one’s dental training is not universal. therefore , when corresponding or writing articles, the

name of the tooth is best used.