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Diagnosis in operative dentistry
1. The seminar is prepared by :
Dr. Hiba Hassan Thabit
Supervised by :
Dr. Aymen Sabah
2. • Pretreatment considerations consisting of patient
assessment, examination and diagnosis, and
treatment planning are the foundation of sound
dental
• Patient assessment
• Before the examination and diagnosis of teeth,
periodontium, and orofacial soft tissues,
attention is given to infection control, the
patient's chief complaint, medical review,
sociologic and psychological review, dental
history, and risk assessment.
• Before, during, and after any patient visit,
appropriate IC (infection control) measures must
be instituted.
3. • Chief Complaint
• Before initiating any treatment, it is important to
determine the patient’s chief complaint, or the problem
that make the patient to visit dental clinic. Record the
complaint verbatim (on patient word) in the dental
record (case sheet):
• 1- Medical Review
• The dentist must identify:
• 1- Contagious diseases that require special precautions or
referral, e.g. hepatitis, AIDS.
• 2. Allergies that may contraindicate the use of certain
drugs.
• 3. Systemic diseases and heart problem (rheumatic heart
disease,) that demand less strenuous procedures or
prophylactic antibiotic
• coverage.
• 4. Physiologic changes associated with aging that may alter
clinical presentation and influence treatment.
4. • 2- Sociologic and psychological review
• During initial visits the clinician should now the patient's
attitudes, priorities, expectations, and motivations
toward dental care. The dentist must begin to explore
patient's preferences for dental care.
• 3- Dental history
• 1. Past dental history consists of reviewing previous or
past dental problems and treatment. if a patient has
difficulty tolerating certain types of procedures or has
encountered problems with previous dental care, an
alteration, of the treatment or environment may help
avoid future complications.
• 2- Patient present problem, the patient guided to discus
the current problem in clouding onset, duration and
related factors.
5. • Clinical Examination
• Examination: is the process of observing
both normal and abnormal condition.
Then have
extra oral examination intra oral examination
6. • The extra oral examination:
• The extraoral head and neck soft tissue
examination includes checking for
asymmetries, a lymph node examination
and a brief temporomandibular joint
examination.
7. • The intra oral examination: should be
examine
the soft tissue teeth
8. • The soft tissue examination:
• The intraoral soft tissue examination
includes checking the soft tissues of the
mouth, the throat, the tongue and the
gums.( Lips and labial mucosa , Buccal
mucosa and vestibular mucosa ,hard and
soft palate, Floor of mouth, Gingiva and
alveolar mucosa)
10. • The examination of crown include :
• 1. caries
• 2. amalgam
• 3. fracture
• The examination of pulp include:
• Thermal test
• Electrical test
• Bite test
• Anesthesia test
11. • Caries :
• Caries is mostly located in pits and fissures of the occlusal surfaces.
When the probe placed in pit and fissure it will provide a tag-back or
resistance of removal.
• proximal surface caries, smooth-surface caries, is usually
diagnosed radiographically. However, it also may be
detected by careful visual examination either following
tooth separation or through fiber-optic transillumination .
12. • Brown spots on intact, hard proximal enamel surface gingival to the
contact area are often seen-in older patients whose caries activity is
low .
• proximal-surface caries in anterior teeth may be identified by
radiographic examination, visual inspection (transillumination
optional) and or probing with an explorer. Transillumination is
accomplished by placing the mirror, on the lingual side of the
anterior teeth and directing light through the teeth.
13. • Another form of smooth-surface caries often occurs on the facial
and lingual surfaces of the teeth,particularly gingival area that are
less accessible for cleaning. This-is Incipient caries (white spot)
which partially or totally disappear with wetting, while drying again
will cause it to reappear.
• This disappearing reappearing phenomenon distinguishes
• the smooth surface incipient- carious lesion from the
• white spot resulting from enamel hypocalcification.
14. • Fracture: the fracture of crown due to
trauma or badly carious teeth and other
reason( high spot, unsupported teeth
structure) .
• Have forms of crown fracture:
a. fracture in enamel.
b. fracture in enamel and dentine
20. • The examination of pulp: include:
• 1.Thermal test: which test the vitality of the tooth. A
cotton applicator tip sprayed with a freezing agent or hot
gutta-percha is applied directly to the tooth.
• If the pain subside within a few seconds following
removal of the stimulus indicates healthy pulp.
• Pain lasting 10 to 15 seconds or less after stimulation by
heat or cold suggests a hyperemia , an inflammation
that may be reversed by timely removal of the irritant.
• Pain of longer duration from hot or cold usually
suggests irreversible pulpitis.
• Lack of response to thermal tests may indicate that the
pulp is necrotic.
21. • 2. Electrical test: also has value in
determining the vitality of the dental pulp. The
electric pulp tester is placed on the tooth and
not on a restoration, A small electric current
delivered to the tooth causes a tingling
sensation. Results of an electric pulp test should
not be the sole basis for a pulpal diagnosis
because false positives or false negatives can
occur
22. • 3.Bite test: if a patient complains of pain on chewing
and there is no evidence of periapical inflammation , an
incomplete fracture of the tooth may be suspected .
biting on a wood stick in these cases can elicit pain
Usually on release of biting pressure.
• 4.Anesthesia test: in cases where the patient can not
locate the pain and the thermal test is negative, a
reaction may be obtained by asking the patient to sip
hot water from a cap. The patient is instructed to hold
water first against the mandibular teeth on one side and
then by tilting the head to include the maxillary teeth. If
a reaction occurs , an intraligamental injection may be
given to anaesthetize the suspect tooth and hot water is
then again applied to the area , if there is no reaction ,
the pulpitis tooth has been identified.
