CLINICAL EXAMINATION

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					              CLINICAL EXAMINATION
                       AND
           RADIOGRAPHIC INTERPRETATION
LEARNING OBJECTIVE:

1. That the student will understand the need for an efficient clinical and radiographic
examination
process that allows for the collection of clinically relevant information

  key concepts:        process, efficiency, relevance, diagnosis, complexity,
correlation with                       historical findings



1. THE CLINICAL EXAMINATION

A systematic approach is very useful. If one performs the same steps in the same
order, EVERY TIME, one is much less likely to forget a step and miss something.
Particular attention to a specific area (eg. a tongue ulcer) is integrated into your
habitual, systematic examination routine. The examination requires palpation as well
as retraction and inspection ............... it is a hands on process.

General Appearance (general health)

robust .vs. feeble
disability:                           eg. wheelchair bound
colour:                               flushed, pale, cyanotic
anxiety:                              level of, management, issue especially with
children
distress:                             from pain, anxiety, etc.
vitals:                               BP, pulse, respirations

General Head & Neck

neck stiffness:                       arthritis, muscle spasm, deformity

Extra-Oral

jaw alignment:                        retro .vs. prog .vs. orthognathic
TMJ:                                  clicks, pops, trismus
muscles of mastications:              muscle spasm, trismus
muscles of facial expression:         Bell's palsy
lymph nodes:                          swelling, tenderness, mobile .vs. fixed
skin of the face:                     swelling, colour, induration, tenderness
lips:                                 actinic change, Herpes, angular cheilitis
Intra-Oral

general appearance:                  number of teeth (intact .vs. mutilated dentition)
                                     Angle classification: Class I, II, III
                                     spacing / crowding: surgical or restorative
difficulty
oral hygiene:                        amount of potential surgical site contaminant
                                     an indication of the patient's interest in
preservation
state of restoration:                open carious lesions
                                     broken restorations
                                     an indication of the patient's dental experiences
mucosal surfaces:                    ulcerations, discolouration: white, red, purple,
yellow
gingiva:                             inflammation: localized .vs. generalized
                                     recession: periodontal disease
the tooth in question:               caries: will tooth fracture during extraction
                                     restorations: likelihood of filling
fracture....aspiration
                                     angulation: access and path of withdrawal
                                     condition of the teeth adjacent: access, choice of
technique                                   and instrumentation ... elevators or
forceps only


2. THE RADIOGRAPHIC EXAMINATION

In the usual clinical situation, the clinician orders the appropriate films and then
correlates the radiographic information with the history and the clinical examination.
The radiographic is also systematic, starting with a critique of the film(s) and
proceeding from general to specific.

radiograph:                          type: extra .vs. intraoral, panoramic, lateral
oblique,                                                     periapical
                                     quality: exposure, focus, contrast, area examined
                                     date: recent .vs. outdated
normal anatomy:                      context and orientation
                                     sinus floor, nasal floor, mandibular canal,
mental foramen
adjacent teeth:                      caries, restorations, endodontics, periodontal
disease,
                                     root proximity
tooth in question:                   caries: occlusal, interproximal, root
                                     size: proximity to pulp
                                     restorations: crowns, large amalgams
                                     endodontics: brittleness and tendency for
fracture
                                      periodontal disease: bone height & density,
isolated                                             pockets, furcation involvement,
periapical radiolucency,
                                      perio-periapical combination
root number:                          one .vs. two .vs. three .vs. more
root morphology:                      slender, tapered, bulbous, straight, curved,
dilacerated
                                      hypercementosis, ankylosis
impactions:                           depth: level of crown, neck, root or apex of
adjacent tooth
                                      angle: upright, mesio or disto angular, horizontal
                                      proximity of adjacent crown, root or apex
                                      amount of overlying bone: posterior mandible or
ramus
threat to normal structures:          mandibular canal, mental foramen, sinus floor,
tuberosity



In all cases, the clinician should correlate the clinical and radiographic information
with the information gathered in the history taking process. In most cases, the
findings of the clinical or radiographic examination will confirm or support the initial
differential diagnosis established during history taking.

				
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posted:9/17/2012
language:English
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