Friday, November 2, 2012
What Is Involved In A Dental Examination?
When a patient is seen for his or her routine dental examination, these are some of the major points involved. First: The patient is asked to fill out a recent medical questionnaire. In most cases this is a verbal confirmation, where the patient is asked about recent health concerns, changes or new medications. The oral area cannot be separated from the general health of a patient. A recent heart problem should be addressed, as there could be dental / general health ramifications. For example, cardiac surgery may involve premedication with antibiotics, as a thorough dental cleaning could cause oral bacteria to enter the circulatory system. This can cause potentially serious problems in areas where recent scar tissue has formed. As well joint surgery and artificial joint placement may require antibiotics.
Other recent conditions should be discussed as well: pregnancy, diabetes, cancer treatment, stoke, and any surgeries. Most conditions do not require special attention; but, the dental team will ensure that no consequences occur as a result of an oversight in recognizing potential problems.
X-rays are taken on a varying basis depending of the oral status of the patient. A patient with a full mouth of fillings is perhaps more vulnerable so may require more frequent x-rays., every year in some cases. Patients with minimal dental problems can do well with x-rays every two years. Some patients require more that the standard 'bite wings'. These are the x-rays that show if there are cavities between the back teeth. Patients who have had root canal therapy should receive what are called, 'periapical' x-rays, that monitor the progress of root canal treatment. Not all patients follow through; but, it is a worthwhile and challenging goal for the dental team to ensure they do. And all dental clinics like to ensure that patients return for regular exams. This ensures that any problems are noted and as importantly, it helps to ensure the patient is motivated to take a full role in his or her oral hygiene and home care.
In some offices the hygienist does a thorough cleaning. She / he can often detect cavities through the manual act of scaling. When the dentist comes for the exam phase, the hygienist will be able to supplement this exam with observations that he/she has seen. This team work helps a patient achieve the greatest of care. The dentist will physically touch each tooth with a sharp instrument called an 'explorer" This can show if an area of concern is in fact decay or just a stain. An interesting addition to the dental exam is a laser instrument that can detect decay. One model is a Diagnodent. It emits a low power laser beam which is directed, from close distance, to the tooth surface. Some of the light reflects back and is read by the instrument. The nature of the reflected light will signify a possible decay. This has been an excellent way of detecting decay before it gets larger.
The dentist will also do, what is termed,a soft tissue exam. The tongue, cheeks, palate, upper throat, and gum tissues are examined for any problems. Of special concern are smokers, who do have a tendency to have more intra-oral cancers. As well the neck from the collar bone to the chin is examined for any hard lesions. The dentist is looking for cysts, signs of infection and cancers.
The gums are given a thorough exam both visually and with an instrument called a probe, which is demarcated in millimeters. A normal gum pocket, the area around the teeth, is 3 mm. In gum disease some pockets can range to 10 mm. In such severe cases the patient is referred to a gum specialist, for possible surgery. In less severe cases some dentist do minor gum surgery. The laser is now a popular and successful instrument to correct gum problems.
An important aspect of the dental exam is to motivate and encourage the patient to take more attention to home preventive care. It is felt that a good habit takes 21 days to achieve. The hygienist and dentist work to reach that part of the patient that registers the need for better home care, if this is required. Not all patients follow through; but, it is a worthwhile and challenging goal for the dental team. The initial exam should always be followed by scheduled examinations. The time frame will be selected depending on the oral health status of the patient and the level of home care motivation, shown. In subsequent exams progress should be noted. One simple way to compare oral health between visits is what is called a bleeding index. During cleaning bleeding may occur in patients with poor home care. A scale of zero to three is chosen to represent the amount of bleeding. Three sites are chosen on the outer surface of upper teeth and three inner surfaces of lower teeth are selected. If there is bleeding the score is calculate. A person with heavy bleeding in all sites will score a 12, this can be compared at subsequent visits. Low scores are also calculated and the patient is encouraged to maintain this level. This index is not a scientific measure but one that can objectively be repeated and used for motivation and comparison purposes
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