Hard Tissue Charting

Hard Tissue Charting Dental Hygiene Theory Instructor: Nickee dela Cruz R.R.D.H.

Hard Tissue Charting
Is completed & documented at the ASSESSMENT appointment
Is updated at each maintenance appointment
Should follow a routine so that nothing is missed (sequencing)
Do not use erasers or white out, if you make a mistake stroke 1 line through it & date & initial the change

Charting
Conditions which exist or are present in the oral cavity are recorded in BLUE
Carious lesions, teeth requiring treatment (extractions & other pathologic conditions, such as abcesses) are recorded in RED
SUSPECTED carious lesions are charted in GREEN , but if they are diagnosed by the DDS as being decay, they are changed to RED

Normal, Atypical, & Abnormal Findings to Observe during Hard Tissue Exams

The dental hygienist should be able to …
Recognize signs of development anomalies & acquired tooth damage & bring them to the DDS’s attention
Be able to properly document in the odontogram (hard tissue) in the client’s chart

Anomalies of the Teeth
Hyperdontia – or supernumary teeth, extra teeth such as mesiodens which will occur between the maxillary anterior teeth
Hypodontia – absence of 1 or 2 teeth or anodontia, congenitally missing teeth most common are 3 rd molars than maxillary lateral incisors, than mandibular premolars

Mesiodens

Mesiodens (arrow) . A, Radiographic appearance. B, Clinical appearance

Hypodontia

Microdontia (arrow)

Supernumary Teeth

Anomalies of the Dental Tissue
Macrodontia – larger than normal teeth, they tend to be wider, longer, & higher than normal teeth, may affect several or all teeth in the dentition

Gemination – a tooth tries to split or twin

Gemination

Gemination (arrow)

Dens in dente – a tooth within a tooth usually the lingual of maxillary incisors

Dens in dente

Dilacerations – severe distortion or crown or root by trauma during formation

Dilaceration

Definition of DYSPLASIA
medically abnormal development or growth of a part of the body, for example, an organ, bone, or cell, including the total absence of such a part

Intrinsic Staining Stain or discoloration within the tooth
Enamel dysplasia
HYPOPLASIA – (rough, pitted enamel surface, ameloblasts disrupted during the matrix formation of the tooth)
Interruption of the enamel developmental process results in irregular enamel formation or lack of enamel formation. Restorative treatment may be required because of susceptibility to decay and to improve appearance.

Enamel Hypoplasia

Enamel hypoplasia

Syphilitic enamel hypoplasia.
A, Hutchinson's incisors.
B, Mulberry molars.

Enamel Dysplasia
HYPOCALCIFICATION – defect in enamel during mineralization, spotted surface is generally smooth, may be from trauma, nutritional deficiencies, excess fluoride intake

Enamel Hypocalcification

Enamel Dysplasia
AMELOGENESIS IMPERFECTA – hereditary condition where dentin & pulp develop normally but enamel is easily chipped or worn away
A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only.
teeth vary in color from white opaque to yellow to brown
all teeth are affected, smaller and pitted

Amelogenesis Imperfecta

Enamel Dysplasia
Dentinogenesis Imperfecta
The bluish color and translucent features of this dentition are very suggestive of dentinogenesis imperfecta.
Unlike amelogenesis imperfecta, the enamel in dentinogenesis imperfecta is normal; it is the underlying dentin that is structurally deficient.

Dentinogenesis Imperfecta

Here is another example of the clinical features of dentinogenesis imperfecta.

Dentin Dysplasia (Rootless Tooth)
A hereditary defect in dentin formation in which the coronal dentin and tooth color is normal; the root dentin is abnormal with a gnarled pattern and associated shortened and tapered roots

Taurodontism
A malformed multirooted tooth characterized by an altered crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and the pulp chamber being abnormally large.
Observed on radiographs – shows enlarged pulp chamber resulting in thinner dentin

Taurodontism

Talon Cusp
Lingual of maxillary & mandibular anterior teeth

Acquired Anomalies
Attrition – wear from tooth on tooth
Attrition of the mandibular anterior teeth

Abrasion
Mechanical tooth wear caused by a foreign substance

Erosion
Loss to tooth surface due to a chemical agent
Erosion from sucking on lemons (arrow) NEXT SLIDE

Tooth Fracture
Small to large chips or breaks in the enamel

Surfaces of the Teeth

Quadrants Primary vs. Permanent

Charting Symbols for Oxford Dental Hygiene Clinic Chapter 13 pg 247

Missing Teeth  M
Teeth that are not present because of extraction or are congenitally missing
Charting procedure
Place a vertical line or X through the facial, occlusal & lingual surfaces
Chart in BLUE ink

Unerupted Teeth  U
Teeth that have not yet erupted or are impacted
Circle facial, occlusal, & lingual surfaces of tooth
Chart in RED ink

Teeth to be extracted  Ex
Teeth to be extracted because of pathologic or orthodontic reasons
Draw a RED diagonal line through the tooth, or an alternative method is to draw 2 RED parallel lines through the tooth

Amalgam Restorations  A
Alloy of silver/mercury; silver or dark grey in color; widely used as a restorative material
Chart surfaces where the restorations appear
Outline the shade in BLUE for precise notation use Black’s classification

Tooth Colored Restorations  R = resin CR = Composite resin
Outline exact size & shape of restoration
Shade with BLUE ink
Chart surfaces involved
Use Black’s Classification

Temporary Restorations  Temp, T
Temporary filling cements; zinc oxide-eugenol cement
Chart temporary restorations the same as amalgam or resins in BLUE ink, but distinguish from amalgams with the abbreviation

Veneer  Ven
Veneer or layer of resin that is used to cover the unsightly area of tooth
Outline & shade in surface of tooth where veneer is found
Chart in BLUE ink

Full Gold Crown  FGC
Can be onlays or inlays or crowns
Outline & fill in with diagonal lines covering all surfaces
Chart in BLUE ink

¾ Gold Crown  ¾ GC
Covers less than ¾ of tooth surfaces
Outline & fill with diagonal lines places on all surfaces or portion of surfaces covered by crown
Chart in BLUE ink

Ceramic to Metal Crowns
GCFP = crown, porcelain face
GCAF = gold crown, acrylic face
Chart similarly to gold crowns
Abbreviation can be used to distinguish it from full gold or ¾ crowns
Chart in BLUE ink

Gold Inlay  GI
Does not cover the cusps
Outline the shape of the restoration on the surfaces where it appears
Chart in BLUE ink

Gold Onlay  GO
Restoration which involves the cusp tips
Outline & color the shape of the restoration on the surfaces where it appears
Chart in BLUE ink

Fixed Bridges
Each tooth may be labeled with the appropriate abbreviations FGC, GCPF, ¾ GC
Outline abutment & pontic teeth in BLUE ink & fill in with diagonal lines on occlusal, facial, & lingual surfaces
Chart the pontic teeth as extracted
Place 2 horizontal lines between the occlusal surfaces of the teeth to represent the splinted unit

Dental Implants  IMPL
Make a written comment under the teeth involved

Dental Caries  C
Outline the SUSPECTED carious area(s) in GREEN
Once diagnosed as caries by DDS, outline in RED
On completion of the restoration, fill in the RED areas with BLUE

Black’s Classification

Recurrent Decay  RD
Outline the area of recurrent decay in RED
Recurring caries around the margin of an existing restoration

Appliances – Partial or Complete Dentures
PUD = partial upper denture
PLD = partial lower denture
CUD = complete upper denture
CLD = complete lower denture
Chart the missing teeth with vertical lines or X’s through all surfaces
Join vertical lines or X’s with horizontal line at root apex & label to indicated upper or lower & partial or complete denture

Overhanging Restorations  OH
Chart with triangular symbols in the interproximal area
Chart in BLUE ink

Dental Sealants  S
Encircle & place abbreviation inside the circle
Chart on occlusal surface in GREEN

Root Tip  RT
Chart tooth as missing & place abbreviation symbol near root apex
Chart in BLUE ink

Root Canal  RC
Place vertical line through pulpal area of root
Label with abbreviation
Chart in BLUE ink

Decalcification or Hypocalcification  Decal
Outline the area & label with abbreviation
Chart in BLUE ink

Erosion  Ero
Shade area in BLUE & place symbol

Hypoplasia  Hypoplas
Chart using wavy lines to denote the irregularity of enamel with symbol
Indicate with abbreviation

Attrition  Att
Place a horizontal line over the affected surfaces
Chart in BLUE ink

Abrasion  Abr
Chart 2 horizontal lines in BLUE ink
Caused by mechanical wear caused by improper toothbrushing or other habits such as chewing on pencils, pipe smoking

Supernumary Teeth  Su
Draw additional tooth in location found
Chart in BLUE ink
Label with abbreviation

Other Dental Anomalies
Other anatomic variations such as dens in dente, should be clearly indicated in the record section of the dental chart

TMJ Evaluation
Detecting or noting any noises while bilaterally palpating the TMJ
Noises include
CREPITUS (cracking/grinding of the bones rubbing together)
POPPING or CLICKING
Tenderness & pain/muscle tension should also be noted

Percussion
Is done on each tooth to check for sensitivity, by gently tapping the dental mirror handle tip on each tooth & recording the finding’s noted as:
Normal = WNL
Sensitive = +P
Very Sensitive = ++P
Extremely Sensitive = +++P

Open Bite

Crossbite

Overbite

Occlusal relationship of primary molars

Reviewing Radiographic Findings Relevant to the Clinical Assessment Found on the back of the Hard Tissue

Radiographic Findings
Review normal or pathological findings
Is part of the ASSESSMENT phase & can be used in the IMPLEMENTATION phase
Radiographs are also required for documentation & record keeping of client’s dentition ( ie. Forensic dentistry often uses radiographs)

Periodontal Conditions Observed in Radiographs
Normal anatomy & the tooth crown to root ratio
Confirmation of clinical findings & topography of root surfaces
Status of the lamina dura
Changes in the PDL
Remaining bone height
Local irritants such as calculus & overhanging restorations
Patterns or extent of disease
Possible furcation areas
Disease progression or remission by serial radiography

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Hard Tissue Charting

by Oxfordlibrary on Jan 15, 2008

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Hard Tissue Charting — Presentation Transcript