This document provides an overview of patient evaluation, examination, diagnosis, and treatment planning for conservative and endodontic treatment. It discusses taking a thorough case history, medical history, and clinical examination including inspection, palpation, percussion, and exploration of the soft tissues, hard tissues, periodontal tissues, existing restorations, and use of radiographs and diagnostic tests to arrive at a diagnosis and treatment plan. The goal is to identify any dental or systemic issues, thoroughly examine the patient, and determine the appropriate treatment.

1. Dept : conservative and endodontic
Seminar
Patient Evaluation , Diagnosis And
Treatment plane of Conservative
Guided by :
Dr. Rohit Miglani (HOD)
Dr. Sudhakar (Prof.)
Dr. A. Mandal (Reader)
Dr. Amit Kumar (Reader)
Dr. Malvika Sisodiya(Sr.Lec.)
Dr. Amit Kumar (Sr. Lec.)
Submitted By :
Ajeet Kumar
(2017-18)
Intern

2. Contents
• Patient Evaluation
– Case History
– Chief Complaint
– History of Present Illness
– Past Dental History
– Medical History
• Examination and Diagnosis
– Clinical Examination
– Periodontal Evaluation
– Evaluation of Carious Lesions
– Evaluation of Existing Restorations
– Radiograph
– Study Casts
– Laboratory Investigations
– Occlusion Examination
– Pulp Vitality Tests
– Recent Advances in Pulp Vitality Testing
• Treatment Planning
• Treatment Record

3. Introduction :
 To provide best treatment and patient
satisfaction, thorough clinical history, examination
and diagnostic aids are required.
 Diagnosis is defined as utilization of scientific
knowledge for identifying a diseased process and
to differentiate it from other disease process

4. PATIENT EVALUATION :
The diagnostic process actually consists of
four steps:
1. First step: Assemble all the available facts gathered from chief
complaints, medical and dental history, diagnostic tests and
investigations.
2. Second step: Analyze and interpret the assembled clues to
reach the tentative or provisional diagnosis.
3. Third step: Make differential diagnosis of all possible diseases
which are consistent with signs, symptoms and test results
gathered.
4. Fourth step: Select the closest, possible choice.

5. Case History:
Definition of case History:
 Pre-planned , Professional conversation between the patient
and the clinician in which the patient reveals his/her
symptoms fears , or feeling to the clinician so that the nature
of the real or suspected illness and mental attitude to it may
be determined .
 The purpose of recording patients history and conducting a
clinical examination is to arrive at a logical diagnosis to the
patients chief compliant and to institute a suitable treatment
plane.

6.  Chief Complaint:
- Before initiating any treatment it is important to
determined the patients chief complaint or the problem that initiate own
words.
-Patient should be encouraged and guided to discuss all aspects of
current problem , including onset , duration symptoms and related
factors.
-- It should be recorded in patients own words and should not be
recorded in medical terminology .
PRETREATMENT CONSIDERATION

7. History of present illness:
 Once the patient completes information about his/her chief
complaint, a report is made which provides more descriptive analysis
about this initial information.
 Examples for the type of questions asked by clinician include :
• How long have you had the pain ?
• Do you know which tooth it is ?
• What initiates pain ?
• how to relieved pain ?
• when was the problem first noticed ?
• Mode of onset ?

8.  How would you describe the pain ?
– Quality—Dull, Sharp, throbbing, constant
– Location—Localized, diffuse, referred, radiating
– Duration—Seconds, minutes, hours, constant
– Onset—Stimulation required, intermittent, spontaneous
– Initiated—Cold, heat, palpation, percussion
– Relieved—Cold, heat, any medications, sleep
In other words, history of present illness should indicate severity
and urgency of the problem.

9. - A history of pain which persists without exacerbation may
indicate problem of non - odontogenic origins. The most
common toothache may arise from either pulp or periodontal
ligament. Pulpal pain can be sharp piercing if A-delta fibres are
stimulated. Dull, boring or throbbing pain occurs if there is
stimulation of C-fibers .
- If pain is from periodontal ligament, the tooth will be sensitive to
percussion, chewing and palpation. Another hint that pain is of
pulpal origin is its intensity.

10.  Past Dental History :
This helps to know any previous dental experience,
and past restorations.
 Medical History :
For a proper medical history , importance should be given
to the following :
1. Allergies and medications ( allergic to local anaesthetics)
2. Communicable diseases ( HIV, hepatitis )
3. Systemic diseases ( valvular heart diseases , oral lesions
, immunocompromised patients )
4. Psychological problem associated with aging.(gingival
recession , staining , decreased salivary flow )

11. Systemic Diseases
Checklist for medical history (Scully and Cawson )
 Anaemia
 Bleeding disorders
 Cardio respiratory disorders
 Drug treatment and allergies
 Endocrine disease
 Fits and faints
 Gastrointestinal disorders
 Hospital admissions and attendance
 Infections
 Jaundice
 Kidney disease
 Likelihood of pregnancy or pregnant itself.

12. Physiological Changes Associated with Aging
• Attrition, abrasion and wear of proximal surfaces
• Extrinsic staining
• Edematous gingivae
• Diminished salivary flow
• Gingival recession.
Generalized attrition of teeth

13. EXAMINATION AND DIAGNOSIS
Diagnosis : it is the process of identifying a disease by its sign ,
symptoms and results of various diagnostic procedures
• Clinical examination:
It includes both extraoral and intraoral
examination
• Intraoral examination:
It includes the examination of soft and hard tissue
 Clinical examination of the patient should be done thoroughly
and in proper sequence.
 Inspection( extraoral & intraoral )
 Palpation
 Percussion
 Auscultation
 Exploration
Following sequence is followed during
clinical examinations :

14. Periodontal Evaluation
Periodontal condition can be assessed by palpation, percussion,
mobility of tooth and probing Periodontal examination shows
change in color, contour, form, density, level of attachment and
bleeding tendency.
The presence of plaque, supra- and subgingival calculus should
also be checked so that restorations can be contoured accurately to
maintain proper periodontal health.
Grading of mobility
Slight (normal)
Moderate mobility within a range of 1 mm.
Extensive movement (more than 1 mm) in
mesiodistal or lateral direction combined with
vertical displacement in alveolus.

15. Evaluation of Carious Lesions
Dental caries is diagnosed by the following :
• Visual changes in tooth surface
• Tactile sensation while using explorer
• Radiography—Definite radiolucency indicating a
break in the continuity of enamel is carious enamel
• Transillumination.
A translucency producing a characteristic shadow on the
proximal surface indicates presence of caries.
Carious teeth Radiograph showing dental caries