This presentation is releated to chair side investigation in dentistry

1. CHAIRSIDE
INVESTIGATION
presented by
Roopak jha
GUIDED BY:-
DR PREETI TOMAR (HOD)
DR MOAZZAM JAWAID(LECTURER)

2. Investigation
Investigation are an extension of he physical
examination in which tissue ,blood ,other
specimen are obtained from the patient and
subjected to microscopic
,biochemical,microbiological or immunologic
examination.
Chair side investigation
Simple test & examination procedures
performed at the chairside

3. Classification of chairside investigation
Investigation for hard tissue examination
PULP VITALITY TEST
• Classification of Chairside Investigations
• 1. Investigations for Hard Tissue Examinations
• Α) Pulp vitality tests
• i. Thermal test
• a) Cold test
• b) Heat test
• ii. Electric pulp testing
• iii. Other tests
• a. Pulse oximetry
• b. Test cavity
• c. Selective anesthesia

4. d. Laser Doppler flowmetry
e. Spectrophotometry
2- Caries detection test
3- Plaque disclosing agents
4- Mobility test
5- Tests to detect cracked tooth
6- test for detection of vascular lesion
7- Test for detection of potentially malignant lesion and condition
• Vital staining

5. • Light based detection system
• Cytological technique
• Histological technique
8- investigation for maxillary sinus
9-investigation for saliva and taste evaluation
10- test for oral malodor
11- investigation for allergy

6. Thermal test
Heat test
• Hot water
• Hot burnisher
• Gutta percha
3mm of the end of the stick of gutta percha is heated in flame for 2 sec and is applied to the
suspected tooth
Precaution (tooth surface is lightly coated with Vaseline to prevent the sticking of gutta
perchance.)

7. Observation
• No response- necrosis,gangrene, chronic abscess
• Mild to moderate response –normal pulp
• Painful response which subside after removal of stimulus – reversible pulpits
• Painful response which continues even after removal of stimulus – irreversible pulpits, acute
alveolar abscess,acute pulpitis

8. Cold test
• Ice
• Co2 snow
• Ethyl chloride spray
Observation
• No response – non vital or false negative
• Moderate response- normal pulp
• Painful response which subside immediately after the stimulus removed – reversible pulpits/hyperemia
• Painful response which may remain after removal of stimulus- irreversible pulpits
• In case of hyperemia there may be quick response and in chronic pulpits may be delayed response.

9. Electric pulp test
• Pulp tester are designed to elicit response by electrical excitation of neural element in the
pulp
• pulp pain is a result of nociceptors activated by fluid movement with possible other irritants
through the patent dentine tubules.
• The fast conducting myelinated Aδ-fibres are known to be responsible for the acute “sharp
shooting pain” whereas the slower conducting unmyelinated C-fibres

10. PULSE OXIMETRY
• A non invasive method to measure the oxygen concentration in the blood & pulse rate
• Oxygenated haemoglobin and deoxygenated haemoglobin are different in color and
therefore absorb different amount of red and infrared light
• Pulse oximeter therefore utilizes probes emitting red and infrared light to transilluminate the
target vascular area which allow photodetector to identify absorbance peaks due to pulsatile
blood circulation and thereby calculate the pulse rate and oxygen saturation level .

11. Laser doppler flowmeter
• A non invasive method of assessing and measuring the blood flow of pulp tissue
Principle
• The light beam’s frequency will shift when hitting moving red blood cell but will remain
unshifted as it passes through static tissue
Advantages
• Based on objective findings :
• Accurate
• Reliable
• Reproducible

12. Test cavity
• The preparation of a test cavity has been suggested as a last resort in a tooth where no other
means can ascertain the pulp status
• the cavity test is initiated on a suspicious tooth, without anesthetic, and involves drilling a
small window through either enamel or a restoration to dentin.
• The cavity test will stimulate a vital pulp and provoke a painful response when dentin is
invaded.
• Test cavities are not generally recommended as a means of testing pulp sensibility.

13. Selective anesthesia
• The final test that the dentist may use in determining your diagnosis is selective anaesthesia.
• This is used when it is difficult to isolate the cause of your pain.
• The dentist will selectively anaesthetize small areas at a time until the pain is eliminated.

14. Caries detection test
1- Caries dyes
• Various dye like PROCION have been used to detect enamel caries but have not been successful for
clinical use
• Dyes are useful to detect carious dentin
• 0.5% basic fuchsia in propylene glycol was used
• This stain the infected demineralised dentin selectively while the affected dentin remain unstained.
2- Fiberoptic transillumination
• Carious lesions have lower index of light transmission
• When teeth are examined with fibroptic light source ,caries appears as darkened shadow

15. • After drying the tooth a fiber optical probe can be placed in the buccal or lingual embrasure
directly beneath the contact area between two adjacent teeth
• If caries is present ,it is evident as a dark shadow beneath the marginal ridge

16. Plaque disclosing agents
• A material which when applied on natural teeth makes biofilm visible, focusing on areas that
have been missed out during daily toothbrushing.
• Iodine solution (21 ml of tincture Iodine in15 ml of water) is formally the most classic
disclosing solution used for staining the plaque

17. Mobility test
• Mobility test- the test consist of moving a tooth laterally in its socket by using the finger or
preferably in the handles of two instruments
• The objective of this test is to determine whether tooth is firmly or loosely attached to its
alveolar
• Measurement of tooth mobility by Millar
• 0 – no detectable movement when force is applied ( normal)
• 1 –it indicate mobility greater than normal
• 2 –mobility up to 1mm in buccolingual direction
• 3 – mobility greater than 1mm in bucco lingual direction combined with the ability to depress the tooth

18. Test to detect cracked tooth
• The Fractfinder or Tooth slooth can be used on each individual cusp and the patient is asked
to bite, thus allowing the placement of selective pressure on one cusp.
• If there is pain on biting or release of biting pressure, it is indicative that the cusp is cracked.

19. Test for detection of vascular lesion
Diascopy
• Diascopy is used to determine whether erythema in a lesion is due to blood within superficial vessels
(inflammatory or vascular lesions) or is due to hemorrhage (petechiae or purpura).
• A microscope slide is pressed against a lesion (diascopy) to see whether it blanches.

20. Test for detection of potentially malignant lesion
and condition
• Vital staining
1- Toluidine blue stain :Toluidine blue is a metachromatic stain when used for histological analysis. Clinically one mechanis
to be greater penetration and temporary retention of the dye in the intercellular spaces of rapidly dividing cancer cells in viv
2- Methylene blue : Methylene blue may penetrate into cells with an abnormal increase in nucleic acid, thus resulting in diff
between normal and highly dysplastic/malignant cells. Usage of the methylene blue technique in detecting oral malignant o
malignant lesions

21. • Cytological technique
1- Oral brush biopsy : This biopsy method utilizes an improved brush to obtain a complete transepithelial biopsy
specimen with cellular representation from each of the three layers of the lesion: the basal, intermediate, and
superficial layers.
2- Exfoliative cytology : non-invasive character of the technique, which allows a simple and pain-free collection of
intact cells from different layers in the epithelium for microscopical examination and quantitative evaluation
3- fnac : Fine Needle Aspiration Cytology (FNAC) is a rapid, reliable and safe diagnostic tool used for various
lesions of the oral cavity and salivary glands.

22. • Histological technique
1. Incisional biopsy : involves taking a small portion of the lesional tissue for diagnostic purpose. Incisional
biopsies are commonly used: When a lesion is large enough that definitive removal for histologic diagnosis
would produce significant morbidity.
2. Ecxisional biopsy :surgical procedure in which a cut is made through the skin to remove an entire lump or
suspicious area so it can be checked under a microscope for signs of disease. A small amount of healthy
tissue around the abnormal area may also be removed.
3. Punch biopsy: procedure in which a small round piece of tissue about the size of a pencil eraser is removed
using a sharp, hollow, circular instrument. The tissue is then checked under a microscope for signs of disease.

23. Investigation of maxillary sinus
• Transillumination test
• A light is shined against the sinuses. Normally the sinus appears hollow and the light shines through giving a
reddish glow. When inflamed and blocked with secretions and mucus the light fails to sine through and
the sinus appears opaque. This test is called the transillumination test.

24. Investigation for saliva and taste evaluation
• Collection of whole saliva
1. Draining technique
2. Spitting
3. Suction method
• Parotid collector - Carlsson Crittenden cup
• Sub mandibular – segregator
• Minor salivary gland - periotron

25. Test for xerostomia
• Tongue blade sign :
when you touch the oral mucosa with a tongue blade, it will stick to the oral tissues.
• Lipstick sign:
the lipstick will stick to the labial surface of maxillary anterior teeth

26. Test for detection of taste disorder
• Electrogustometry:
1. Electrogustometry is the measurement of taste threshold by passing controlled anodal current
through the tongue. When current passes through the tongue a unique and distinct metallic taste is
perceived.
2. Normal difference <20uAmp(threshold differing by more than 25%abnormal
3. Total lack of chords timpani: no response at 300uAmp

27. Test for oral malodor
• Organoleptic method : The oldest way for unpleasant odor detection is by smelling with the
nose. Measurement of unpleasant odors by smelling the exhaled air of the mouth and nose
is called organoleptic measurement. It is the simple way for the detection of halitosis.
• Sulfide monitors : The three main gases are hydrogen sulphide, methyl mercaptan and
dimethyl sulphide. The simplest measuring device is a sulphide monitor called the
Halimeter®, which measures the sum of the three gases. The sampling technique involves
placing a straw on the back of the tongue and closing the mouth for one minute.

28. Investigation for allergy
• Skin prick test :The gold standard for allergy testing is as simple as pricking your skin,
inserting a small amount of a substance, and waiting to see what happens. If you’re allergic
to the substance, a reddish, elevated bump with a red ring around it will appear. This bump
may be severely itchy.
• Patch test: patch testing, different substances are placed on the skin and taped in place. The
patches are typically placed on the back, left on for 2 days and then removed. The area of
skin that was tested will be evaluated by the dermatologist 2 to 4 days after the patches are
removed.

30. Thankyou ✨