rpd history examination diagnosis

1. Examination, diagnosis and treatment
planning in cast partial denture
Topic
2 Jan 2024
Adnan Sunny – Bds(PK), Fcps, Chpe, Harvard(US) certified
23 slides/1 hour LGIS

2. Introduction
Dental treatment is provided to address the needs
• Subjected BY THE PATIENT
• Objected BY THE CLINICIAN
Each patient is unique
ASSESSMENT of patient condition and PLANNED accordingly
J Pharm Bioallied Sci. 2012 Aug; 4(Suppl 2): S406–S409.

3. DEFINITIONS
Diagnosis
The determination of the nature of a disease or A diagnosis is an identification of a disease via examination
Prognosis
It is a prediction of the course of the disease as well as the treatment and results.
Treatment plan
The sequence of procedures planned for the treatment of a patient after diagnosis
https://www.sciencedirect.com/topics/medicine-and-dentistry/treatment-planning

4. Effective communication
Role of Effective Communication in Fabrication of RPD
According De Van “we should meet the mind of the patient before we meet mouth of the
patient.
Meet the patient brain before commencement of the treatment, which is only possible if one
have good communication skill. Communication skills help to provide an effective exchange of
information and teamwork with patients, the families of patients and other health care
professionals. Students who are good in communication skills have shown greater patients
satisfaction. Effective communication is the key to record prompt history.
Do not overcommit
Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4

5. Consent form
Consent letter, which is discussed with patient and given a documented
structure is kept in patient record. All the patient should receive a treatment
plan letter before proceeding with treatment. Most importantly if these factors
are discussed with the patient prior to starting, they are a diagnosis, if they are
discussed once the problem arises after denture provision they are often
thought of as “an excuse”, by the patient, that is a potential red flag and the
dentist would be on the back foot.
Advantages
Disadvantages
Risks
Cost
Timing durations/no of visits
Alternatives
No treatment
https://www.ncbi.nlm.nih.gov/books/NBK430827/

6. The BRAN
protocol
B
Benefits
R
Risks
A
Alternates
N
No
Treatment
According to Dental Updates which I as a prosthodontist consider a
treatment protocol. The BRAN protocol
B benefits (advantages/disadvantages)
R risks
A alternatives
N no treatment (yes no treatment)
The BRAN protocol

7. Examples on the list are:
1. initially the denture might feel sore
2. The dentures will cause alteration to speech
3. The dentures are a prosthetic replacement – mouth by nature is not made for dentures, it’s a treatment not a cure
4. Adaptation is required – neuromuscular control is important for denture use
5. Saliva flow changes (initially patient might hypersalvate later on hypo salvation)
6. Chewing and eating difficulty
7. Cheek, lip and tongue might be subjected to bite
8. Potential feeling of fullness
9. Might need repeated follow-ups
10. Dentures shall be refabrication after every 5 to 8 years
11. Recommend a spare denture
12. Dentures by default are analogous to natural teeth and can never completely replace the natural teeth
https://www.finlaysutton.ao.uk/contact

8. SOAP
Subjective
Objective
Assessment
plan
Subjective – referring to what the patient tells the doctors
Objective – referring to the doctor observed after listening to what the patient said
Assessment – refers to the doctor assessment after evaluating the subjective and objective findings
Plan – the management actions taken by the doctor
Standardize medical evaluation
https://www.dentalclaimsupport.com/blog/soap-notes-document-value-of-dental-care

9. Patient psychological assessment
House classification:
House classified patient’s behaviors, Philosophical
Critical/exacting
Indifferent
skeptical
p i c s
philosophical indifferent critical skeptical
They are cooperative and
well-motivated. They are
sensible, understand the
limitation of artificial
prosthesis and usually remain
clam during the course of
treatment. Best prognosis
There prognosis remain
questionable. Usually lacks
motivation and show less
interest in treatment.
Indifferent patients have little
concern for their teeth or
oral health. Brought by a
family member
Find fault with everything that is
done for them. They are methodical
and exacting in nature. Very
demanding but if treated well might
show good result.
These patients have the
worst of prognosis. Patients
have had bad results with
previous treatment and are
therefore doubtful that
anyone can help them.
Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4

10. Greets the patient
Introduces himself/herself
Acquires Consent from the patient before
Inquires Presenting Complaint from patients’ perspective
Reports elaborate history of presenting complaint
Reports detailed dental history
Reports detailed medical history including medications, hospitalization, and
allergies
Reports Social History (occupation/ Habits)
Reports family history
Performed general physical examination
Performed intraoral / extra oral examination
Professionalism and Communication Skills
Patient Safety and Infection Control
Thanking the patient
Evaluation of history and examination includes the following the checklists
https://ksumsc.com/download_center/Archive/3rd/433/433%20Teams%20work/History%20taki
ng%20%26%20examination/HISTORY%20TAKING%20AND%20PHYSICAL%20EXAM.pdf

11. HISTORY TAKING AND EXAMINATION OF EDENTULOUS PATIENT
Personal Information
Patient name: ____________________
Age:
Gender: M / F
Occupation: ______
Socioeconomic Status:
Dependency
Marital Status: Single/Married/Widowed
If married age of the last born baby
Address/demographics: __________________
Contact No.: _______________
Never give your personal number to patient
• Chief complaint
• History of chief complaint
https://doi.org/10.1016/0022-3913(76)90283-3

12. Hx Continued
Medical history/Systemic history
Allergies
Bone/joint diseases
Bleeding disorders
Cardiac disorders
Covid 19
Diabetes
Endocrinal disorders
Fungal
GIT disorders
Hepatitis
Hypertension (medicines), gingival enlargement)
Infections( communicable) HIV
Jaundice
Liver diseases
Mental issues
Neuromuscular disorders
Organ transplant
parkinsonism
Tuberculosis
Hospitalization:
Within last year (diagnosis/complication/operated for)
Surgeries performed (type of anesthesia) Sedation, GA, LA
TMJ history:
Symptoms (clicks, pops, crepitus), diagnosis and treatment
Radiation history:
Last 6 months
Drug history:
Prescribed/over the counter
Corticosteroids, anti-coagulants, insulin, bisphosphonates, tetracycline
(Dosage/ Duration)
Any drug abuse
https://doi.org/10.1016/0022-3913(76)90283-3

13. Previous dental treatment
Received from( name of the previous dentist)/ quack
Experience
Type of Treatment received
Previous prosthesis experience
Nature of prosthodontic treatment
Any complication during the procedure
Dental history:
https://geekymedics.com/taking-a-dental-history-osce-guide/

14. 1
2
3
Oral hygiene practices:
Method Tooth brush
Tooth paste
Miswak
Mouthwash
Floss
Tooth pick
Any other
Frequency:
More than twice a day
Twice a day
Once a day
Once a week
Sometimes
Never
Duration:
More than 5 Minutes
3 to 5 Minutes
1 to 3 Minutes
Less than 1 Minutes
Frequency of visit to dentist: (when teeth
were present)
Regular
Irregular
Never before
Reason for tooth loss:
Periodontal
Caries
Trauma
Any other
https://geekymedics.com/taking-a-dental-history-osce-guide/
Hx Continued

15. Habits:
Smoking
Paan
Gutka
Niswar
Chalia
Alcohol
Any other
Any parafunctional habits:
Bruxism:
Yes No
Clenching:
Yes No
Edentulous period:
< 6 months
6 months to 1 year
1 to 2 years
2 years
Tooth replacement in past:
No
Yes (Removable / Fixed / Other ____________)
https://geekymedics.com/taking-a-dental-history-osce-guide/
Hx Continued

16. First time denture wearer:
Yes
No
If no, then how many dentures have been made for
the patient?
1
More than 1
Experience with previous replacement:
Satisfactory
Unsatisfactory
Complaints regarding
Function (unable to eat, speak properly)
Retention, stability, looseness,
Esthetics
Denture hygiene: if any
Method:
Brushing with Soap
Brushing with toothpaste
any other: _____
Denture usage:
Daytime only
24 hours
Never
Denture history: if any
Hx continued
https://geekymedics.com/taking-a-dental-history-osce-guide/

17. General physical examination:
General health and Appearance
Weight
Gait
Facial symmetry:
Symmetrical
Asymmetrical
Frontal face form:
Square
tapering
ovoid
Lateral face form:
Normal
retrognathic
prognathic
Facial nerve examination
Forehead wrinkles
Bow the mouth
Forceful closer of eyes
Dropped angle of the mouth
Muscles of mastication
Sternocleidomastoid
Masseter
Temporalis: anterior, middle
and posterior fibers.
Medial and lateral pterygoid
Extraoral examination:
Lip
Length
Thickness
mobility
Support
Mouth opening:
Normal
limited / restricted
Excessive
Mouth opening
Deviation
Deflection
>2 unacceptable <2 acceptable
https://nature.com/articles/s41407-021-0622-z

18. Oral mucosa:
Normal
Abnormal (Buccal mucosa / Tongue / Lip / Floor of
mouth/Palate)
Soft tissue lesion:
Asymmetrical
Square
White lesion
Ulcers
Epulis
Other
Saliva:
Quantity / Flow
Normal
Excessive
Restricted
Consistency:
Normal
Thin
Thick / Ropy
Frenal attachment:
Maxillary:
Labial frenum:
Right Buccal frenum
Left buccal frenum
Mandibular:
Labial frenum
Lingual frenum
Right Buccal frenum
Left Buccal frenum
Class1: Favorably away from the crest of the ridge
Class 2: Between favorable and unfavorable attachment
Class 3: Unfavorably near crest of the ridge
Intraoral examination:
Tongue:
Size:
Large
Normal
Small
Position:
Normal
Retruded
Surface:
Roughness
Ulceration
Color:
Pink
Reddish
White
https://nature.com/articles/s41407-021-0622-z

19. Ridge:
Maxillary/mandibular
Arch size:
Large
Medium
Small
Arch shape:
Squarish
Tapering
Ovoid
Degree of resorption:
Normal
Excessive
Ridge evenness:
Yes □ No □ ___________________
Ridge Undercut:
Yes □ No □ ___________________
Examination continued
https://nature.com/articles/s41407-021-0622-z

20. Examination continued
Hard palate:
High palatal vault
Flat Shaped
U shaped
V shaped
Torus:
None
Palatal
Mandibular
https://nature.com/articles/s41407-021-0622-z
Maxillary tuberosity:
Enlarged:
Yes No
Undercut:
Bilateral Unilateral
Bony
Fibrous/hyperplastic/pedenculous
Oral hygiene:
Good
Poor
Normal
Halitosis

21. Denture examination(if any)
Denture Hygiene:
Plaque
Calculus
Stains
Denture wear (damage):
Yes
No
Dentures examination:
Inside the mouth
Peripheral extensions, retention, stability, esthetics, lip support,
occlusion,
Outside the mouth:
Shape of the peripheries, tooth set up, quality of the denture base,
integrity of the components
https://nature.com/articles/s41407-021-0622-z

22. CONCLUSION
Radiographic examination(of the remaining abutment)
Preextraction records (pictures, diagnostic cast if any)
Diagnosis( Kennedy class )
Prognosis
Treatment plan
https://nature.com/articles/s41407-021-0622-z

23. Thank You
Jan 2024