DLA 1203- Exam 4

1. Dental
Charting

2. Key Terms
◦ furcation – Area where the root portion of a tooth divides.
◦ gingivitis – Inflammation of the gingiva.
◦ morphology – Study of the structure and form of living organisms.
◦ periodontal disease – Site-specific infection of the dental
supporting structures.
◦ periodontal probe – Hand instrument with millimeter calibrations
used to measure pocket depth, attachment width, and size of soft
tissue lesions.
◦ periodontitis – Inflammation of the periodontium that extends
beyond the gingiva.

3. Key Terms
◦ periodontium – Tissues that surround and support the teeth, i.e., the gingiva,
cementum, periodontal ligament, alveolar bone, and supporting bone.
◦ pocket depth – Distance in millimeters from the gingival margin to the base of
the pocket.
◦ prognosis – Foretelling the probable course of a disease, as well as forecasting the
outcome of a disease or regimen of treatment.
◦ recession – Loss of part or all of the gingiva covering the root of a tooth.
◦ treatment plan – Sequence of procedures planned for the treatment of a patient.

4. Charting Colors and Systems
◦ Colors (red/blue) and symbols are used in charting to indicate the condition
of the patient’s teeth and surrounding tissues and the restorative services
required.
◦ In some cases, it may be appropriate to use either color.
◦ An example would be that a patient has a fracture (red), but no discomfort
or appearance issues(blue); therefore, a notation is made on the chart that
nothing is to be done at this time and charted in either color.

5. Charting Colors and Systems
◦Red
◦Indicates work to be completed
◦Blue
◦Indicates completed work
◦Lines and fill-ins
◦Indicate restoration type

6. Charting (completed work)
◦ Amalgam restoration (outlined and filled solid blue when complete or red when to
be done)
◦ Composite restoration (outlined in red when to be done or blue when complete)
◦ Gold restoration (area outlined with diagonal lines, red when to be done or blue
when complete)
◦ Porcelain restoration (outlined with red when to be done or blue when complete
and/or P inside the outline)
◦ Sealant (S on occlusal surface, red when to be done or blue when complete)
◦ Stainless steel (outlined with swervy lines through it or two Ss inside it, red when to
be done or blue when complete).

7. Charting

8. Charting

9. Charting

10. Charting

15. Charting

17. Charting

19. #1 Impacted
#2 Class II DO amalgam restoration present
#4 Class II MOD amalgam restoration present
#6 Class III M composite restoration present
#8 Class IV MIFL composite restoration present
#8 #9 Diastema present
#9 Class III M decay
#13 Class II MOD amalgam restoration with recurrent decay
#14
Class II MO amalgam restoration present; food impaction between 13
and 14
#16 Has been removed

20. #17 Partially impacted and must be removed
#19 Bridge present, abutment full gold crown
#20 Bridge present, pontic porcelain with gold
#21 Bridge present, abutment porcelain with gold
#24
Mobility of III, periodontal pocket on M and D of 4 mm each, heavy
calculus from mandibular left cuspid to mandibular right cuspid
#25 Periodontal pocket on M and D of 3 mm each
#28 Needs a full gold crown with a porcelain facing
#28 Has a completed root canal
#30 Class I O decay
#31 Class II MO amalgam restoration present
#32 Has been removed

21. Computer programs
◦ The computerized systems of today work wonderfully.
◦ Although there are many dental software programs, they are easily
learned.
◦ You can use voice-activated systems, light pen systems, or use a
covered keyboard (to keep it sanitary).
◦ Dental assistants can become very proficient at computer charting.
◦ The software programs can handle periodontics, conditions of
dentition, tissue, occlusion, or any notations the dentist or auxiliary
would like.
◦ We will learn how to use Eaglesoft for paperless charting.

22. Charting Game
◦ https://www.quia.com/hm/244164.html

26. Can you chart these conditions?

27. Bridge
◦A fixed prosthetic
device placed in the
mouth to replace
missing teeth

28. Abutment
◦A tooth, a root, or an implant for retaining a fixed or
removable prosthesis; the teeth adjacent to a pontic in a
bridge
◦Which is the abutment?

29. Pontic
◦ Portion of the bridge that replaces the missing teeth

30. What does this mean?

31. Maryland Bridge
◦A resin-retained, fixed bridge that
replaces one tooth

32. Can you chart this condition?

33. Inlay, Onlay

34. What is the difference?

35. Cantilever bridge
◦Prosthetic device in mouth attached at only one side;
useful in area with little stress such as a missing lateral

36. Fractured tooth or root

37. Can you chart these conditions?

38. Can you chart these conditions?

39. Veneer

40. How can you tell?
◦What’s the difference between a crown
and a veneer?

41. Dental Implant
• Used to replace a missing tooth or teeth.
• There are different types
• You can use in conjunction with a crown, or use to
support a partial or complete denture

42. Can you chart these conditions?

43. Incipient
◦Beginning tooth decay that has no broken through the enamel
into the dentin

44. Denture
◦A prosthesis that replaces
missing teeth in the same
arch
◦Partial
◦Full

45. Mobility
◦Tooth movement in the socket; may be due to
periodontal disease or trauma

46. Mobility
◦ Mobility is an indicator of bone loss around the tooth.
◦ In order to accurately evaluate mobility, two non-working ends of the dental
instruments (i.e., the mirror handle and the probe handle) are pressed on the buccal
and lingual surfaces of the tooth.

47. Mobility Classification
Class O Complete tooth stability.
Class I Tooth moves ½ mm buccally and ½ mm lingually.
Class II
All degrees between Class I and Class III mobility of up to
1 mm in any direction.
Class III
Tooth is terminally mobile; movement is greater than 1 mm
in any direction and is depressible in the socket.

48. Drifting
◦Moving a tooth into the space created by a missing tooth

49. Can you chart these conditions?

50. Diastema
◦Space between maxillary central incisors in humans; can also
be used to denote a space between two adjacent teeth in the
same arch

51. Can you chart this condition?

52. Overhang
◦Excess restorative material
projecting over the cavity
margin

53. Can you Chart these conditions?

54. Partial Dentures
◦Prosthetic devices containing artificial teeth supported on
metal frameworks and attached by clasps to natural teeth

55. Root Canal
◦Where the pulp is removed and replaced with a filling
material

56. Can you chart these conditions?

57. Abscess
◦Local Area of pus and infection
◦Caused by?

58. Can you chart these conditions?

59. Gingival Recession
◦ Gingival recession is important to the periodontal examination
because it accurately indicates the total amount of attachment loss.
◦ Attachment loss can vary from tooth to tooth. A tooth can have
attachment loss without having a pocket.
◦ The amount of attached gingiva can be calculated by subtracting the
probing depth from the width of the keratinized gingiva.
◦ Tissue appearance for keratinized tissue is lighter pink with a stippled
appearance.

60. Can you chart these conditions?

61. Periodontal Pocket
◦ Space in the gingival sulcus (beyond the normal 1-3mm) created by periodontal disease

62. Periodontal Probing

63. How to read a perio probe:

65. Periodontal Probing Disadvantages
◦Even though periodontal probing is one of the best diagnostic
tools to assess periodontal disease, there are also certain
pitfalls to avoid:
◦ subgingival calculus can interfere with accurate readings
◦ in an area with elevated inflammation, the attachment is easily
perforated
◦ the pocket may be too tight to probe
◦ the patient may present with hypersensitivity making accurate
probing difficult

66. Periodontal Disease
Type I
Gingivitis
No loss of attachment
Bleeding on probing may be present
Type II
Early Periodontitis
Pocket depth or attachment loss: 3-4mm
Bleeding on probing may be present
Localized area of gingival recession
Possible grade I furcation involvement
Type III
Moderate Periodontitis
Pocket depths or attachment loss 4-6 mm
Bleeding on probing
Grade I or II furcation involvement
Class I mobility
Type IV
Advanced Periodontitis
Pocket depths or attachment loss >6 mm
Bleeding on probing
Grade II or III furcation involvement
Class II or III mobility
Type V
Refractory & Juvenile
Periodontitis
Periodontitis not responding to conventional therapy or which recurs
soon after treatment.
Juvenile forms of periodontitis.

67. Furcation Classification
◦Furcation involvement indicates a serious periodontal
condition that can affect multi-rooted teeth.
◦If it is detected early, it is treatable with guided tissue
regeneration.
◦Frequently, the areas that are most vulnerable to furcation
involvement (the posterior areas of the mouth) are difficult to
access.
◦As a result, abscesses, progressive attachment loss, and deep
periodontal pockets may develop and be undetected.

68. The four classes of furcation involvement that are
identified with the Naber’s probe are:
Class I
The furcation can be probed to a depth of 3 mm. Using the probe,
the anatomic fluting between the roots can be felt, but cannot
engage the roof of the furcation.
Class II
The furcation can be probed to a depth greater than 3 mm, but
not through and through.
Class III
The furcation can be completely probed through and through
subgingivally.
Class III+ Naber’s probe can go halfway across the tooth.
Class IV
The probe goes completely through the furcation and is
supragingival.

69. Can we identify?

70. Sealant
◦ Enamel sealant is a resin material used to seal pits and fissures to
prevent future decay

71. Restoration
◦Process of replacing missing tooth structure; results in
“fillings”

72. Charting
◦If an anterior tooth is fractured and
needs to be restored, which color
would it be charted in and why?
◦What if its fractured, but not causing
pain, and the dentist doesn’t feel its
necessary to repair at this time?

73. Charting
◦What are the five surfaces
on an anterior tooth?
◦Which of these surfaces is
the same for both anterior
and posterior?

74. Charting
◦Why do we use F for
facial instead of L for
labial, even though they
are the same surface?

75. Charting
◦A young adult broke his upper teeth at a
drinking fountain, from the middle of the
biting edge to the middle of each front
tooth in an upside-down V pattern.
◦Which surfaces, classifications, and teeth
numbers would be involved if using the:
◦Universal System for numbering?
◦The FDI system?
◦The Palmer System?

76. Can you
identify each
notation??

77. Answer key
◦ Tooth #1 is missing (charted in blue) with retained root tip (charted in red)
◦ Tooth #2 existing MOD amalgam (charted in blue) with mesial overhang (charted in red)
◦ Tooth #3 gingival recession with furcation involvement (charted in red)
◦ Tooth #4 existing porcelain fused-to-metal crown (charted in blue)
◦ Tooth #5 existing sealant (charted in blue)
◦ Tooth #6 existing implant (charted in blue), needs porcelain fused to HNM crown (charted in
red)
◦ Tooth #7 existing DF composite (charted in blue)
◦ Tooth #8 has a MI fracture or MI caries (charted in red)
◦ Tooth #9 has an all ceramic or all porcelain crown (charted in blue)
◦ Tooth #10 has a DI composite (charted in blue)
◦ Between tooth numbers 11-12 there is an open contact or diastema (charted in blue)
◦ Tooth #11 is sound
◦ Tooth #12 existing DO amalgam with recurrent caries (charted in blue, outlined in red)
◦ Tooth #13 has MOD caries, composite treatment planned (charted in red)
◦ Tooth #14 existing porcelain fused to HNM crown - three-unit bridge (charted in blue)
◦ Tooth #15 existing HNM crown (pontic) - three-unit bridge (charted in blue)
◦ Tooth #16 existing HNM crown (abutment) - three-unit bridge (charted in blue)
Maxillary

78. Answer Key
◦ Tooth #17 fully erupted, to be extracted (charted in red)
◦ Tooth #18 existing stainless steel crown (charted in blue)
◦ Between 18-19 food impaction (charted in red)
◦ Tooth #19 existing MODFL amalgam (charted in blue)
◦ Tooth #20 endontically treated with post and core (charted in blue)
◦ Tooth #21 rotated to the distal (charted in red)
◦ Tooth #22 existing lingual amalgam (charted in blue)
◦ Tooth #23 existing porcelain veneer (charted in blue)
◦ Tooth #24 existing retainer for Maryland bridge (charted in blue)
◦ Tooth #25 existing Maryland pontic (charted in blue)
◦ Tooth #26 existing retainer for Maryland bridge (charted in blue)
◦ Tooth #27 existing F composite (charted in blue)
◦ Tooth numbers 27 – 30 existing lingual tori (charted in blue)
◦ Tooth #28 is sound
◦ Tooth #29 existing periapical abscess; tooth is extruded (charted in red)
◦ Tooth #30 needs an occlusal sealant; tooth has drifted medially; has class V buccal caries
(charted in red)
◦ Tooth #31 missing (charted in blue)
◦ Tooth #32 is impacted and horizontal (charted in red)
Mandibular

79. Eaglesoft
Perio Probe
FINDINGS USE BUTTON DISPLAY
Mobility Grade MOB MOB
Pocket Depth Measurement PD PD
Gingival Margin Measurement GM GM
Clinical Attachment Level Automatically Calculated CAL
Mucogingival Junction MGJ MGJ
Furcation Grade FG FG
Bleeding Bleeding Colors Site Dot
Bleeding All Bleeding all pockets Colors Site Dot
Suppuration Suppuration Colors Site Dot
Suppuration All Suppuration all pockets Colors Site Dot
Bleeding and Suppuration Bleeding and Suppuration Colors Site Dot
Definitions

80. Suppuration
◦The process of pus formation, called
suppuration, occurs when the agent
that provoked the inflammation is
difficult to eliminate.
◦Pus is a viscous liquid that consists
mostly of dead and dying
neutrophils and bacteria, cellular
debris, and fluid leaked from blood
vessels.

81. SOAP notes
◦ The patient chart is a legal record of dental services. Information
noted must be accurate, comprehensive, concise and current.
◦ During an initial oral exam, data recorded includes conditions present
and any previous dental treatment provided.
◦ Dental SOAP notes are written to improve communication among all
those caring for the patient by standardizing evaluation entries made
in dental charts.
◦ Each letter in “SOAP” is a specific heading in the notes.

82. SOAP notes
◦ S – refers to subjective, the purpose of the patient’s dental visit. This section also includes the
description of symptoms in the patient’s own words including: pain, what triggers the discomfort,
what causes the discomfort to disappear and the length of time these symptoms have been
occurring.
◦ O – refers to objective, unbiased observations by the dental team. Included under this heading
would be things that can actually be felt, heard, measured, seen, smelled and touched.
◦ A– refers to assessment, the diagnosis of the patient’s condition done by the dentist. The
diagnosis may be clear or there may be several diagnostic possibilities.
◦ P – refers to the plan or proposed treatment, and is decided upon by the patient and the dentist.
◦ The plan may include radiographs, medications prescribed, dental procedures, patient referral to specialists
and patient follow-up care instructions.

83. SOAP notes
◦ A SOAP notation is not supposed to be as detailed as a progress report
and the usage of abbreviations is standard.
◦ Abbreviations will vary slightly from one practice to another, so it is
important to use notations commonly used within the practice.
◦ It is imperative that the individual making the notation sign their name
and list their credentials so that those reading the record know who was
responsible for the notes.
◦ Notes should be free from scribbles and whiteout errors.
◦ If an error is made, a single line should be drawn through the error, dated
and initialed, and the correction written.
◦ Corrections in computerized formats will vary according to dental
software.
◦ Notations should be written fluently and without blank lines between the
entries.
◦ This will prevent additional information being added without the writer’s
knowledge.