Hard Tissue Charting


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Hard Tissue Charting

  1. 1. Hard Tissue Charting Dental Hygiene Theory Instructor: Nickee dela Cruz R.R.D.H.
  2. 2. Hard Tissue Charting <ul><li>Is completed & documented at the ASSESSMENT appointment </li></ul><ul><li>Is updated at each maintenance appointment </li></ul><ul><li>Should follow a routine so that nothing is missed (sequencing) </li></ul><ul><li>Do not use erasers or white out, if you make a mistake stroke 1 line through it & date & initial the change </li></ul>
  3. 3. Charting <ul><li>Conditions which exist or are present in the oral cavity are recorded in BLUE </li></ul><ul><li>Carious lesions, teeth requiring treatment (extractions & other pathologic conditions, such as abcesses) are recorded in RED </li></ul><ul><li>SUSPECTED carious lesions are charted in GREEN , but if they are diagnosed by the DDS as being decay, they are changed to RED </li></ul>
  4. 4. Normal, Atypical, & Abnormal Findings to Observe during Hard Tissue Exams
  5. 5. The dental hygienist should be able to … <ul><li>Recognize signs of development anomalies & acquired tooth damage & bring them to the DDS’s attention </li></ul><ul><li>Be able to properly document in the odontogram (hard tissue) in the client’s chart </li></ul>
  6. 6. Anomalies of the Teeth <ul><li>Hyperdontia – or supernumary teeth, extra teeth such as mesiodens which will occur between the maxillary anterior teeth </li></ul><ul><li>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 </li></ul>
  7. 7. Mesiodens
  8. 8. Mesiodens (arrow) . A, Radiographic appearance. B, Clinical appearance
  9. 9. Hypodontia
  10. 11.   Microdontia (arrow)
  11. 12. Supernumary Teeth
  12. 15. Anomalies of the Dental Tissue <ul><li>Macrodontia – larger than normal teeth, they tend to be wider, longer, & higher than normal teeth, may affect several or all teeth in the dentition </li></ul>
  13. 16. Anomalies of the Dental Tissue <ul><li>Gemination – a tooth tries to split or twin </li></ul>
  14. 17. Gemination
  15. 18. Gemination (arrow)
  16. 19. Anomalies of the Dental Tissue <ul><li>Dens in dente – a tooth within a tooth usually the lingual of maxillary incisors </li></ul>
  17. 20. Dens in dente
  18. 21. Anomalies of the Dental Tissue <ul><li>Dilacerations – severe distortion or crown or root by trauma during formation </li></ul>
  19. 22. Dilaceration
  20. 23. Definition of DYSPLASIA <ul><li>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 </li></ul>
  21. 24. Intrinsic Staining Stain or discoloration within the tooth <ul><li>Enamel dysplasia </li></ul><ul><li>HYPOPLASIA – (rough, pitted enamel surface, ameloblasts disrupted during the matrix formation of the tooth) </li></ul><ul><li>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. </li></ul>
  22. 25. Enamel Hypoplasia
  23. 26. Enamel hypoplasia
  24. 27. <ul><li>Syphilitic enamel hypoplasia. </li></ul><ul><li>A, Hutchinson's incisors. </li></ul><ul><li>B, Mulberry molars. </li></ul>
  25. 28. Enamel Dysplasia <ul><li>HYPOCALCIFICATION – defect in enamel during mineralization, spotted surface is generally smooth, may be from trauma, nutritional deficiencies, excess fluoride intake </li></ul>
  26. 29. Enamel Hypocalcification
  27. 30. Enamel Dysplasia <ul><li>AMELOGENESIS IMPERFECTA – hereditary condition where dentin & pulp develop normally but enamel is easily chipped or worn away </li></ul><ul><li>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. </li></ul><ul><li>teeth vary in color from white opaque to yellow to brown    </li></ul><ul><li>all teeth are affected, smaller and pitted </li></ul>
  28. 31. Amelogenesis Imperfecta
  29. 32. Enamel Dysplasia <ul><li>Dentinogenesis Imperfecta </li></ul><ul><li>The bluish color and translucent features of this dentition are very suggestive of dentinogenesis imperfecta. </li></ul><ul><li>Unlike amelogenesis imperfecta, the enamel in dentinogenesis imperfecta is normal; it is the underlying dentin that is structurally deficient. </li></ul>
  30. 33. Dentinogenesis Imperfecta
  31. 34. Dentinogenesis Imperfecta
  32. 35. Here is another example of the clinical features of dentinogenesis imperfecta.
  33. 36. Dentin Dysplasia (Rootless Tooth) <ul><li>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 </li></ul>
  34. 37. Taurodontism <ul><li>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. </li></ul><ul><li>Observed on radiographs – shows enlarged pulp chamber resulting in thinner dentin </li></ul>
  35. 38. Taurodontism
  36. 41. Talon Cusp <ul><li>Lingual of maxillary & mandibular anterior teeth </li></ul>
  37. 42. Acquired Anomalies <ul><li>Attrition – wear from tooth on tooth </li></ul><ul><li>Attrition of the mandibular anterior teeth </li></ul>
  38. 43. Abrasion <ul><li>Mechanical tooth wear caused by a foreign substance </li></ul>
  39. 44. Erosion <ul><li>Loss to tooth surface due to a chemical agent </li></ul><ul><li>Erosion from sucking on lemons (arrow) NEXT SLIDE </li></ul>
  40. 46. Tooth Fracture <ul><li>Small to large chips or breaks in the enamel </li></ul>
  41. 48. Surfaces of the Teeth
  42. 49. Quadrants Primary vs. Permanent
  43. 50. Charting Symbols for Oxford Dental Hygiene Clinic Chapter 13 pg 247
  44. 51. Missing Teeth  M <ul><li>Teeth that are not present because of extraction or are congenitally missing </li></ul><ul><li>Charting procedure </li></ul><ul><li>Place a vertical line or X through the facial, occlusal & lingual surfaces </li></ul><ul><li>Chart in BLUE ink </li></ul>
  45. 52. Unerupted Teeth  U <ul><li>Teeth that have not yet erupted or are impacted </li></ul><ul><li>Circle facial, occlusal, & lingual surfaces of tooth </li></ul><ul><li>Chart in RED ink </li></ul>
  46. 53. Teeth to be extracted  Ex <ul><li>Teeth to be extracted because of pathologic or orthodontic reasons </li></ul><ul><li>Draw a RED diagonal line through the tooth, or an alternative method is to draw 2 RED parallel lines through the tooth </li></ul>
  47. 54. Amalgam Restorations  A <ul><li>Alloy of silver/mercury; silver or dark grey in color; widely used as a restorative material </li></ul><ul><li>Chart surfaces where the restorations appear </li></ul><ul><li>Outline the shade in BLUE for precise notation use Black’s classification </li></ul>
  48. 55. Tooth Colored Restorations  R = resin CR = Composite resin <ul><li>Outline exact size & shape of restoration </li></ul><ul><li>Shade with BLUE ink </li></ul><ul><li>Chart surfaces involved </li></ul><ul><li>Use Black’s Classification </li></ul>
  49. 56. Temporary Restorations  Temp, T <ul><li>Temporary filling cements; zinc oxide-eugenol cement </li></ul><ul><li>Chart temporary restorations the same as amalgam or resins in BLUE ink, but distinguish from amalgams with the abbreviation </li></ul>
  50. 57. Veneer  Ven <ul><li>Veneer or layer of resin that is used to cover the unsightly area of tooth </li></ul><ul><li>Outline & shade in surface of tooth where veneer is found </li></ul><ul><li>Chart in BLUE ink </li></ul>
  51. 58. Full Gold Crown  FGC <ul><li>Can be onlays or inlays or crowns </li></ul><ul><li>Outline & fill in with diagonal lines covering all surfaces </li></ul><ul><li>Chart in BLUE ink </li></ul>
  52. 59. ¾ Gold Crown  ¾ GC <ul><li>Covers less than ¾ of tooth surfaces </li></ul><ul><li>Outline & fill with diagonal lines places on all surfaces or portion of surfaces covered by crown </li></ul><ul><li>Chart in BLUE ink </li></ul>
  53. 60. Ceramic to Metal Crowns <ul><li>GCFP = crown, porcelain face </li></ul><ul><li>GCAF = gold crown, acrylic face </li></ul><ul><li>Chart similarly to gold crowns </li></ul><ul><li>Abbreviation can be used to distinguish it from full gold or ¾ crowns </li></ul><ul><li>Chart in BLUE ink </li></ul>
  54. 61. Gold Inlay  GI <ul><li>Does not cover the cusps </li></ul><ul><li>Outline the shape of the restoration on the surfaces where it appears </li></ul><ul><li>Chart in BLUE ink </li></ul>
  55. 62. Gold Onlay  GO <ul><li>Restoration which involves the cusp tips </li></ul><ul><li>Outline & color the shape of the restoration on the surfaces where it appears </li></ul><ul><li>Chart in BLUE ink </li></ul>
  56. 63. Fixed Bridges <ul><li>Each tooth may be labeled with the appropriate abbreviations FGC, GCPF, ¾ GC </li></ul><ul><li>Outline abutment & pontic teeth in BLUE ink & fill in with diagonal lines on occlusal, facial, & lingual surfaces </li></ul><ul><li>Chart the pontic teeth as extracted </li></ul><ul><li>Place 2 horizontal lines between the occlusal surfaces of the teeth to represent the splinted unit </li></ul>
  57. 64. Dental Implants  IMPL <ul><li>Make a written comment under the teeth involved </li></ul>
  58. 65. Dental Caries  C <ul><li>Outline the SUSPECTED carious area(s) in GREEN </li></ul><ul><li>Once diagnosed as caries by DDS, outline in RED </li></ul><ul><li>On completion of the restoration, fill in the RED areas with BLUE </li></ul>
  59. 66. Black’s Classification
  60. 67. Black’s Classification
  61. 68. Black’s Classification
  62. 69. Recurrent Decay  RD <ul><li>Outline the area of recurrent decay in RED </li></ul><ul><li>Recurring caries around the margin of an existing restoration </li></ul>
  63. 70. Appliances – Partial or Complete Dentures <ul><li>PUD = partial upper denture </li></ul><ul><li>PLD = partial lower denture </li></ul><ul><li>CUD = complete upper denture </li></ul><ul><li>CLD = complete lower denture </li></ul><ul><li>Chart the missing teeth with vertical lines or X’s through all surfaces </li></ul><ul><li>Join vertical lines or X’s with horizontal line at root apex & label to indicated upper or lower & partial or complete denture </li></ul>
  64. 71. Overhanging Restorations  OH <ul><li>Chart with triangular symbols in the interproximal area </li></ul><ul><li>Chart in BLUE ink </li></ul>
  65. 72. Dental Sealants  S <ul><li>Encircle & place abbreviation inside the circle </li></ul><ul><li>Chart on occlusal surface in GREEN </li></ul>
  66. 73. Root Tip  RT <ul><li>Chart tooth as missing & place abbreviation symbol near root apex </li></ul><ul><li>Chart in BLUE ink </li></ul>
  67. 74. Root Canal  RC <ul><li>Place vertical line through pulpal area of root </li></ul><ul><li>Label with abbreviation </li></ul><ul><li>Chart in BLUE ink </li></ul>
  68. 75. Decalcification or Hypocalcification  Decal <ul><li>Outline the area & label with abbreviation </li></ul><ul><li>Chart in BLUE ink </li></ul>
  69. 76. Erosion  Ero <ul><li>Shade area in BLUE & place symbol </li></ul>
  70. 77. Hypoplasia  Hypoplas <ul><li>Chart using wavy lines to denote the irregularity of enamel with symbol </li></ul><ul><li>Indicate with abbreviation </li></ul>
  71. 78. Attrition  Att <ul><li>Place a horizontal line over the affected surfaces </li></ul><ul><li>Chart in BLUE ink </li></ul>
  72. 79. Abrasion  Abr <ul><li>Chart 2 horizontal lines in BLUE ink </li></ul><ul><li>Caused by mechanical wear caused by improper toothbrushing or other habits such as chewing on pencils, pipe smoking </li></ul>
  73. 80. Supernumary Teeth  Su <ul><li>Draw additional tooth in location found </li></ul><ul><li>Chart in BLUE ink </li></ul><ul><li>Label with abbreviation </li></ul>
  74. 81. Other Dental Anomalies <ul><li>Other anatomic variations such as dens in dente, should be clearly indicated in the record section of the dental chart </li></ul>
  75. 82. TMJ Evaluation <ul><li>Detecting or noting any noises while bilaterally palpating the TMJ </li></ul><ul><li>Noises include </li></ul><ul><li>CREPITUS (cracking/grinding of the bones rubbing together) </li></ul><ul><li>POPPING or CLICKING </li></ul><ul><li>Tenderness & pain/muscle tension should also be noted </li></ul>
  76. 83. Percussion <ul><li>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: </li></ul><ul><li>Normal = WNL </li></ul><ul><li>Sensitive = +P </li></ul><ul><li>Very Sensitive = ++P </li></ul><ul><li>Extremely Sensitive = +++P </li></ul>
  77. 84. Open Bite
  78. 86. Crossbite
  79. 88. Overbite
  80. 90. Occlusal relationship of primary molars
  81. 91. Reviewing Radiographic Findings Relevant to the Clinical Assessment Found on the back of the Hard Tissue
  82. 92. Radiographic Findings <ul><li>Review normal or pathological findings </li></ul><ul><li>Is part of the ASSESSMENT phase & can be used in the IMPLEMENTATION phase </li></ul><ul><li>Radiographs are also required for documentation & record keeping of client’s dentition ( ie. Forensic dentistry often uses radiographs) </li></ul>
  83. 93. Periodontal Conditions Observed in Radiographs <ul><li>Normal anatomy & the tooth crown to root ratio </li></ul><ul><li>Confirmation of clinical findings & topography of root surfaces </li></ul><ul><li>Status of the lamina dura </li></ul><ul><li>Changes in the PDL </li></ul><ul><li>Remaining bone height </li></ul><ul><li>Local irritants such as calculus & overhanging restorations </li></ul><ul><li>Patterns or extent of disease </li></ul><ul><li>Possible furcation areas </li></ul><ul><li>Disease progression or remission by serial radiography </li></ul>