Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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Diagnosis & treatment planing /certified fixed orthodontic courses by Indian dental academy

  1. 1. Diagnosis and treatment Planning in Endodontics INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. contents Introduction. Requirements of a diagnostician Definition Diagnostic sequence – Demographic information and social history. – Chief compliant and history of present illness. – Past medical and dental history. – Clinical examination. – Other clinical tests.  To be continued…. .www.indiandentalacademy.com
  3. 3. Introductionwww.indiandentalacademy.com
  4. 4. Requirements of a diagnosticianwww.indiandentalacademy.com
  5. 5. Knowledge“One recognizes only what one already knows and understands “www.indiandentalacademy.com
  6. 6. Interest •Good diagnosticians asset.www.indiandentalacademy.com
  7. 7. Intuition •Sixth sensewww.indiandentalacademy.com
  8. 8. Curiosity •Delve a little deeper •Probe a little further all of this takes little more timewww.indiandentalacademy.com
  9. 9. Patience •Listen to the patient, •Wait for the diagnosis.www.indiandentalacademy.com
  10. 10. Diagnosis can be defined as : “The translation of data gathered by clinical and Radiographic examination in to an organized, classified definition of the conditions present”.www.indiandentalacademy.com
  11. 11. Diagnostic sequence Demographic information with respect to name, age, sex etc Chief complaint and history of present illness Medical and dental history Clinical examination Radiographic findings Other tests, laboratory values or consultations if required Provisional diagnosis / diagnosis Treatment plan www.indiandentalacademy.com
  12. 12. Interaction “Patients often judge the dentists competence more by their feelings than by his fillings”.www.indiandentalacademy.com
  13. 13. 1) Demographic information and name age,sex etc – Name – Age – Sex – Occupation, address and phone no. – Habits: like smoking, pan chewing, bruxism etc. – Patients education – Address and telephone no. of a • Friend or next of kin : who should be contacted in emergency • Referring dentist or physician • Patients regular dentist or physician – Family history : - Inherited disorders - Hemophilia - Drug allergy - Other infective diseases of family members like tuberculosis, hepatitis etc www.indiandentalacademy.com
  14. 14. 2) Chief complaint and history of present illness a) Chief complaint : Chief complaint is obtained by asking the patient to describe theproblem for which help is sought, or the reason for seeking treatment. The chief complaint is recorded in patients own words as much as possible and should not be translated into technical (formal diagnostic) language unless reported in that fashion by the patient. www.indiandentalacademy.com
  15. 15. b) History of present illness: When did the problem start? What did you notice first? Is the pain mild, moderate or severe? What is the nature of pain, dull, sharp, stabbing, throbbing etc? Could you point to the tooth that hurts? Do heat, cold, biting, chewing, sweets cause pain? When heat or cold causes pain is it momentary or does it lasts longer? Does the pain occur without provocation? Have the symptoms got better or worse at any time? Have you done anything to treat the symptoms ?www.indiandentalacademy.com
  16. 16. 3) Medical and dental history:a) Medical history i. Serious or significant illness ii. Hospitalizations iii. Transfusions iv. Allergies: v. Medications: vi. Pregnancy and lactating www.indiandentalacademy.com
  17. 17. Serious or significant illness •required the attention of a physician, necessitated staying in bed for longer than 3 days for which patient was routinely medicated.www.indiandentalacademy.com
  18. 18. Hospitalizations •Cause, •Duration, •Any complications,www.indiandentalacademy.com
  19. 19. Transfusions •Indicates previous serious medical or surgical problem.www.indiandentalacademy.com
  20. 20. Allergies: •Urticaria, hay fewer, asthma etc •Drug allergies,www.indiandentalacademy.com
  21. 21. Medications: •drug interactions •chronic or systemic disease patent is suffering from.www.indiandentalacademy.com
  22. 22. Pregnancy and lactating Medication prescription Radiological investigations  In doubtful cases the patient should be treated as pregnant.www.indiandentalacademy.com
  23. 23. vii. Problems of major significance for dental treatment  History of spontaneous bleeding or bruising associated with extraction, other minor surgical procedures or menstrual period.  Previously diagnosed hematological disorder.  Therapeutic radiation to head or neck.  Cancer chemotherapy or immunosupression.  Heart murmur, rheumatic fever of congenital heart disease.  Diabetes mellitus.  Contagious diseases like T.B, hepatitis, HIV etc.  Seizure disorders www.indiandentalacademy.com
  24. 24. b) Dental history Frequency of dental visit? Purpose of last dental visit? The type of care provided? Any complications during treatment? Recent dental radiographs?www.indiandentalacademy.com
  25. 25. During these questioning we will come to know about,Patients dental I QPriority given to dental careFears associated with dental treatments.Past dental treatments. www.indiandentalacademy.com
  26. 26. Review of systems  If he or she gets short of breath easily, has excertional pain in the chest or down the left arm, or  If he or she urinates frequently ,or  Has knee or ankle swelling so forth.  And some specific questions which patient did not answer completely during initial questioning.www.indiandentalacademy.com
  27. 27. Examination of patient: “never treat a stranger” Blood pressure Pulse rate Temperature Respiratory rate Height and weight Clubbingwww.indiandentalacademy.com
  28. 28. 1.Blood pressure Blood pressure: Normal – 120/80 mm of Hg. can be measured mainly by, - Palpatory method and - Auscultatory method Auscultory method : 1 Brachial artery Palpatory method : Radial artery In any conditions the patient should not be treated if the diastolic blood pressure is more than 100 mm of Hg.www.indiandentalacademy.com
  29. 29. 2.Pulse rate: 60 – 90 / min •Radial artery, •Brachial artery.www.indiandentalacademy.com
  30. 30. 3. Temperature: 37 º C or 98.6 ° F.4. Respiratory rate: 16-18 / minwww.indiandentalacademy.com
  31. 31. 5. Clubbing Presence of clubbing indicates serious systemic diseases.6. Height and weightwww.indiandentalacademy.com
  32. 32. b) Extra oral examination: Inspection Palpation Percussion Auscultationwww.indiandentalacademy.com
  33. 33. 1. Visual inspection: Here we should observe the general appearance of the individual and evaluate nutritional state and emotional reaction of the patient. Visual inspection of skin or mucus membrane yields information concerning color changes, dryness and edema, changes in morphology such as size, shape, symmetry, etc. Examination for deviation of mandible during opening or closing. Muscular movements should be observed. Mouth opening also should be examined to check for the presence of trismus. www.indiandentalacademy.com
  34. 34. 2. Palpation Palpation is a procedure where in the examiner feels or presses the structures to be examined. Palpation gives more detail about things inspected Visually and reveals information about things that can’t be seen.www.indiandentalacademy.com
  35. 35. Palpate for adenopathy Normal lymph nodes are difficult to palpate and inflamed ones are readily palpable. During lymph node examination check for - Mobility of lymph node i.e. mobile or fixed Submandibular lymph node examination -Tender ness of lymph node  type of pain. - Size and shape of lymph node -Consistency: soft, rubbery, hard - Number of lymph nodes: matted or solitary. Sub mental lymph node examination www.indiandentalacademy.com
  36. 36. If any extra oral swelling is present, it shouldbe examined for, Extension and position of swelling. Dimension (Shape and size). Skin over the swelling  color changes, free or attached to underlying tissue, ulceration, Temperature changes etc Consistency of swelling.www.indiandentalacademy.com
  37. 37. If sinus is present, it should be examined for,  the character of their base, edges, depth, color, discharge and relation to surrounding tissues. A flat sloping edge shows it is a healing ulcer. Punched out edge border shows it is a syphilitic ulcer. Undermined border shows tuberculosis ulcer. Rolled border shows basal cell carcinoma. Everted edge shows squamous cell carcinoma. www.indiandentalacademy.com
  38. 38. Examination of temporomandibular jointIs done during palpation procedure for any crepetius or pain in TMJ. www.indiandentalacademy.com
  39. 39. Percussion:It is the technique of striking the tissue with fingers orinstrument. The examiner observes the response ofthe patient. Extra orally percussion is often used to detect tenderness in the frontal and maxillary sinuses by tapping the finger tips against a finger placed over the sinus.www.indiandentalacademy.com
  40. 40. Auscultation:Auscultation is the act of listening to sounds with inthe body. Bruits in the tissues overlying vascular lesions  T.M.J soundswww.indiandentalacademy.com
  41. 41. c) Intra oral examination Before the start of the examination the area to be examinedshould be dry, all removable dentures, Obturators or otherappliances must be removed. Soft tissue examinations Hard tissue examinationwww.indiandentalacademy.com
  42. 42. Soft tissue examination Inner surfaces of lips, buccal mucosa, the cheeks, maxillary and mandibular mucosal folds the palate, tongue, floor of the mouth, gingiva,tonsils etc are inspected.www.indiandentalacademy.com
  43. 43. Hard tissue examination: Visual inspection The teeth to be examined should be dry for proper examination Inspection procedures are normally done under dental light. But in some special cases fiber optic, or ultra violet light can be used. Fiber-optic light is used to Transilluminate the teeth for inter-proximal caries and cracks. www.indiandentalacademy.com
  44. 44. Palpation:  Sensitivity to finger pressure on the mucosa over the apex of a tooth, signals the spread of inflammation from the PDL to the periostium.  In this manner, an incipient swelling may be detected before it is clinically evident  Additional information about fluctuation or indurations of soft tissues and changes in the underlying bony architecture can also be detected.Bimanual palpation is mostefficient. www.indiandentalacademy.com
  45. 45. Percussion: finger is sufficient to A mouth mirror handle is gently tapped on the occlusal or incisal elicit the pain. surface.Percussion test tells us about the periodontal condition of the tooth in theRoot apex. As apical periodontitis is usually an extension of pulpalinflammation percussion tests are included in pulpal examination. www.indiandentalacademy.com
  46. 46. Auscultation: It is the technique of striking the tissue with the fingers or instrument. The examiner listens to the resulting sounds to gather the data. Ex: Ankylosis of teeth in bone produces a charge in sound www.indiandentalacademy.com
  47. 47. Aspiration: Aspiration is withdrawal of fluids from a body cavity. The areaaspirated may be limited to soft tissue or may be central in bone. Aspirate may be used for culture and sensitivity tests toidentify the pathogen and its best treatment Straw colored or blood tinted fluid may indicate cyst, similarlypus indicates a abscess etc. Aspiration is best performed under local anesthetic with alarge needle of 16 to 20 gauze. www.indiandentalacademy.com
  48. 48. Mobility test: The clinician should use two mouth- mirror handles to apply alternating lateral forces . The degree of depressiblity of the tooth with in its alveolus should also be tested.Degree of mobility can be classified as,1st degree of mobility: Perceptible horizontal movement2nd degree of mobility: No more than 1 mm of horizontal movement.3rd degree of mobility: Greater than 1mm of horizontal movement and or Vertical depressibility.www.indiandentalacademy.com
  49. 49. Other clinical tests:1) TransilluminationTransillumination may also locate teeth with vertical cracks orinterproximal caries and non vital pulp.www.indiandentalacademy.com
  50. 50. 2) Thermal tests:Two types of thermal tests are available, cold and hot the patients reaction after application of heat or cold to specific tooth not only pin points the involved tooth but also strongly suggests the presence of the condition.www.indiandentalacademy.com
  51. 51. i. Hot test: gutta-percha sticks are used to elicit a response to heat The teeth to be treated are isolated. A strip of gutta-percha is heated and applied to the cervical area of the tooth. This produces a response from pulp.o in cast crown sufficient heat is produced by using a rubber wheel mounted on a mandrill revolving at a polishing speedwww.indiandentalacademy.com
  52. 52. ii. Cold test: The cold test may be used to differentiate between reversible and irreversible pulpits and identifying teeth with necrotic pulpits. Cold testing can be done with An air blast A cold drink An ice stick Ethyl chloride Carbon dioxide dry ice sticks etc.www.indiandentalacademy.com
  53. 53. Carbon dioxide dry ice sticks Application to tooth Co2 cylinder Ice stick surface It can be used on teeth with metal restorations. It dont cause any damage to the health of pulp even if it is used for 5 minutes continuously.Disadvantages:  Micro cracks on enamel  Pitting on porcelain  Expensive apparatus www.indiandentalacademy.com
  54. 54. Results of thermal pulp tests No response *pulp is either non vital or possibly vital but giving a false-negative response because of excessive calcification, an immature apex, recent trauma, or patient premedication. A moderate transient response *usually considered normal A painful response that subsides quickly after the stimulus is removed * characteristic of reversible pulpits. A painful response that lingers after the thermal stimuli is removed. *indicates symptomatic irreversible pulpitswww.indiandentalacademy.com
  55. 55. Electric pulp testing Before the use of electric pulp tester the tooth to be examined should be air-dried and should be surrounded by cotton rolls. A electrolytic gel should be used to transmit the current from the machine to the hard structures of the tooth. The electric tip should be placed as much civically as possible With the electrode contacting the tooth, an electric charge is applied, a small charge being given initially and gradually increased until the response is felt. The patient experiences a sense of heat or tingling in the tooth when the nerve tissue is stimulatedwww.indiandentalacademy.com
  56. 56. 3) Electric pulp testing: results interpretation If the current required to gain a response from a test tooth is the same as that needed to exite the control, the pulp of the test tooth is considered normal. The pulp of the test is considered degrading when much more current is required. If much less current is required then the pulp is hyperactive. If no response it indicates pulpal necrosis. www.indiandentalacademy.com
  57. 57. Ideal situations for electric pulp testing: Testing anterior teeth has a high degree of reliability because these teeth are single rooted, easy to isolate, have cast restorations less frequently than posterior teeth and have good access to reach cervical responsive areas Excellent evaluation of teeth involved in traumatic accidents is available with an electric pulp tester. To differentiate between pulpal and periodontal problems. To identify the diseased tooth when periapical radiolucency is involving many tooth apices etc.www.indiandentalacademy.com
  58. 58. Drawbacks of electric pulp tester: Use of EPT in patients with pacemakers is questionable. The electric output may vary from time to time. Some false positive response may be seen in molars due to multiple roots. It gives us the condition of the nerve fibers but not the blood supply to the pulp. In splinted or tooth with bridges response may be due to stimulation of adjacent teeth. Teeth are usually non responsive to electric pulp testing shortly after eruption, after trauma and older tooth. Results of electric pulp testing are always subject to the errors of human interpretation and should be evaluated along with results from the other diagnostic aids before a final diagnosis is made.www.indiandentalacademy.com
  59. 59. a) Selective anesthesia: Selective anesthesia refers to administration of a local anesthetic to facilitate identification of the tooth causing a painful episode.www.indiandentalacademy.com
  60. 60. 5) Test cavity (or) test drilling  It is the final and unquestionably the most accurate pulp vitality test.  The preparation is placed in the lingual or palatal surface of an anterior tooth or occlusal area of a posterior tooth.  The cavity is best prepared by using an airrotor without water spray.  After the response is noted the cavity may be temporarily restored with ZOE.www.indiandentalacademy.com
  61. 61. Thank you for watching www.indiandentalacademy.comwww.indiandentalacademy.com

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