The document provides guidelines for taking a case history, which involves collecting important biographical and medical information from a patient. This includes gathering details on the chief complaint, medical and dental history, and performing examinations. The case history aids in arriving at a diagnosis and creating a treatment plan. It involves collecting systematic and accurate information on factors like the patient's age, gender, symptoms, and relevant medical conditions to understand the nature of their illness.
In this lecture I explain in step-by-step fashion the basics of Endodontic Diagnosis: Pulp Vitality Tests. a photo guide is attached to the guide to aid in better understanding of the topic
In this lecture I explain in step-by-step fashion the basics of Endodontic Diagnosis: Pulp Vitality Tests. a photo guide is attached to the guide to aid in better understanding of the topic
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Apexogenesis & apexification in pediatric dentistryDr. Harsh Shah
SDDCH Parbhani
Presented by : Vipul GIratkar
Dept. of Pediatric dentitstry
Guided by . Dr. Rehan Khan
DIscussion regarding apexification and apexogenesis
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Definition
Contents of case history Personal Information
General Physical Examination
Extra oral examination Intra oral examination Investigations Diagnosis
List of references
Conclusion
Diagnosis and treatment planning in completely edentulous patientsDr ARYA SUDARSANAN
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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.for more details please visit
www.indiandentalacademy.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. DEFINITION
The planned professional conversation that
enables the patient to communicate his/her
symptoms, feelings and fears to the clinician
so as to obtain an insight in to the nature of
patient’s illness and his/her attitude to them.
Bricker
4. INTRODUCTION
It is a classic form of documentation ranges from clinical
sketches to highly detailed and extended accounts that help in
arriving at a diagnosis and formulation of treatment plan of a
person before treatment. select
a closest
possible choice :
Final diagnosis
Make a differential
diagnosis of all possible
complications
Analyse and interpret the
assembled clues to reach the
provisional diagnosis
Assemble all the available facts
gathered from chief complaint,
medical history, dental history,
diagnostic tests
Tandon S
5. To distinguish
between normal
and abnormal
condition
To aid in
treatment
plan
To establish
the diagnosis
To determine
the length of
the
appointment
To determine
whether
delivery of
dental care
requires
complex
procedures
To detect
any medical
problem
7. STATISTICS / Biographical Data
CHIEF COMPLAINT
HISTORY----- History of presenting illness
Medical history
Past dental history
Family history
EXAMINATION------General examination
Extra oral examination
Intra oral examination
DIAGNOSIS-----Provisional diagnosis
Investigations
Final diagnosis
TREATMENT PLAN
8. Statistics/Biographical data
Name & nick name
Patient registration number and date
Age and date of birth
Address/Phone
number
Class /School
Parents name
and
occupation
Gender
Favourite teacher,
subject & activity
9. Name & Nick name :
For identification
For communication
Record maintenance
Psychological benefit mainly in
pediatric patients
Nick name:
To build a rapport with patient
To alleviate apprehension
10. Patient registration no. and Date
Patient registration number useful for:
Record maintenance
Medico-legal aspects
Billing purposes
Date:
Useful for reference
and record maintenance
FEB
07
11. Age
As a growth assessment
parameter
To recognize the
disparities between the
dental – chronological age
aid in treatment planning
to calculate the drug
dosage
Helps in forensic
odontology
In caries :
– Window of
infectivity
– Caries predilection
sites vary distinctly
according to age
(Mejare et al,1999)
In trauma:
– Peak ages
– 2 – 4 yrs
childhood
– 8 – 10 yrs
middle– school child
Andearson
12.
13. Growth spurts:
Just before birth
One year after
birth
Mixed dentition
growth spurt:
Boys:8-11yrs
Girls:7-9 yrs
Pre-pubertal growth
spurt:
Boys:14-16 yrs
Girls:11-13yrs
Growth spurt are faster in girls than
boys…
14. MENTAL AGE : IQ X CHRONOLOGICAL AGE
100
IQ Range Classification
Above 145 Genius or near genius
130-145 Very superior
115-130 Superior
85-115 Normal
70-85 Dullness
Below 70 Borderline deficiency
<69 MR
Alfred Bionet
Standford bionet test
WISC
15. Behaviour management techniques change according
to age
Infant
• Baby needs parents
presence – basic
trust maintained
• Delay in attending
the infants demand
- panic builds up
Toddler(15 mths
– 2 yrs)
• He/ she displays
an ambivalent
nature
Pre-schooler(2 –
6 yrs)
• More effective in
interpersonal
communications
• His/her role is
more role playing
Middle aged
child (6 – 12yrs)
• He/she understands
only what is seen
• An anaesthetic
syringe may poses a
strong threat
• Learns conversation
& his/her thinking
becomes logical and
reversible
16. CHRONOLOGICAL AGE
(days, weeks, months, or years) : time elapsed from birth
DENTALAGE :
Determination of dental age was based upon the rate
of development and calcification of tooth buds.
Dental age estimation was done using Demirjian′s
method.
17. SKELETAL AGE:
The bone age was assessed by means of
hand-wrist radiograph using
Bjork, Grave and Brown′s method -9 stages
Fishman’s skeletal maturity indicator -11 stages
SMI
FISHMAN 1982
18. Diseases present in children
and young adults :
Nursing bottle caries
Juvenile periodontitis
OSMF
Fissured tongue
Eruption cyst
Dental caries
Dentigerous cyst
Pulp polyp
Diseases present in infancy:
Haemangioma
Thalassemia
Palatal cyst of newborn
Fibrous dysplasia of the
jaw
Diseases present at birth :
Cleft palate
Cleft lip
Micro and macro glossia
Cleft tongue
Erythroblastosis fetalis
Diseases present in adults and
older patients:
Attrition
Gingival recession
ANUG
Lichen planus
Periodontitis
Leukoplakia
Herpes zoster
19. Gender
• Sex related diseases
like haemophilia, G6PD
deficiency
(causes haemolytic
anaemia)
• As an aid in treatment
planning
– Growth spurts in
girls are ahead of
boys
In trauma:
– Boys sustain more
injuries than girls
– Ratio approx – 2:1
Females :
Dental caries
Lichen planus
MPDS
Anaemia
Sjogren’s syndrome
Juvenile periodontitis
Males :
Leukoplakia
Herpes simplex
Hodgkins lymphoma
Attrition
20. Address
Communication
Record purpose
To know certain endemic diseases
High fluoride content – dental/skeletal fluorosis
Filariasis
22. Parent’s name/occupation
• For communication
• Reflects the socioeconomic status
• (lower socioeconomic status are
much more likely to develop chronic
illness like heart disease, COPD, etc.,)
Favourite teacher, subject
and activity
• To create interest in
communication
• To know the child better
23. CHIEF COMPLAINT
• Reason which prompted the patient to seek
dental treatment
• Better ask the question first to the child
before involving the parents
Recorded in child’s own words in a
chronological order
In kids < 5yrs, Parents – 'Best Historians'.
24. HISTORY OF PRESENTING ILLNESS
Elaboration/detailed description of
the chief complaint
• Duration
• Mode of onset
• Progression
• Severity
• Nature
• Aggravating/relieving factors
• Postural variation
• Any medications/treatment
received for the same
PAIN
25. Detailed history of particular symptom
PAIN
Anatomical location (site)
Origin and mode of onset
Intensity of pain
Nature of pain
Progression of pain
Duration of pain
Movement of pain
Effect of functional activity
26. Pain
• Most common complaint that leads to dental treatment
• According to intensity
Mild pain
• Controlled
by simple
analgesics
Moderate
pain
• Controlled
with narcotic
analgesics
Severe pain
• Cannot
controlled
with
analgesics
• Require
elimination
of cause
27. According to nature
– Pricking/piercing
– Throbbing
– Lancinating
– Aching
– Dull, boring, gnawing
Localization of pain
Localised when patient can
point to a specific tooth or site
Sharp , piercing and
lancinating pain in a
tooth responds to cold
and is easy to localize
Dull, boring pain is
diffuse and responds
abnormally to heat than
to cold is difficult to
localize.
28. According to duration
According to onset
• Pain of short duration & seperated by wholly
pain free periodIntermittent
• Pain of longer durationContinuous
• Two or more similar episodes of painRecurrent
• Characterized by regularly recurring episodePeriodic
Spontaneous
• Pain occurs
without
being
provoked
Induced
• Provocation
causes
painful
sensation
Triggered
• When evoked
response is
out of
proportion to
the stimulus
29.
30. SWELLING
SWELLING
Anatomical location (site)
Duration
Mode of onset
Symptoms
Progress of swelling
Associated features
Secondary changes
Impairment of function
Recurrence of swelling
35. Social/Family history
Questions to be asked
Health of his/her parents
Number and age of siblings and their
health
Consanguineous marriage
Any familial conditions / traits exists
Inherited disorders
(diabetes, hemophilia,
G6PD, b-thalassemia,
familial hyperlipidemia,
allergies)
36. Medical history
Check list of medical history-by Scully and Cawson
-Anemia
-Bleeding disorders
-Cardio respiratory disorders
-Drug treatment and allergies
-Endocrine disorders
-Fits and faints
-Gastrointestinal disorders
-Hospital admissions and surgeries
-Infections
-Jaundice and liver diseases
-Kidney disease
37. – Ex: juvenile diabetes: increased risk of dental caries
– Asthma and Epilepsy are strongly associated with dental
procedures
Various diseases and functional disturbances predisposes to oral
problems either directly or indirectly. History about
multiple/prolonged hospital admissions
39. Pre-natal History
Condition of mother during pregnancy???
Disease
Trauma
Medications
Food and habits
Radiation
Anomalies scan
Gene testing
Abnormal fetal position – abnormal pressure on some
part of face ----- FACIAL ASYMMETRY
Were you on any drug therapy???
Which??? How long???
Tetracycline – discoloration of the teeth
DISEASES
Viral infections – cleft lip & palate
German measles in 1st trimester – cleft lip & palate
Maternal rubella, fetal alcohol syndrome
ACCIDENTS / TRAUMA -- Orofacial deformities
40.
41. Natal History
• Term of delivery: Full term/ premature
• Patent ductus arteriosus, encephalopathy,
cerebral palsy, respiratory distress
syndrome, kernicterus
• Type: Normal / Forceps / Caesarian
• Forceps delivery ---- injury to TMJ ---
retarded growth of mandible
• Intracranial hemorrhage
Cyanosis at birth : congenital heart defect
Rh incompatibility : erythroblastosis fetalis.
42. Post natal
Post Natal
Feeding history-Duration ,
Weaning?
Natal or neonatal teeth?
Vaccinations
DPT
BCG
OPV
Tetanus
MMR
• Milestones of development
• Habits
• Childhood diseases
• History of tonsillectomy and adenoidectomy
47. Which school and class child studying and
performance?
What is the child’s nature in the school?
Is your child following you commands?
How do you discipline your child?
How does your child react to separation from
you?
Does he has many friends?
Preference of games
Any problems in
learning/reading/understanding
48. Quite ---cooperative
Stubborn---resists treatment and can be made cooperative
Fearful ---considerable support required
Hyperactive---child resorts to screaming and kicking
Complaint----whining type of behaviour
Shy/Timid---cooperates treatment
Wilson-1975
50. Personal
history
Oral hygiene history
– Method of cleaning teeth
– Who brushes the teeth
– Type of brush
– Method of brushing
– No. of times of brushing
– Other oral hygiene aids used like
flossing, rinses
– How often it is changed
– Fluoridated/non fluoridated tooth
pastes
51. Diet history
It includes recording of the following :
Veg/non-veg/mixed diet
No. of meals/day
Cariogenic snacks/day
Does your child eat everything you prepare
Does your child constantly snack on food
Favourite foods
Other food habits
52. DETERMINE THE ADEQUACY OF DIET:
Dental health diet score = Food score+ nutrient score
- sweet score
53. FOOD SCORE:
Milk 3 *8
Meat 2 *12
Fruits & Vegetables 1 *6
Vitamin c 1 *6
Others 2 *6
Breads and cereals 4 *6
FOOD RDA NO OF SERVINGS
54. NUTRIENT SCORE:
Mark one score for each nutrient consumed
SWEET SCORE:
Liquid : (*5)
Solid and sticky : (*10)
Slowly dissloving : (*15)
55. ASSESMENT DENTAL HEALTH DIET SCORE:
SCORE RESULT INTERPRETATION
72-96 Excellent Counseling not
required
64-72 Adequate Educate the patient
56-64 Barely adequate Counseling required
56 OR less Not adequate Counseling with diet
modification
56. Nutritional Status
NUTRITION is the “science
that interprets the
interaction of nutrients
and other substances in
food in relation to
growth, development and
maintenance of an
organism” (WHO)
57.
58. STEPS IN DIETARY COUNSELING VISIT:
PURSUE DIARY FOR COMPLETION
DETERMINE DAILY ROUTINE
EXPLAIN THE CAUSE OF DECAY
ISOLATE SUGAR FACTORS
59. ANALYSE SWEETS INTAKE
DETERMINE ADEQUACY OF DIET
DIET PRESCRIPTIONS AND SUGESSTED MENU
REINFORCEMENT BY FOLLOW-UP REEVALUATION
63. Nutritional status and its correlation with
dental caries:
-Nutrition affects the teeth during development
and malnutrition may exacerbate periodontal and
oral infectious diseases.
-The most significant effect of nutrition on teeth
is the local action of diet in the mouth on the
development of dental caries and enamel erosion.
Public Health Nutrition
64. Dental history
Child’s first dental visit?
Any unfavourable dental experience?
How much satisfied was the previous treatment?
Does your child complain of tooth ache ?
Has your child suffered any injury to teeth?
Did he have any fluoride treatment done before?
Source of drinking water?
Place of residing for the last few years?
65. Does your child have any abnormal Oral habits history
Finger/thumb sucking, nail biting, lip biting, tongue
thrusting, bruxism, mouth breathing
Frequency
Intensity
Duration
67. Clinical examination
General examination:
– Assessment of general appearance should start before the child is
seated in the dental chair
– It includes
1. Child’s stature/ built
2. Weight
3. Height
4. Gait
5. Speech
6. Vital signs
71. (Jerky, uncoordinated)
Multiples sclerosis
Brain tumours,CNS)
(Hip elevation
exagerrated, a
duck-like walk)
Muscle dystrophy
the knees and thighs hitting
or crossing in a scissors-like
movement (cerebral strokes,
multiple sclerosis)
High stepping,
Neuropathic gait
typical of Parkinson's in which,
during walking, steps become
faster and faster with
Progressively shorter steps
72. Speech
Aphasia
Delayed speech
Sluttering speech
Cluttering speech
Significance:
-For Management of child in the dental chair
-To know if any systemic diseases associated
Aphasia-CNS disorders
Sluttering speech – parrot like speech (Autism)
73. Vitals
Temperature
Normal Oral
37C/98.6F
Axillary, Rectal,(>0.5 -1 F)
Pulse
60-100 beats/min
BP
120-80 mm Hg
75. Extra Oral Examination
See
Head
Face
Hair
Eyes
Ears
Nose
Lips
Feel
Lymph Nodes
TMJ
Swallow
Shape
Profile
Symmetry
76. Head
Maximum skull width (Transverse dimension)
Cephalic index =
(CI)
Maximum skull length (Anteroposterior dimension)
Martin and Saller (1957)
77. Head Forms (Cephalic)
Mesocephalic - (76-80.9)
Brachycephalic - (81-85.4)
Dolichocephalic - ( <75.9 )
Hyperbrachycephalic (>85.5)
• It is Brachycephalized Dolichocephalic Crainal
Index
81. Facial Symmetry
Gross Asymmetry of face
can be due to :
Abscess due to dental
infection
Parotid enlargement
Unilateral condylar
hyperplasia
Unilateral ankylosis of TMJ
82. Facial divergence
• It is the anterior or posterior
inclination of the lower face
relative to the forehead
83. FACIAL HEIGHT
UPPER FACIAL HEIGHT
45% of the total facial
height
LOWER FACIAL HEIGHT
55% of the total facial
height
84. Increased :
• Skeletal open bite
• Long face syndrome
Lowered :
• Growing children
• Skeletal deep bite
• Class II div 2
Lower facial height
87. Naso labial angle
• Angle formed between
lower border of nose to the
upper lip(90-110degree)
Increased:
Retrusive maxilla
Decreased :
Proclined maxilla
88. Mentolabial sulcus
Seen between lower lip and mentalis
muscle
• Normal - class I occlusion
• Deep - class II div 1 occlusion
• Shallow -bimaxillary protrusion
89. Chin
Chin prominence is related to
mandibular position
• Recessive chin-class II molar
relation
• Prognathic chin-class III molar
relation
• Normal position-class I occlusion
92. Lymph node examination
Look for:
Location
Number
Size
> 1.5 cm in jugulo diagastric
nodes
> 1.0 cm in other nodes
Consistency
Discrete or matted nodes
Tenderness
Fixity to the overlying
skin/deeper structures
Texture
Soft – Infection
Firm – Granuloma,
Lymphoma?
Matted - Tuberculous
Stony hard –
Carcinoma?
Mobility
Indurated –
Carcinoma?
Mobile – infection
- Neck lymphnodes are better palpated while standing behind the
patient
- Neck is slightly flexed to that side to relax the muscles
93. Lymphatic drainage of teeth
Lymphatic
drainage of
teeth
Maxillary teeth
Mandibular
posteriors
Submandibular
lymphnodes
Deep cervical
lymph nodes
Mandibular
anteriors
Submental
lymphnodes
Submandibular
lymphnode
94.
95.
96.
97. TMJ examination
• Symmetry
• Interincisal opening
• Mandibular movement---Observe path of closure for
deviations,Range of motion(also in lateral
movements)
• Palpation of the joint
– Pretragus palpation
– Intra-auricular palpation
• Auscultation of the joint
– Clicking
– Crepitus
98. Mouth opening
• Adults:
– Males- 50 – 60 mm
– Females- 45 – 55 mm
• Children:
– 35-45 mm
– Lateral movements- 8 – 12 mm
99. • Altered path of closure
• Occlusal prematurities
• Lingually or palatally
erupting incisors
• Class II div 1-habitual
• Class III-forward
placement
• Backward or lateral path
of closure
• Discrepancies of TMJ:
• Muscular imbalance
• Deviation/swelling/
redness, trismus or spasm
of muscles
100. Swallow :
• Infantile swallow (Visceral)
• Adult swallow
Teeth apart swallow : no temporalis contraction
Teeth together swallow : temporalis contraction seen
101. INTRA ORAL EXAMINATION
Soft Tissue
Lips
Mucosa – Labial + Buccal
+ Vestibule
Frenum
Tongue
Floor of mouth
Palate – Hard + Soft
Gingiva and periodontium
Pharynx
Tonsils
Hard Tissue
Teeth
108. Frenum
Check for:
High labial frenae
Tongue Tie
High labial frenae may cause
Midline diastema when
attached highly - to incisal
papilla
Blanch test confirms
117. Gingiva and periodontium
Child gingiva Adult gingiva
Marginal gingiva is thicker and rounded Marginal gingiva is knife edge margin
Attached gingiva:
• Less stippling
• Less keratinization
• Red in color
• Interdental clefts
• Retrocuspid papillae
Attached gingiva:
• Stippling is common
• Keratinized
• Coral pink
Mostly pyramidal shape interdental
gingiva
Col shape interdental gingiva is common
118. Gingival and periodontal tissues
– Colour
– Contour
– Consistency
– Surface texture
– Position
– Bleeding
– Ulceration
– Any sinus present
Check for bleeding on probing using probe
119. Mandibular tori Amalgam tatooPericoronitis
ANUGHerpetic gingivostomatitis Fibromatosis gingiva
121. Periodontal evaluation
• Selective probing of
anterior teeth and
permanent first molars
• Mobility test
• Depressibility test
• Grading of mobility-Miller
• Periodontal pocket evaluation
• Furcation involvement
125. Pharynx
• Hoarseness of voice
• Any swelling,nodules,adenoid,discharge are
checked
• Airway assessment
Mallampati classification
126. Tonsil
• Color
• Size
• Any abnormalities
• Airway restriction
• Any discharge
• Tenderness
127. Tonsils
1. The palatine tonsils or simply referred to as 'the tonsil'- inbetween the
anterior & posterior pillars of oropharynx
2. The Nasopharyngeal tonsils or the adenoids- in the nasopharynx
3. The tubal tonsils- near opening of eustachian tubes.
4. The Lingual tonsils- in the base of the tongue.
Peritonsillar abscess/quinsy
Hockey stick appearance
128. TEETH
Caries
Fractured teeth
Hypoplastic teeth
Retained teeth
Erupting teeth
Supernumerary teeth
Any other dental anomalies
Orthodontic evaluation
HARD TISSUE EXAMINATION
141. -Inter arch relationship
• Class II div 1 – more prone for
trauma
• Bimaxillary protrusion
-Presence of crowding/spacing
-Deviations/Displacements
Malocclusion
-Severe skeletal abnormalities
-Overjet and overbite
-Increased overjet – may predispose to
trauma
-Anterior open bite – skeletal problem,
digit sucking habit, tongue thrust
3mm=abnormal
(Reddy et al 2010)
Instruments used:
Boley gauge (Ravn)
Stainless steel scale(Farsi)
>3mm overlap = abnormal
(Reddy et al 2010)
145. Provisional diagnosis
A provisional diagnosis is one that is initially determined to be the
diagnosis, except for the fact that all test results have not been
received and/or analyzed
Also called Tentative/Working diagnosis
Arrived after evaluating the case history
and
Clinical examination
156. USES:
Helps in
orthodontic
treatment
planning
Evaluation of
treatment results
Helps in
predicting the
growth related
changes and
changes
associated with
surgical
treatment.
CEPHALOMETRIC ANALYSIS
157. DIFFERENTIAL DIAGNOSIS
“Differential diagnosis is
distinguishing a particular
disease or condition from
others that present similar
clinical features”.
Differential diagnosis can be regarded as
implementing aspects of the hypothetico-
deductive method, in the sense that the
potential presence of candidate diseases or
conditions can be viewed as hypotheses that
physicians further determine as being true or
false.
Benign Reactive swelling
Inflammatory
swelling
Posttraumatic
swelling
Hamartoma
Vascular tumors
Myofibroma
Malignant Lymphoma
Soft tissue sarcoma
Rhabdomyosarcoma
Ewing sarcoma
Synovial tumors
Fibrosarcoma
Differential diagnosis of soft
tissue masses/ subcutaneous
swelling in children :
158. Final/Definitive diagnosis
• Chronologic organization and critical evaluation of the information
obtained from the case history, physical/clinical examination and
the result of radiologic and other
investigative procedures leads
to definitive diagnosis.
• It identifies the chief
complaint first and then the subsidiary diagnosis of other problems
164. In case of trauma
The goal of treatment for
traumatically injured teeth
is to return the teeth to
acceptable function and
appearance.
165. Acute treatment:
• There are situations
where treatment within a
few hours can
significantly affect the
outcome.
– Tooth avulsions, alveolar
fractures, extrusive and
lateral luxations, and
possibly root fractures.
– Early repositioning and
stabilization will promote
the best PDL repair
Subacute treatment:
• Treatment within 24 h
after injury allow the
following injuries
proper care
– Concussion,
subluxations, and
intrusive luxation, and
crown fractures with
pulpal exposure.
– Pulpal and PDL
responses do not seem to
be adversely affected by
a delay of 24 h
166. Delayed treatment:
• Crown fractures without
pulpal exposure appear
to have the same
prognosis whether
treatment is performed
within a few or several
hours
Immediate care :
• It may be initiated with
the emergency
treatment provided,
such as pulp protection
for continued root
formation in developing
teeth with complicated
crown fractures.
In cases of luxation and avulsion injuries, the immediate concern is to stabilize the
tooth in its normal position to allow re-attachment and re-organization of the
periodontal ligament support.
171. Prognosis
• Prediction of the probable course,
duration and outcome of the disease
based on a general knowledge of the
pathogenesis and the presence of risk
factor of the disease
• Established after the diagnosis is made
and before the treatment plan
180. MECHANICAL AIDS:
GAUZE PIECE
Moist gauze piece wrapped around finger
for cleaning gum pads in infants
BRUSHING TECHNIQUE Common method :
Circular brushing method (or) Fone’s
technique is used twice daily.
DENTRIFICE
No flouridated tooth paste should be used
till 3years.
Till the child is 7 years of age only pea size
quantity of dentrifice should be dispensed.
181. POWERED TOOTH BRUSH
Patients who lack manual dexterity
Orthodontic patients
DENTAL FLOSS Waxed dental floss is used in children
Longer handle floss are used
Floss with 8 to 10 vertical strokes
Floss atleast once a day
The important time to floss is before
going to bed
185. Decision making tree for dental caries(Nyvad & Fejerskov,1997)
Status of the
tooth
Filling
Active lesion
Cavity
Repair/
replacement
No cavity
Non operative
treatment
Inactive lesion No treatment
Defect
Ditching/
Overhanging
No treatment/
reburnishing
Fracture/
Food impaction
Repair/
replacement
No defect No replacement
Lesion
Active
Cavity
Operative
treatment
No cavity
Non operative
treatment
Inactive No treatment
Clinically sound No treatment
186. Definitve Rx Phase
Restorative and Pulpal treatment
Prosthetic rehabilitation
Orthodontic interventions – serial
extractions, space management,
tooth movements
Orthognathic surgery
Periodontal therapy
187. Maintenance Phase
-3-6 month recalls
-review check up of oral health indices
-repeat caries activity tests
-reinforcement of home care measures
-motivation and re-counseling of the parent
-follow up of treatment procedures
188. Anticipatory Guidance
It is defined as pro-active counseling of parents
and patients about developmental changes that will
occur in the interval between health supervision visits that includes
information about daily caretaking specific to that upcoming interval.
If child is sleeping with a bottle, or if there are incipient white spot lesions, then the dentist
should make recommendations on how to stop the bottle habit or improve oral hygiene.
189. Informed consent
• Sufficient information must be given by the dentist to the
parent /guardian, so that the parent has a reasonable
understanding of the proposed dental care for the child
• Basic concepts of informed consent (Schultz,1985)
A standard consent form is not a substitute for a dentist parent discussion
Nonremote risks
to care
Any referral to
other health
providers
Consequences if
proposed
treatment is
refused
Acceptable
alternatives
190.
191. Scheduling operative treatment
The following are general rules of thumb
• Small, simple restorations should be completed first
• Maxillary teeth should be treated before mandibular teeth
• Posterior teeth should be treated before anteriors
• Quadrant dentistry should be practised
• Endodontic treatment should follow completion of simple
restorative treatment
• Extractions should be the last items of operative care
unless the patient presents with an acute problem.
193. References
• Pediatric Dentistry: A Clinical Approach by Goran Koch, Sven
Poulsen
• Dental caries by Ole Fejerskov and Edwina Kidd
• Textbook and colour atlas of traumatic injuries of teeth by
J.O.Andreasen and F.M.Andreasen
• Fundamentals of pediatric dentistry by Richard.J.Mathewson
• Pediatric dentistry:principles and practice by M.S Muthu and
N.Sivakumar
• Textbook of pedodontics by Shobha Tandon
• Orthodontics The Art and Science – Balaji
• Oral Diagnosis, Oral Medicine and Treatment Planning –
Bricker & Langlais
• ENLOW AND HANS-facial growth of orthodontics
• Grabers textbook of orthodontics
• Principles and practice of pedodontics-Arathi rao