This document discusses the process of diagnosis and treatment planning for prosthodontic patients. It covers evaluating the patient's general health and medical history, dental history, extraoral and intraoral examination. Key parts of the examination include assessing facial features, lip and muscle function, and the temporomandibular joint. Gathering this information through diagnosis is important for determining the appropriate treatment plan and expectations.

1. Diagnosis and
Treatment Planning
SANKET HARAL (III YR)
DEPARTMENT OF PROSTHODONTICS

2. Diagnosis
 Defination :- Determination of nature of disease.
 Patient Evalution :-
This Process commences as the patient walks to the dentist’s chair as well as
during the introductory and history taking conversation .
1] Gait :- Observation regarding the patients walk, steadiness and the level of coordination .
Stooped shoulders – Spinal changes.
Tremor of head – Parkinson disease, tranquillizers.
Dragging of one leg – stroke.
Staggering – Excessive alcohol and medication .

3. 2] Age :-
This refers to the physiological age and provides information about the patient’s expectations
care of denture.
3] Facial Expession:-
This provide information about the mental attitude and presence of any disorders.
4] Complexion:-
Used to select the colour of the teeth.
Pale – anaemia, lack of nourishment
Ruddy – Polycythemia
Bronze – radiation therapy
Bluish - Purple – Vitamin deficiency, cynosis
Lemon-yellow- jaundice

4. Mental Attitude
Dr.M.M House (1950) Classified patients -
Class I : Philosophical patient
• They desire treatment for maintenance of
health and appearance
• They learn to adjust rapidly.
• These patients have the best mental attitude
Class II : Exacting patients
• They are very methodical, precise and accurate, making
severe demands.
• They are comfortable when each procedure is explained
and discussed with them in detail.
• They require extreme care, effort and patience on part
of the dentist.

5. Class III: Indifferent patients
• These patients are identified by their lack of concern
and motivation
• They may not pay any attention to instructions.
• A patient education programme is recommended
before treatment.
Class IV: Hysterical patients
• They are emotionally unstable, excitable and
apprehensive.
• psychiatric counselling is required prior to the
treatment.

6. History
 General Information
• Name
- important for documentation and record
maintenance.
- Patients are more comfortable and confident
when addressed by their names.

7. • Age
- Younger patients usually show better
healing ability.
- Older patients need more care and
patience on part of the dentist.
- medications may be more relevant in
older age.
• SEX
- Generally, appearance is a higher
priority for women.
- Males may be more concerned about
comfort and function of the dentures.

8. • Occupation/Social information
- occupation can help in setting up a
convenient appointment for the
treatment procedure
- In tooth selection and
arrangement.
• location / Address
- Some endemic disorders may be
confined to certain localities.

9. • Habits
- Pan chewing, smoking, chronic alcoholism may modify the systemic
status and evoke concerns regarding the hygiene, maintenance and
wear of the denture.
- Habits like pencil biting and nail biting may cause denture
Instability.
• Nutritional History
- This helps in evaluating the nutritional status of the
patient.
- The ability of the oral tissues to withstand the stress of
dentures is greater in a well-nourished patient.
- Dietary counselling is necessary in
malnourished patients.

10. Medical History
 Debilitating diseases
The following need to be assessed:
- The most common is diabetes mellitus.
- Patients are at a higher risk of opportunistic infections such as
candidiasis and show delayed wound healing.
- Their medication and mealtime should be given due importance
while scheduling appointments.

11.  Diseases of the joints
- Rheumatoid arthritis and osteoarthritis are common diseases
affecting the joints.
- If fingers are affected, patient will find it difficult to insert
and clean dentures.
- When the temporomandibular joint (TMJ) is affected, special impression trays are
required due to poor mouth opening.
 Cardiovascular disease
- A consultation with the physician is required if any invasive
preprosthetic procedure is contemplated.
- Short appointments may help the patients to
manage stress better.

12.  Neurological conditions
- Conditions like Bell palsy and Parkinson disease will present
problems related to denture retention.
- Patients need to be educated regarding these anticipated
problems.
 Epilepsy
- Patient may aspirate or break the denture during the
seizure.
- Patient an close relatives may also need to be educated on
quick removal of the dentures prior to or during seizures.

13.  Diseases of the skin
- Dermatological diseases like pemphigus have painful oral
manifestations like ulcers
- Medical treatment may or may not provide relief to these
patients.
- The constant use of dentures in such patients must
be discouraged.
 Medications
- Xerostomia is a common side effect of antihypertensives and
antidepressants.
- This can decrease denture retention and cause
increased soreness.
- Diuretics cause changes in tissue fluids which affect
retention and stability of dentures.

14. Dental History
 Chief complaint
- The chief complaint is recorded in patient’s own words.
 Patient’s desires and expectations
- It is important to find out what the patient expects
from the treatment.
- Unrealistic expectations will be detrimental to
success of treatment.

15.  Past dental history
1. Reason for tooth loss
2. Period and sequence of
edentulousness
3. Previous dental and denture
experience
If periodontal disease was the reason, more bone loss is anticipated.
It also helps in prognosis.
- Longer the period, more will be the bone loss.
- By understanding the sequence, bone resorption pattern can be
identified.
- Traumatic experiences will affect the attitude of the
patient towards dental treatment.
-They will require more counselling and education.

16.  Current denture
The examination and evaluation of the present prosthesis gives an insight
into the patient’s previous experience, patient tolerance and aesthetic values
 Pre-Extraction records
• Old diagnostic casts
• Old radiographs
• Photographs

17. Examination
 Extraoral examination
• The patient’s head and neck should be examined for the
presence of any pathologic condition.
• Facial colour and tone, hair texture, eye clarity symmetry
and
neuromuscular activity should be noted.

18.  Facial examination
Face form
Leon William has classified the facial form based on
the approximate shape of the face as
(A) Square (B) Square-Tapering, (C) Tapering (D) ovoid.
This helps in selecting the shape of the artificial tooth for the patient

19. Facial profile
The facial profile is classified as:
• Class I: Straight profile
• Class II: Retrognathic or convex profile
• Class III: Prognathic or concave profile
Class I Class II Class III
This helps in selection and arrangement of artificial teeth

20. Colour of face, hair and eye
This helps in determining the tooth shade.
 Lip examination
• Lip health
- Fissures, cracking or ulcers at the corner of the mouth indicate vitamin B
deficiency, candidiasis and loss of vertical dimension or neoplasm.
- The cause should be determined before denture construction.
• Lip support
- Lack of proper support can lead to wrinkling.
- If the same is caused due to age and health of the patient, it cannot
be corrected with dentures.

21. • Lip thickness
• Lip length
-In patient with thin lips, even a slight change in the labiolingual tooth
position makes an impact on lip fullness and support.
- Thick lips can tolerate more alterations in tooth position
without visible changes.
- Length of the lips affects the amount of anterior tooth exposure and
the anterior tooth size.
- They are classified as :
I Normal
II Long
III Short

22.  Muscular examination
- The musculature surrounding the mouth plays
an important part in the stability of the
prosthesis.
- The musculature can be classified
according to House as:
• Class 1: Normal muscle function and tone
• Class 2: Normal muscle function with mildly decreased muscle
tone.
• Class 3: Decreased muscle tone and function

23.  Temporomandibular joint
- The TMJ and associated muscles should be examined for pain
by
palpation or mandibular movement.
- Range of opening, deviation, clicking and should
be noted.
- It must be decided if CD construction will solve some of the
problems associated with the TMJ and explained to the patient.

24. “
”