History, diagnosis, and examination in exodontia

1. HISTORY ,
EXAMINATION
AND DIAGNOSIS
Dr. Firas Kassab

2. Dr. Firas Kassab 2

3. Dr. Firas Kassab
• Exodontia can be defined as painless removal of tooth or
tooth root from the socket with minimal injury to the bone and
surrounding structure so the postoperative healing is good.
3

4. HISTORY
Dr. Firas Kassab 4

5. Dr. Firas Kassab 5
Table 1:
• Personal details
• Presenting complaint (PC)
• History of presenting
complaint (HPC)
• Relevant medical history
(RMH)
• Drug history
• Social history
• Family history
Essentials
of
History
taking

6. • The history (or anamnesis) is the information gained
by a health care professional with the aim of
formulating a diagnosis, providing medical care and
identifying medical problems relevant to health care.
• The history is obtained from either the patient or
people who know the patient and can provide the
necessary information.
• When taking a history, a structured guide such as that
shown in table 1 should be followed.
Dr. Firas Kassab 6

7. The personal details of the
patient include their age,
sex, educational status,
religion, occupation,
relationship status, address
and contact details.
This is necessary information
for administrative purposes
and, since the questions are
largely nonthreatening, this
stage provides a gentle
introduction into the meeting
of patient and clinician
Dr. Firas Kassab 7

8. • the primary symptom that a patient states as the reason for
seeking medical care.
Dr. Firas Kassab 8

9. • The timing of the complaint and its evolution should be
elicited. If the patient has pain, a useful mnemonic is
‘SOCRATES’:
• S –site,
• O – onset (gradual/sudden),
• C – character,
• R – radiation,
• A – associations (other symptoms), T – timing/duration,
• E –exacerbating and alleviating factors, S – severity (rate the
pain on a visual analogue scale of 1–10).
Dr. Firas Kassab 9

10. • This includes any past medical and surgical problems: patients
should be asked if they carry a medical warning card or device.
• Careful note should be taken of it, particularly in respect of
corticosteroid or warfarin use, a bleeding disorder or diabetes.
• Functional enquiry or review of systems (ROS) helps disclose
undeclared medical problems. Patients should be asked
specifically about conditions;
• Table 2 : offers an alphabetical list that is easy to recall.
Dr. Firas Kassab 10

11. • Ask if the patient has any allergies to medication or other
substances. If they state they have an allergy, ask them to
describe what reaction occurred. Often, a medical problem is
revealed only after a drug history has been elicited, but some
patients may be unaware of the name of, or reason for taking,
their medication.
• Ask the patient if they are taking any prescription-only
medication
• Find out tactfully about the occupation, marital status, partner’s
job and health, mobility, lifestyle habits (tobacco, betel etc and
recreational drugs), culture and faith
Dr. Firas Kassab 11

12. • The medical history of blood relatives may be very
informative. The history may also radically change with time,
so it is essential that the history be updated before each new
course of treatment, every sedation session and especially
before surgery.
Dr. Firas Kassab 12

13. Dr. Firas Kassab
HISTORY
PHYSICAL EXAMINATION
ACCESS TO TOOTH
MOBILITY OF THE TOOTH
CONDITION OF THE CROWN
RELATION OF THE TEETH
TO IMPORTANT STRUCTURES
CONDITION OF THE
ADJACENT TEETH
THE CONDITION OF
ORAL HYGIENE
EXTRA ORAL
SWELLING/SINUS/FISTULA/
LYMPHNODE
ENLARGMENT/TMJ , ETC.
INTRAORAL
TONGUE.MUCOUS
MEMBRAN OF
LIP,CHEEK,PALAT
E,FLOOR OF
MOUTH ETC.
COMPARISON OF
BOTH SIDE
NEUROVASCULAR
BUNDLE,MAILLARY SINUS..
DENTAL/MEDICAL/EVALUATION OF
LEVEL OF ANXIETY
NEED FOR
REFERENCE?
RADIOGRAPHIC
EVALUATION OF
THE TOOTH OR
ROOT
13

14. Dr. Firas Kassab
I-EVALUATION OF LEVEL OF ANXIETY
II-EVALUATION OF HEALTH STATUS
NEED FOR
REFERENCE?
14

15. • Some patients need to be operated under conscious
sedation or general anesthesia, these include
• A) Anxious patients
• B) Allergy to local anesthesia
• C) Small children
• D) Marked Gagging in palatal procedure.
Dr. Firas Kassab
GENERAL ANETHESIA
15

16. 4.Previous dental history :
 Any difficulties in previous extraction
 Any Allergic reaction to local anesthesia
 Any prolong bleeding
 Any other relevant problem encounter during previous
 dental treatment
5.Medical history: [ CKECK LIST/PREPARED PERFOMA]
 An accurate medical history is the most useful information a
clinician can have when deciding whether a patient can safely
undergo planned dental therapy.
 Asked about common medical problem that can alter dental
treatment of the patients. These include angina,
 Myocardial infection, rheumatic heart disease,bledding
disorder(including anticoagulant use),asthma,hepatitis,renal
disease, hemophilia, corticosteroid use, seizure disorder,
implant supported devices and lung disease ,Pregnancy
Dr. Firas Kassab 16

17. • Allergies
• Bleeding disorders
• Cardiorespiratory disorders
• Drug treatment
• Endocrine disorders
• Fits or faints
• Gastrointestinal disorders
• Hospital admissions and attendances
• Infections
• Jaundice and liver disorders
• Kidney disorders
• Likelihood of pregnancy
• Mental state
• Neurological problems
Dr. Firas Kassab 17

18. The physical examination of dental patient focus on the
oral cavity and to lesser degree on the entire maxillofacial
region.
Any physical examination begin with measurement of
vital signs.
This serve as screening device for unsuspected medical
problem and baseline for future.
Dr. Firas Kassab 18

19. Dr. Firas Kassab 19

20. 1.Patient ability to open the mouth:
• Limitation of mouth opening may compromise the
procedure.
• The surgeon should diagnose the cause: Trismus,
TMJ dysfunction …etc.
2.The location of the tooth in the arch:
• A properly aligned tooth has a normal access.
• Crowded dentition may complicate the use of forceps
or elevators.
Dr. Firas Kassab 20

21. Dr. Firas Kassab 21
Greater mobility than normal is associated with severe
periodontal disease, cyst, fracture, hemangioma, neoplasm.
 Less mobility than normal mobility should be assessed
for ankylosis or hypercementosis where surgical removal
should be considered. The most common associated
condition with ankylosis :Retained single primary molars, or
less commonly non-vital endodontically treated teeth for a
long period.
its need to verify by taking radiographs before the start of the
procedure.

22. • Present/Absent/Fractured/Carious/Cervical Erosion.
• RCT/Large Restoration may wakened the tooth
• Whether having large restorations or crowns , the use of
elevators or forceps should be cautious to avoid
disturbing these restorations with previous information to
the patient.
Dr. Firas Kassab
5. CONDITION ADJECTION TOOTH
22

23. Dr. Firas Kassab
RADIOGRAPHIC
EXAMINATION
23

24. Position of neurovascular structure
Maxillary sinus
Dr. Firas Kassab 24

25. Number of roots
Curvature of roots
Shape of roots, size
Root resorption, internal or external resorption, previous
endodontic therapy
Dr. Firas Kassab 25

26. • Density of bone surrounding tooth to be extracted.
• Bone that is more radiolucent is likely to be less dense.
Which makes the extraction easy.
• Bone that is radiographically opaque indicating increase
density, which makes the extraction difficult.
• The surrounding bone should also examined carefully for
evidence of apical radiolucency that present granuloma
or cyst.
Dr. Firas Kassab
Awareness of the presence of such lesions
is important because teeth should be
removed at time of surgery
26

27. • VALUES OF DENTAL RADIOGRAPHS
• This permits proper planning of the operation
before starting it, which results in much less
trauma to the tissues, reduction of the operation
time, decrease liability of infection, improved
healing & little post-operative pain.
Dr. Firas Kassab 27

28. • If a history of difficult extraction is given.
• A tooth abnormally resistant to forceps extraction.
• All mandibular 3rd molars, in standing premolars, or misplaced canines
• Heavily restored & pulpless teeth.
• Any isolated upper molar for a long time.
• Any tooth that has been subjected to trauma.
• Teeth or roots in close relationship to maxillary sinus or inferior dental &
mental nerves
• Any partially erupted or unerupted tooth.
• Any tooth with abnormal crown form.
• Any tooth that has been decided to be removed surgically.
• Any condition which predisposes to dental or alveolar abnormality
such as osteitis deformans, cleido-cranial dystostosis or cleft palate.
Dr. Firas Kassab 28

29. Dr. Firas Kassab
Root
fracture
29

30. Provisional diagnosis.
Investigation.
Final diagnosis.
Treatment plane.
Dr. Firas Kassab 30

31. Dr. Firas Kassab
“ The cautious rarely create error”
- Confucious
31

32.  Fonseca Oral &Maxillofacial Surgery Vol:1
 Contemporary Oral & Maxillofacial Surgery Peterson . Ellis . Hupp . Tucker
2nd Edition
 Textbook of Practical Oral & Maxillofacial Surgery . Daniel E Waite 3rd
Edition
 Minor Oral Surgery Geoffrey Howe 3rd edition
 The extraction of teeth Geoffrey Howe 3rd edition
 Killey and Kay’s outline of Oral Surgery Part 1
 Laskin Vol:2
Dr. Firas Kassab 32

33. Dr. Firas Kassab 33