This document provides guidance on examining the oral cavity, including the lips, labial mucosa, buccal mucosa, tongue, palate, floor of the mouth, and gingiva. It describes inspecting and palpating each area to check for abnormalities, lesions, or signs of disease. Specific pathological conditions that could be observed in each area are also listed. The document aims to guide dentists in thoroughly examining the structures of the oral cavity through direct visualization and touch.
A simple Presentation Created by me in 2008, titled Intra-oral Examination.
its light heart-ed and fun to watch...
It contains some images of the most common lesions you might face during oral examination.
A simple Presentation Created by me in 2008, titled Intra-oral Examination.
its light heart-ed and fun to watch...
It contains some images of the most common lesions you might face during oral examination.
By Ogundiran Temidayo a student of OBAFEMI AWOLOWO UNIVERSITY ILE IFE. a presentation on edentulism, prevalence, causes, types, treatment, and its adverse effect in the oral cavity.
this seminar consist of INTRODUCTION
HISTORY
EPIDEMIOLOGY
DEFINITION & CLASSIFICATION
ETIOLOGY
HISTOGENESIS OF DENTAL CARIES
HISTOPATHOLOGY OF DENTAL CARIES
DIAGNOSIS
TREATMENT
Oral Submucous Fibrosis and its Management.Maxfac Center
Oral Submucous Fibrosis and its various treatment modalities inclusive of both non-surgical and surgical management.
Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India
Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri
Email : maxfacmail@gmail.com
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Dental Management of Patient with Diabetes Mellitus PresentationIraqi Dental Academy
This lecture discuss the topic of dental management of medically compromised patient who suffers from diabetes mellitus. it's simple lecture that directed to the level of mind of undergraduate students. thanks for viewing and reading, and please share the knowledge!
By Ogundiran Temidayo a student of OBAFEMI AWOLOWO UNIVERSITY ILE IFE. a presentation on edentulism, prevalence, causes, types, treatment, and its adverse effect in the oral cavity.
this seminar consist of INTRODUCTION
HISTORY
EPIDEMIOLOGY
DEFINITION & CLASSIFICATION
ETIOLOGY
HISTOGENESIS OF DENTAL CARIES
HISTOPATHOLOGY OF DENTAL CARIES
DIAGNOSIS
TREATMENT
Oral Submucous Fibrosis and its Management.Maxfac Center
Oral Submucous Fibrosis and its various treatment modalities inclusive of both non-surgical and surgical management.
Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India
Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri
Email : maxfacmail@gmail.com
One of the most painful but easy-to-treat dental emergencies is a dry socket.
• Dry socket symptoms are experienced after a tooth extraction.
• This condition requires follow-up care by the doctor who performed the surgery, an oral surgeon or a dentist who is familiar with how to treat it.
For more information, contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
#drysocket #management #thirdmolarextraction #extractioncomplications
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Dental Management of Patient with Diabetes Mellitus PresentationIraqi Dental Academy
This lecture discuss the topic of dental management of medically compromised patient who suffers from diabetes mellitus. it's simple lecture that directed to the level of mind of undergraduate students. thanks for viewing and reading, and please share the knowledge!
-Salivary glangs - totall.Description and managementEdouardMudekereza
Observation by an assistant and notation of facial switching and motion and its location generlly are more helpful than the use of a facial nerve stimulator.
8- Aciod making the posterior portion of the flap in the infraauricular area too thin or too long to prevent skin necrosis.
9- infection after parotidectomy is rare: preoperatively, anitibiotics are only needed with a pre-existing history of sialadenitis. 1- Use of a facial nerve stimulator is unnecessary except in reoperations.
2-Reoperating in the parotid bed should with the aid of intraperative faical nerve monitoring.
3- Key landmarks for identifying the facial nerve include the cartilaginous pointer, the mastiod tip, and the posterior belly of the digstric muscle. Observation by an assistant and notation of facial switching and motion and its location generlly are more helpful than the use of a facial nerve stimulator.
8- Aciod making the posterior portion of the flap in the infraauricular area too thin or too long to prevent skin necrosis.
9- infection after parotidectomy is rare: preoperatively, anitibiotics are only needed with a pre-existing history of sialadenitis.
for undergraduate dental students this presentation includes essential & common disorders which related to the tongue very briefly. Though this may be very helpfull to you to as a start for further readings & studying.
The presentation explain white lesions in oral cavity and the classification the demonstrate the etiology, histopathology, diagnosis and treatment for each one.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
3. The dentist should examine?
1) Lip mucosal surface.
2) Labial frenum.
3) Vermilion border.
4) Oral commissures.
5) Vestibules of the mouth.
6) Minor salivary glands.
1--Clinical Examination
of
Lips & Labial Mucosa
4. Means of clinical examination
1- Inspection
Color of the lips and labial mucosa,
morphology, function, texture and the
presence of abnormal lesion such as
ulceration, anatomic or developmental
abnormalities as cleft lip, double lip, lip pit
and short lip.
5. observe the following:
1) Consistency of the lips and labial mucosa.
2) Pliability of lip surfaces.
3) Indurated lesions of the lips as well as the
glandular involvement.
4) Texture of the lip.
5) Size & shape of the lip must be examined for the
presence of some pathologic conditions.
2- Palpation
6. Lesions of the Lips and labial mucosa
A- Specific
1) chelitis glandularis.
2) chelitisglandularisapostematosa “Melkerson_Rosenthel syndrome”.
3) Lip pits (Congenital sinus of the lower lip).
4) Commissural pit.
5) Double lip.
6) Angular chelitis.
7) Cleft lip.
7.
8. B-common
1) Recurrent herpes labialis.
2) Erythema multiform “Steven Johnson” syndrome.
3) Stomatitis medicamentosa and venenata and angioedema.
4) Smoker’s patch of the lip.
5) Condyloma latum and Condyloma acuminatum .
6) Lichen planus showing white lines “Wickham's stria” on the vermilion border of the
lip.
7) Focal epithelial hyperplasia, characterized by appearance of slightly raised multiple
papules that could involve the lip, caused by human papilloma virus (Heck’s disease).
8) Malignant lesions of the lip as spindle cell carcinoma and epidermoid carcinoma.
9. Recurrent herpes labialis
Erythema multiform
Stomatitis medicamentosa
Smoker’s patch of the lip
Condyloma latum
Condyloma acuminatum
Focal epithelial hyperplasia
10. Means of clinical examination
to see any abnormalities e.g.
- Linea alba buccalis
- Fordyce's granules
- Parotid duct opening
- Ulcers
- Pigmentation e.g. melanoma
2--Clinical examination
of
buccal mucosa
12. Means of clinical examination
to feel the consistency and texture of some pathologic conditions as:-
leukodema
leukoplakia
White spongy nevus
keratotic lichen planus “papule type”
Specked leukoplakia
Frictional keratosis
Smoker keratosis
Indurated ulcers e.g. malignant ulcer
Clinical examination of buccal mucosa
14. 3--Clinical Examination
of
Tongue
Taste distribution on the tongue surface
Sweet tip
Sour lateral
Salt dorsal
Bitter back
Nerve supply
Anterior two thirds:
• General sensation by lingual nerve,
branch of trigeminal 5th C.N .
• Taste sensation by chorda tympani,
branch of facial 7th C.N.
Posterior one third:
• General and taste sensation by
glossopharyngeal 9th C.N.
Motor supply
• By hypoglossal nerve 12th C.N.
15. 1- Active movement
Technique:
The clinician ask
- the patient to raise his
tongue against the
palate to see the
ventral surface.
- the patient move the
tongue anteriorly and
laterally to see the
dorsal surface.
Movements of the tongue
2- Passive movement
Technique:
examiner holds tongue
with a piece of gaze
and moves it up and
down and from side
to side to detect any
abnormalities or any
associated pain.
3- Abnormal
movement:
This
movement
usually
performed
by mental
patient.
16.
17. Decreased Tongue Coating: (Atrophy)
1) Pernicious anemia “iron deficiency anemia”.
2) Drug allergy.
3) Diabetes mellitus.
4) Lichen planus of the tongue.
5) Chronic atrophic candidiasis.
6) Tertiary syphilis “syphilitic glossitis”.
7) Geographic tongue and median rhomboid glossitis.
8) Sub epithelial vesiculo-bullous lesions.
18. Pernicious anemia
Drug allergyLichen planus
Chronic atrophic
candidiasis Syphilitic glossitis Geographic tongue
median rhomboid glossitisErythema multiform
19. 1) Hairy leukoplakia “AIDs patients”.
2) Mouth breather patients.
3) Vomiting and stomach upset.
4) Smoker patients.
5) Xerostomia.
6) Some tongue lesions as black hairy tongue.
Increase Tongue Coating
21. By bidigital palpation to examine
- The consistency of tongue lesion.
- The resiliency and texture.
- The presence of induration, scars and
lesions.
Palpation of the tongue
22. A-- Congenital anomalies
1. Microglossia and aglossia.
2. Macroglossia.
3. Cleft tongue “bifid tongue”.
4. Fissural tongue .
5. Lingual thyroid nodule.
6. Thyroglossal tract cyst.
7. Ankyloglossia
8. Median Rhomboid glossitis.
Diseases of the tongue:
26. C- As a manifestation of systemic diseases.
1. Infections e.g. syphilis of tongue “syphilitic glossitis”, gamma of
tongue and T.B. ulcer of tongue.
2. Metabolic e.g. Diabetes militius patients showing depapillation
and atrophic tongue coating.
3. Hormonal e.g. secondary “acquired” macroglossia that associated
with acromegaly and cretinism.
4. Allergy e.g. stomatitis medicamentosa and stomatitis venenata.
5. Hematological e.g. hunter glossitis manifestation of pernicious
anemia and decrease tongue coating. Atrophic tongue changes
commonly associated with iron deficiency anemia and plumer
venison syndrome.
6. Neoplastic e.g. squamous cell carcinoma of the tongue,
lymphangioma, Haemangioma and neurofibromatosis which result
in secondary macroglossia.
27. Clinical examination of Palate
Hard palate
Soft palate
Uvula
1- Inspection:
By using direct and indirect light, visual examination can
be performed by observing the following: the palatal
contour, palatal height, rugae area, incisive papillae and
width of the arch palate. The soft palate should be
inspected for color changes, which usually associated with
different types of anemia, and the mobility of soft palate
must be observed.
28. 2- Palpation:
By using one finger of one hand i.e. “Bidigital
palpation” the palate can be palpated starting
from the anterior region and proceeding
posteriorly and laterally.
The junction between soft and hard palate
should be palpated gently. Any abnormal
texture such as egg shell, cracking or
fluctuation and swelling must be recorded.
29. The movement of soft palate should be
observed by asking the patient to say ahh,
this giving idea about the integrity of the 9th
and 10th cranial nerves. If paralysis of these
nerves occurred the uvula will be shifted
toward the unaffected side.
The uvula is varying considerably in size
from individual to another and examined by
means of inspection.It may be congenitally
absent or lost during surgery or may appear
bifid and represent a form of cleft palate.
46. 1- Inspection:
floor of mouth can be inspected by asking the patient
to raise his tongue to reveal the structures and
landmarks such as lingual frenum, orifices of the
sublingual and submaxillary salivary gland and
lingual vein.
The color of the mucosa covering the floor of the
mouth must be observed for any pathological lesions
such as rannula, mucocele, ulceration and swelling.
Clinical examination of floor of mouth
47. 2- Bimanual palpation
The Clinician fix the tissues extra-orally by four
finger of one hand and the other hand running intra-
orally to help in the identification of any pathologic
condition involving the floor of mouth such as
salivary gland calculi and sub-maxillary lymph node
involvement.
48.
49. 1) Ranula and mucous retention cyst
2) Hyperkeratotic lesion e.g. leukoplakia
3) Dermoid and epidermis carcinoma
4) Dermoid and epidermoid cyst
5) Salivary gland stone.
6) Ulcer of the floor of the mouth
Common lesions involving the floor of mouth
51. 1. gingiva:
It divided into free gingival, interdental papilla and attached gingiva.
2. Periodontal ligament (P.L):
Principal Collagen Fibers of Periodontal Ligament include Alveolar
crestal fibers, Horizontal fibers, Oblique fibers and apical fibers.
Periodontal ligament have mechanical, formative, nutritive and sensory
functions.
3.The alveolar bone:
These processes are composed of cancellous bone covered with cortical
bone. The spaces in the alveolar bone that accommodate the roots of the
teeth are known alveoli. The alveoli are lined with a layer of bone called
alveolar bone proper or cribriform plate.
4.Cementum:
It is continuously formed on root surfaces that are in contact with the
periodontal ligament or gingival fibers. The width of cementum varies
from 16-60um in the coronal half of the root, its much thicker, on the
apical third of the root, being 150-200um.
Clinical examination of periodontium
52. Lamina Dura: it is alveolar bone proper or cribriform plate
which appears as white line on the radiograph.
57. radicular bone: it is the alveolar process located on the
facial or lingual surfaces of the roots of teeth
58. Fenestration: it is isolated areas which the root denuded of bone
and root surface is covered only by periosteum and overlying
gingiva.
Dehiscence: it is denuded areas extend through the marginal
bone.
59.
60. to determine the following:
1) Whether the patient periodontium is healthy or
diseased.
2) The extent of the tissue damaged if pathological
change is present.
3) The characteristics of the periodontal disease
that well enable the determination of the
diagnosis, etiology, prognosis and treatment
plan.
importance of periodontium examination
61. I- Inspection
a. Gingival colour: pink, red, bluish red or other colour
variation.
b. Gingival contour “Both marginal and papillary”: normal,
rounded, crater or other anatomical variation.
c. Gingival size: normal size, gingival enlargement or
gingival recession.
d. Position of the gingiva: Adjacent to cemento-enamel
junction or receded coronal to cement enamel junction.
Means of clinical examination
62. II- Palpation
a. Gingival consistency: Normal, edematous, fibrotic or
fiber edematous.
b. Gingival texture “stippling”: normal, decrease, increase
or lack of it.
c. Tooth mobility: by using the handles of two dental
instruments apply alternate pressure on the buccal or lingual
surface of each tooth.
d. Migration: migration is a pathological movement of the
teeth in labial, distal, mesial or supra occlusion. Migration is
common feature of some periodontal disease e.g. aggressive
periodontal, it may relate to some habit e.g. tongue
thrusting.
63. III- Probing
A. Bleeding on probing: No or yes if yes slight, moderate or
severe.
B. Evaluation of probing depth: By use of the calibrated
periodontal probe.
C. Furcation involvement: The furcation involvement exists
if the periodontal disease extended to involve the alveolar bones
i.e. bone resorption as well as attachment loss occurs.
The straight periodontal probe adequate to detect buccal and
lingual furcation. However special curved probe (Naber’s-1 and
Naber’s-2) is helpful for examination of furcation region. The
periodontal abscess may be complication in area of furcation
involvement.
64. • The graduated periodontal probe should not
penetrate apically beyond cemento-enamel
junction
Gingival pocket
• The graduated periodontal probe should
penetrate beyond the cemento-enamel
junction but not pass apically to the crest of
the alveolar bone
Suprabony pocket
• the periodontal probe should penetrate the
cement enamel junction and pass apically to
the crest of the alveolar bone.
infrabony pocket
Types of periodontal pockets
67. Glickman (1958): Horizontal classification
Grade I: Incipient involvement of furcation with suprabony pocket
and no interradicular bone loss.
Grade II: Any involvement of the interradicular bone without through-
and-through probability (cul-de-sac ).
Grade III: Through-and-through loss of interradicular bone.
Grade IV: Through-and through loss of interradicular bone, with total
exposure of furcation owing to gingival recession.
Classification of furcation involvement
68.
69. Tarnow and Fletcher (1984): vertical classification
loss is measured in mm from the roof of the furcation
Grade I: Vertical loss of to 3 mm.
Grade II: Vertical loss of 4 to 6 mm.
Grade III: Vertical loss of 7 mm.
70. The mesial furcation should be probed from the palatal
aspect of the tooth.
The distal furcation can be probed from either the buccal
or the palatal aspect of the tooth.
Maxillary molars furcation involvement
71. D. Assessment of attachment level:
III- Probing
The attachment level is measured by means of
graduated periodontal probe “ mm
measurement” from the cemento-enamel
junction to the bottom of the gingival sulcus.
Probing of attachment levels gives an accurate
estimation of the degree of the periodontal
tissue destruction and indirectly reflect the
levels of the alveolar bony defects.
72. If there is apparent recession clinically i.e. the cemento-
enamel junction visible
the attachment level is measured directly from the
cemento-enamel junction to the bottom of the pocket.
In cases of gingival recession the attachment level is
greater than pocket depth.
Assessment of attachment level
73. If there is no apparent recession i.e. the cemento-enamel junction is
covered by the free gingiva.
Slide the probe along the tooth surface into the pocket until the
CEJ is felt. Then Record in mm from CEJ to the gingival margin.
Measure in mm the distance from the gingival margin to the bottom
of the pocket.
Subtract the mm distance from CEJ to the gingival margin from the
total pocket depth to obtain attachment level.
74. E. Bone involvement
by using periodontal probe the amount of
bone resorption can evaluated by
measuring the distance from the dento-
gingival attachment to the level of
cemento-enamel junction.
75. The patient is anesthetized and the periodontal
probe is placed in the sulcus and pushed
through the attachment apparatus until the tip
of the probe engages alveolar bone. The
measurements are made on anterior teeth mid-
facially and at the facial/interproximal line
angles.
Bone sounding procedure
78. It is determined by subtracting the sulcus or
pocket depth from total width of gingiva.
WIDTH OF ATTACHED GINGIVA
79. 1. Mucogingival junction assessed as a
scalloped line separating attached
gingiva from the alveolar mucosa.
Assessed as a borderline between
movable and immovable tissue.
2. Tissue mobility is assessed by running
a horizontally positioned probe from
the vestibule toward the gingival
margin using light force (tension test).
3. Assessed visually after staining the
Mucogingival junction with iodine
solution. Attached Gingiva –
Keratinized – No glycogen in the
superficial layer – Iodine Reactive
Negative
80. Inspection
Inspection of the dentition must be include the following:
1. Discoloration and staining.
2. The teeth number.
3. Teeth shape and structures.
4. The size of the teeth.
5. Dental caries.
6. Attrition, Abrasion and erosion.
7. Functional relation and proximal contact & occlusion.
8. Teeth vitality.
9. Other problems e.g. tooth fracture.
10. Mobility of the teeth.
Clinical examination of the teeth
81. Causes of extrinsic discoloration.
1. - Dental plaque formation.
2. - Food pigments.
3. - Tobacco and smoking.
4. - Chromogenic bacteria.
5. - Medications by drugs.
82. Causes of intrinsic discoloration of the teeth
1.Amelogenesis imperfecta.
2.Dentinogenesis imperfecta.
3.Fluorine intoxication, tooth appears “chalky
white”.
4.Severe jaundice, the teeth appear blue or green.
5.Porphyria the teeth appear dark red.
6.Tetracycline administration appear dark brown .
7.Teeth with necrotic pulp, caries or injuries
90. a- Amelogenesis imperfecta
b- Enamel hypoplasia due to
- Nutritional deficiency.
- Congenital syphilis.
- Hypoplasia due to hypocalcaemia.
- Hypoplasia due to tooth injuries.
- Hypoplasia due to local infection and trauma.
- Hypoplasia due to fluoride (Mottled enamel) .
c- Enamel and dentin aplasia
d- Enamel and dentin hypocalcification.
Abnormality of tooth structure.
92. Anomalies of growth “eruption of the teeth”
Attrition, erosion and abrasion of the teeth
Function relationship between teeth and jaws:
1- Pathologic migration
2- Open contact (proximal contact)
3- Occlusion abnormalities
- Open bite - Cross bite
- Edge to edge - Deep over jet
- Deep over bite
1- Delayed eruption.
2- Multiple unerupted teeth.
3- Embedded and impacted teeth.
100. Palpation
tooth mobility
Causes of tooth mobility:
1- Periodontal inflammation
2- Bone loss “bone resorption”.
3- The presence of occlusal trauma
Classification of tooth mobility:
Grade I: Slight mobility but the patient is not aware of it.
Grade II: Moderate mobility but the patient know it and not feel
discomfort during eating.
Grade III: Severe mobility and the patient feel discomfort
during eating.
101. Probing “Exploration of the teeth”
detect pulpal exposure, worn teeth and dental caries.
Exploration of teeth must be fine and sharp, the
clinician should be considered that many areas of the
occlusal and proximal portions of the teeth which may
be over looked. Exploration is performed with explorer
No. (17).
All surface of the tooth must be examined before
proceeding to the next one.
102. by using light instrument e.g. explorer no. 17
1- Solid sound (vital tooth)
2- Dull sound (non-vital tooth)
Percussion of the teeth
103. 1- Dental caries
2- Gemination
3- Concrescence
4- Dilaceration
5- Dens in dent
6- Supernumerary root
7- Ankylosed decidous tooth
8- Impeded and impacted teeth
Radiographic examination
112. General indication of vitality test:
1) Teeth discoloration.
2) Fractured tooth.
3) Deep carious lesion.
4) Dental restoration.
Non vital teeth appear clinically as gray, black or
bluish black.
Causes of non-vital tooth: Trauma, Caries,
Accidental exposure
Pulp vitality test
113. Vitality pulp examined by
1- Electric pulp testing
2- Thermal pulp test
3- Periapical x- ray film
4- Percussion
114. Indication;
It is indicated to determine the presence or absence of
vital nerve within the pulp chamber.
Test result;
The result of electric pulp testing is painful response
following stimulation is an evidence of tooth vitality.
Advantage of electric pulp testing
control stimulation can be applied in gradual increase
of the degree so the clinician avoid excessive pain to
patient.
Electric pulp testing
115. Technique of electric pulp testing
1. The clinician should inform his patient about the
nature of vitality test.
2. The teeth must be dry and then the dentist applies
the electrode on the sound tooth structure.
3. The electrode must be gradually increased to avoid
sever pain to the patient.
4. The electrode should not place near the gingival
tissues or any metallic felling.
5. Testing of sound tooth may be performed as a control
for comparison.
116.
117. Indication:
Painful tooth in which the cause of pain is not clear.
Procedures:
1. The tooth surface should be dry.
2. Small piece of cotton sprayed with ethyl chloride is applied on
the tooth surface.
3. A hot cylindrical stick of gutta percha may be used.
The result of thermal pulp testing
Tooth with painful pulpitis will give severe painful response either
with hot or cold application than adjacent normal teeth.
Thermal pulp testing
118. Primary components of the TMJ.
1- Mandibular condyle.
2- The articular surface of the temporal bone.
3- The articular disc.
4- The joint capsule.
Clinical Examination
of
Tempromandibular Joint
120. major sensory innervations of the T.M.J.
are derived from branches of the
auriculotemporal nerve with branches of
the masseteric and posterior deep temporal
nerve.
The blood supply of T.M.J. is primary
by the superficial temporal artery.
123. The patient is asked about:
a- History of pain in ear & TMJ, face, neck.
b- During opening wide, chewing, speaking, or
swallowing. Also history pain on yawing.
c- Do you experience pain in the teeth.
d- Do you feel clicking & snapping on TMJ
e- History of jaw injuries.
f- Muscle and joint pain in any site of the body.
History
124. To determine deviation of jaw from the midline
during the opening and closing of the jaws.
Causes of jaw deviation.
- Traumatic injuries of the joint.
- Infection of the jaw.
- Fractures of the jaw.
- Muscles hypertrophy and hypotrophy.
- Some neuromuscular diseases.
Inspection of TMJ:
125. Palpation of TMJ may be bimanual and bidigital
palpation.
a- Palpation may reveal pain and irregularities
during condylar movement, described as clicking.
b- Palpation just anterior and posterior to the
lateral pole should detect pain associated with
TMJ capsular ligament.
c- The comparison between both condyles may be
assessed by palpation.
Palpation of TMJ: