5. 5
INTRODUCTION
If u are not certain of where u are going, you may very
well end up some where else not even know it.
6. 6
Definition
CASE HISTORY
Isdefined asplanned professional conversation that enables
Thepatient to communicatehissymptoms, fearsto clinician
So that natureof patientsreal or suspected illness&mental
Attitudemay bedetermined.
7. 7
OBJECTIVES OF CASE HISTORY
Tentative diagnosis
Systemic factor that might affect formulation of a
diagnosis
Any systemic condition that requires special
precaution prior to/ during .
11. 11
Vital statistics
NAME:
Verbal communication.
Establish rapport
AGE:
For comparison-chronological age with dental and
skeletal age.
SEX:
Girls mature faster than boys, they may required treatment
earlier.
common in females .eg: Anorexia
males .eg: Haemophilia
13. 13
CHIEF COMPLAINT
Recorded in chronological order –
should be recorded in patients own words.
Also mask symptoms of a more generalized disorder.
eg:. Hypophosphatasia
14. 14
H/O present illness
ETIOLOGY
PAIN
Type of pain,
Onset,
Location,
Related symptoms,
Referral pain,
Associated complication
SWELLING
Onset
Size and shape
Tender or non tender
Diffused or localized
18. 18
Diet Chart
Step by step progression through:Step by step progression through:
Idea behind the recordingIdea behind the recording
Diet dairyDiet dairy
24 hr diet record24 hr diet record
Six days diet diary & analysisSix days diet diary & analysis
Isolate the sugar factors: type, frequency, timeIsolate the sugar factors: type, frequency, time
Day Breakfast amount Lunch
amount
Dinner
amount
Between
meals
amount
19. 19
FAMILY HISTORY
Hereditary diseases : seen in males
eg: Hemophilia
Glucose 6-phosphate deficiency
History of parents and grandparents:
eg: Familial hyper lipidemia
Neurofibromatosis
Congenital spherocytosis
Diseases due to consanguineous marriages :
eg: β-Thalessemia
Sickle cell anemia
20. 20
PAST DENTAL HISTORY
Past dental care and child’s reaction
Oral habits: Bruxism
Digit sucking
Lip biting
Tongue thrusting
Mouth breathing
Oral hygiene habits
Food habits
Flouride therapy
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SOCIAL HISTORY
Family background. (economic status)
Dietary practices. (veg /nonveg)
Personality traits-Child’s Behaviour
Attitude
Preferences
School situation
SIGNIFICANCE: Behaviour management
Determination of developmental delay
Emotional stability
Rapport with child
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GROWTH RATE OF WEIGHT
Growth rate is approximately 2kg/yr.in3 to 5yr period
Growth rate is approximately 3 to 3.5kg/yr in 6 to 12yr
period
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SIZE:
Appropriateness for age, obesity, thickness,
proportionality of body parts.
SKIN:
Color, ulceration, pigmentation lesions, bullae,
scaring burns, acne, dryness, scaling, temperature,
signs of inflammation (child abuse).
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Skin and hands indicators of systemic
problems:
Jaundice: icteric tint of skin which varies from faint
yellow to dark yellow.
Viral hepatitis: olive dark green.
Obstructive jaundice: yellow.
Massive hemorrhage, shock, intense emotions &
anaemic patient : Pallor
Cyanosis: bluish-purplish tinge.
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NAILS:
Splinter hemorrhages under the nails: systemic vasculitis
Infective endocarditis: Multiple splinter hemorrhages
Long standing iron deficiency: Brittle nails-flat-spoon shaped
(Koilonychia).
Hypoalbuminaemia: Isolated white patches (Terry’s nail)
Anxiety neurosis: Bitten nails
Congenital heart diseases and Subacute bacterial endocarditis
and chronic severe cyanosis: clubbing
Subacute bacterial endocarditis- 0sler nodes
30. 30
VITAL SIGNS
BLOOD PRESSURE
Aneuroid sphygmomanometer –
appropriately sized cuff should be
about 40% of the diameter of the
patient arm. Bladder length
should encircle 80% of arm.
Age Mean systolic B.P
mm/Hg
New born
6 months
1 year
3 year
5 year
10 year
15 year
Adult
60-75
80-90
96
100
100
110
120
125
Diastolic isaround 60 upto 5 years.
38. 38
HAIR:
Inspect for thickness, color, dryness and consistency.
Excellent indicator of health status
Ectodermal diseases
Pink disease
Kwashiorkor
SCALP:
Inspect for sore, flaking, inflammation, swellings
and symmetry.
CRANIUM:
Measure head circumference
40. 40
TMJ EXAMINATION
By palpating the head of both mandibular condyle at the same time.
Deviation of mandible,
Crepitus,
Abnormal sounds.
Auscultation:
initial clicking
Inter mediate clicking
Terminal clicking
45. 45
Normal variants of the mucosa
Palpate bi-digitally for swellings and ulcerations
Parotid gland and Stenson’s duct opening
BUCCAL MUCOSA
46. 46
Gingiva
Colour, shape, consistency
Marginal gingiva:
Free gingiva: is thicker and rounder
ATTACHED GINGIVA
Less dense and redder, more flaccid
Interdental clefts and retrocuspid papilla
INTERDENTAL GINGIVA
Inter dental spacing, saddle area
ALVEOLAR MUCOSA
Thin epithelium and absence of keratin
47. 47
Floor of mouth:
Inspect for inflammation
and ulcers.
Tongue tie
BIMANUAL PALPATION OF FLOOR OF THE MOUTH FOR
SUBMANDIBULAR AND SUBLINGUAL GLANDS.
51. 51
Examination of tooth
Stages of development
Number, size, shape and color
Occlusion
Oral hygiene status
Probe for caries
Palpate for mobility
Tran illumination for fractures, interproximal caries
Percussion for periapical pathosis
54. 54
DIAGNOSIS
• The art or act of identifying a disease from its signs and
symptoms
PROVISIONAL DIAGNOSIS
it is a general diagnosis based on clinical impression with
out any laboratory investigations.
DIFFERENTIAL DIAGNOSIS
57. 57
Systemic phaseSystemic phase: Premedication (antibiotic prophylaxis): Premedication (antibiotic prophylaxis)
Preventive phasePreventive phase:: Caries risk assessment.Caries risk assessment.
Assessment of preventive measures like fluorideAssessment of preventive measures like fluoride
application, pit and fissure sealants, diet counseling.application, pit and fissure sealants, diet counseling.
Preparatory phase:Preparatory phase:
a)a) Behaviour management.Behaviour management.
b) Oral prophylaxis.b) Oral prophylaxis.
c) Caries control.c) Caries control.
d) Orthodontic consultation.d) Orthodontic consultation.
e) Oral surgery.e) Oral surgery.
f) Endodontic therapyf) Endodontic therapy
Treatment plan
58. 58
Treatment plan
Corrective phaseCorrective phase::
a) Restorative dentistry.a) Restorative dentistry.
b) Prosthetic Rehabilitation.b) Prosthetic Rehabilitation.
c) Early orthodontic intervention.c) Early orthodontic intervention.
Maintenance phase:Maintenance phase: Frequency depends on child’s initialFrequency depends on child’s initial
needs, success of therapy, parental cooperationneeds, success of therapy, parental cooperation
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.
According t o GEORGE E WHI TE
Dental treatment should be conducted in stages
1st level or mesa 1 - is to control the disease.
2nd level or mesa 2 - is to restore the teeth.
3rd level or mesa3 -align teeth.
4th level or mesa 4 -adjust occlusion
60. 60
NEW PATIENT
HISTORY AND EXAMINATION
MANAGEMENT OF ACUTE PROBLEM
ASSESMENT
Longterm treatment objectives Pt/parent co operation
preventive restorative aesthetic
discussion
SUMMERY
64. 64
REFERENCES
Dentistry for the child and adolescent-Mcdonald
•Pediatric dentistry-Pinkham
•Clinical oral pediatrics-George e white
•Dental management of child patient-Hannelore T.loevy
•Text book of pedodontics-shobha tandon
•Text book of orthodontics-Balaji
•Kerr, Ash, Millard’s Oral Diagnosis
•Text book of pedodontics-wellbury
