clinical examination and testing

Question 1

The Objective of Clinical
Testing is to?

Answer 1

The Objective of Clinical
Testing is to reproduce
chief complaint and find
an etiology for the
patient ́s pathosis.

Question 2

Clinical Testing is
performed based on?

Answer 2

performed based on CC.

Question 3

info to collect during pt interview

Answer 3

1. CHIEF COMPLAINT & Relevant Dental HX.
2. Complete Medical HX (supplemental as necessary)
   Blood Glucose
   PT time
   Pregnancy test
3. Rx Medications Taken (dose/
   frequency)
4. Supplements
   or other non Rx
   DRUGS

Question 4

when to do interview and vital signs

Answer 4

Do the Patient Interview and Vital Signs together
starting with the walk back from the waiting are

Question 5

Intraoral Examination
when its an emergency
new pt?

Answer 5

If it is emergency or pain related: Do a “problem focused exam”
If it’s a new patient; Do the
prescribed exam sequence

Question 6

tests used in AOS

Answer 6

You can do palpation/
percussion testing,periodontal
probing and mobility testing in
the specific Area Of Suspicion
(AOS)

Question 7

what to note in intraoral exam

Answer 7

note tissue color,
consistency swelling , DST, and
any inconsistencies or
irregularities.

Question 8

Periodontal and Mobility testing methods

Answer 8

Take at least 6 probings on each tooth.
Turn the probe around; add a
mirror handle on the lingual/
palatal and wiggle the tooth to
test mobility

Question 9

Palpation
what to look for?

Answer 9

gently feel the Tissues
Look for:
Tenderness
Swelling
Unusual texture, color or
composition
Draining sinus tract (DST)

Question 10

root palpation due to ortho

Answer 10

can lead to roots being placed outside the bone and can be palpated, leads to some discomfort but not pain

Question 11

A DST usually is associated with?
Pulp is expected to be _________?
pain?

Answer 11

A DST usually is associated with a CHRONIC Apical
Abscess;
Pulp is expected to be necrotic Most are minimal pain or none due to drainage.

Question 12

tracing DST?

Answer 12

trace with gutta percha cones and radiograph

Question 13

percussion testing
where to start? why?

Answer 13

gently tap on the teeth
NEVER start on the suspected tooth!!
You are trying to establish a BASE-LINE of normal response for this patient
Begin your percussion testing GENTLY in an area of the mouth NOT RELATED to the
Area Of Suspicion
MAINTAIN a CONSISTANCY of
percussion technique on ALL teeth tested

Question 14

how to determine post teeth restorability?

Appropriate Radiographs for diagnostic purposes

Answer 14

Radiographs must be “Diagnostic” in quality

Peri-Apical films are required to see the surrounding tissues
Straight-on and Angled P/A (Shift Shot 20º change in horizontal angulation)

Bite Wing film (B/W XR) on posteriors to determine RESTORABILITY

Question 15

Pulp Sensibility Test

Answer 15

Assessment of pulp sensory response.
Sensibility test is defined as an ability to respond to stimulus,
and this is therefore an accurate and appropriate term for typical and common clinical pulp tests, such as thermal and electrical tests, given that they do not detect or measure the blood supply of the dental pulp

Question 16

Thermal & EPT Testing: in the mouth procedure

Answer 16

Question 17

what to look for with thermal testing?

Answer 17

1. What is NORMAL for this patient at this time
2. What is decidedly DIFFERENT for a particular tooth
3. The TIME to RECOVERY is much more important
   than the SEVERITY of PAIN reported

Question 18

intensity or duration for thermal testing

Answer 18

The intensity of discomfort is not generally significant but the
period of time to return to normal following cold stimulation must
be noted before continuing.

A (“lingering” of discomfort) for more than 10-15 seconds is significant to test and record. (“Normal” is 3-8 seconds) but it varies from patient to patient.

Question 19

what must you have fr thermal testing results to be proper

Answer 19

a base line control

Question 20

A false-negative response is common when cold is applied to

Answer 20

teeth with calcific metamorphosis presumably due to reduction
in hydrodynamic fluid flow.

Question 21

A false-positive response to cold may occur with

Answer 21

A false-positive response may result if cold contacts gingiva
or is transferred to adjacent teeth with vital pulps.

Question 22

early and late pulpitis thermal responses

Answer 22

cold sensitivity early followed by hot sensitivity in later stages

Question 23

Heat Testing:

Answer 23

Heat testing is NOT performed
unless the chief complaint of the patient is pain produced by warm liquids
Normal teeth are NOT sensitive to HOT
if required isolate tooth with dam and drip 140 degree water on

Question 24

What if you get NO RESPONSE (NR)? (thermal) but there is a normal baseline

Answer 24

If NR on a SINGLE tooth with normal BASE-LINE, may mean NECROTIC PULP .
. . (RCT indicated)

Question 25

next step?

IF NR (thermal) on MOST or ALL TEETH:

Answer 25

probably older person – test with EPT (any time thermal testing is unclear)

Question 26

when else could we see no thermal response

Answer 26

• YOUNG permanent teeth
  - Teeth immediately following TRAUMA (Recheck
  in 2-4 weeks)
  - Look for INJURY to tooth (if none – may be
  “NORMAL”)

Question 27

Electric Pulp Tester:
procedure?
must establish?

Answer 27

DRY the teeth and ISOLATE with Cotton Rolls.
Place a small dab of tooth paste (conductor)
on facial of each tooth to be tested.
Must develop BASE-LINE first here also.

Question 28

What if you have symptoms on a tooth with NO
Caries, NO Trauma, NO Restorations?
what should be suspected? how to prove?

Answer 28

•Suspect an axial crack
•How to PROVE it:
•Radiographs
•Biting Tests with “Tooth Slooth”
•Periodontal probing
•Transillumination

Question 29

what does the tooth sluth allow for ?

Answer 29

testing biting on individual cusps to look for fx

Question 30

transillumination and fractures

Answer 30

An Axial Crown Fracture will NOT allow light to
pass through the line of fracture

Question 31

how can probing be useful for finding fx

Answer 31

look for drop off pockets= strong indicator of fracture

Question 32

radiographic evidence of fractures

Answer 32

unusual bone loss patterns

Question 33

restorations of fx teeth

Answer 33

The Restoration may need to be removed to
view crack. Staining may be indicated.

Question 34

number 1 and 2 prevalence of fractured teeth

Answer 34

No.1 Prevalence: Mandibular 2nd Molar
No. 2 Prevalence: Maxillary Premolars

Question 35

treatable vs non treatable fractures

Answer 35