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ICS Local anaesthetic > Patient examination > Flashcards

Patient examination Flashcards

1
Q

What happens during a dental patient appointment?

A

-The complaint – why the patient has attended
• HPC – history of the present(ing) complaint
• PDH – past dental history
• PMH – past medical history
• Clinical examination
• Special investigations
• Diagnosis and treatment (planning)

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2
Q

what do we need to know from the patient?

A
  • That it’s the right patient in the chair!!
  • Why your patient is attending (routine/emergency)
  • Whether there is anything wrong
  • How long the problem has been going on for (if there is one)
  • Where/what is it (pain)
  • Oral hygiene habits
  • Appliances worn, fit and age
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3
Q

what additionally do we ask over and above taking a history?

A
  • Whether regular attender
  • Any problems with previous dental treatment
  • Family history of gum disease & any teeth lost to gum disease
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4
Q

How can patients in pain behave?

A
  • anxious

- aggressive

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5
Q

what are the dental pain questions?

A
  • The type of pain/discomfort
  • When and where it started
  • Does the pain travel anywhere else?
  • Does anything make it better or worse (hot/cold/sweet/biting)?
  • Does the pain stop them doing anything?
  • Does it keep the patient awake at night?
  • Is it getting better or worse?
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6
Q

what condition is irreversible pulpits worse in?

A

hot

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7
Q

what other things can the patient mention (pain)?

A
  • Swelling
  • Bleeding
  • Bad taste
  • Loose teeth
  • Difficulty eating
  • Difficulty swallowing
  • General malaise (looks unwell)
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8
Q

what happens if a patient has a difficulty with swallowing?

A

send to medical A and E

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9
Q

what is the extra-oral examination used for?

A
  • diagnosis

- screening

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10
Q

what is screening used for?

A

-Oral cancer
• Only cancer which is increasing
• 7000+ new cases each year
• 2000 deaths (more than from RTAs, prostate or cervical cancer)
• 25% of cases have no risk factors- so must screen every patient

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11
Q

How do you carry out extra-oral examination?

A

• Explain to patient
• Get consent
• Remove prosthesis…(you may have to put it back in later if may be relevant to the diagnosis)
- check all nodes down to towards the clavicle

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12
Q

what do you look for during extra-oral examination?

A
  • Symmetry/asymmetry
  • Swelling
  • Colour changes
  • Ulceration
  • Lesions
  • Also note patient’s temperature and general ‘wellness’
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13
Q

how should you look at a patient when completing an extra oral exam?

A

Look face on when speaking to patient and from above when lying back (you may have to ask patient to remove safety glasses for a minute while you do this

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14
Q

what do you feel for in extra oral exam?

A

Palpate use pads of fingers and feel for:
• Tenderness
• Swellings: is it hard/soft or is there fluctuance. fixed/non-fixed

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15
Q

How do you carry out a methodical extra oral exam?

A
  • Nodes
  • Anterior cervical
  • Posterior cervical
  • Tonsillar
  • Sub-mandibular
  • Submental
  • Supra-clavicular
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16
Q

what do you record if there is a positive finding?

A
  • site
  • size
  • shape
  • surface
  • colour
  • consistency
17
Q

why do you carry out an intra-oral examination?

A
  • diagnosis

- screening

18
Q

How do you carry out an intra-oral examination?

A 
Look and palpate: 
• Lips
• Labial sulci
• Buccal sulci
• Buccal gingivae
• Palatal and lingual gingivae
• Tongue (hold with gauze and move about) dorsum, lateral borders, ventral
• Floor of mouth (bilateral palpation required)
• Hard palate
• Soft palate
• Throat/fauces/ tonsillar pillar region
19
Q

what are you looking for in an intra oral examination?

A
  • Looking for
  • Swelling
  • Ulceration
  • Colour changes
  • Texture changes
20
Q

what do you record in intra oral examinations?

A
  • Record positive and negative findings in notes

* Don’t alarm your patient

21
Q

How do you know what is normal mucosa?

A
  • Many variations on ‘normal’
  • Build your knowledge through experience
  • Ask staff (try to do this without alarming your patient!)
  • You eventually develop an informed feeling for what’s suspicious
22
Q

what is abnormal?

A
  • Swelling
  • Suppuration
  • Ulceration that doesn’t heal
  • Red patches
  • White patches
  • Lumps
  • Unxplained loose teeth
  • Numbness or altered sensation (in the absence of LA)
  • Weight loss or unexplained hoarseness of throat
23
Q

what is in patient records?

A
  • Record everything in the notes, negative and positive findings
  • Photos of lesions can be helpful
  • Review lesions as required
  • Refer suspicious lesions early
  • Don’t alarm the patient!
24
Q

what does the dental chart look like with a healthy tooth?

A

no marks on chart

25
Q

what does the dental chart look like with a cavity?

A

draw hole on affected surface -represent caries

26
Q

what does the dental chart look like with a restoration?

A

cavity is drawn and filled in

27
Q

what tool is never used for charting?

A

sharp probe

28
Q

what does the dental chart look like with an extraction?

A

horizontal line through the tooth

29
Q

what does the dental chart look like with a very recent extraction?

A

cross through it

30
Q

what does the dental chart look like with a crown?

A

vertical lines through it

31
Q

what does the dental chart look like with a Pontic (false tooth as part of a bridge)?

A

horizontal lines through it

32
Q

what does the dental chart look like with a bridge wing/veneer?

A

surfaces involved coloured in

33
Q

what does the dental chart look like with an implant?

A

An “I” is drawn above tooth

34
Q

what equipment is used in dental charting?

A
  • Mirror
  • Blunt ended probe (WHO probe ideal)
  • 3:1
  • Nurse or colleague to help
35
Q

How do you start charting?

A

-Ensure tooth surfaces are clean and dry
• Have a general look and think about what’s present and missing
• Check for appliances!
• Communicate to your nurse where you are starting

36
Q

what terms are used in charting?

A
  • Upper/lower
  • Left/right
  • Tooth number
  • Present/missing
  • Sound
  • Caries present: Surface (s)
  • Restoration:Surface(s)
  • Fracture
  • Crown
  • Pontic
  • Partiallyerupted
  • Root present
37
Q

what do you need to remember when charting?

A
  • Note a little ‘R’ and ‘L’ on the chart
  • Always work systematically!
  • Go round in a circle
  • Consider tooth anatomy
  • Look back at previous charts if available before you examine your patient
  • Examine all surfaces of the tooth
  • Look for shadowing and decalcification (caries)
  • Teeth don’t grow back!
  • Speak clearly

ICS Local anaesthetic (6 decks)

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