CLINICAL EXAMINATION AND RADIOGRAPHIC INTERPRETATION

LEARNING OBJECTIVE: 1. That the student will understand the need for an efficient clinical and radiographic examination process that allows for the collection of clinically relevant information key concepts: process, efficiency, relevance, diagnosis, complexity, correlation with historical findings

1. THE CLINICAL EXAMINATION A systematic approach is very useful. If one performs the same steps in the same order, EVERY TIME, one is much less likely to forget a step and miss something. Particular attention to a specific area (eg. a tongue ulcer) is integrated into your habitual, systematic examination routine. The examination requires palpation as well as retraction and inspection ............... it is a hands on process. General Appearance (general health) robust .vs. feeble disability: colour: anxiety: with children distress: vitals: General Head & Neck neck stiffness: deformity Extra-Oral jaw alignment: retro .vs. prog .vs. orthognathic TMJ: clicks, pops, trismus muscles of mastications: muscle spasm, trismus muscles of facial expression: Bell's palsy arthritis, muscle spasm, eg. wheelchair bound flushed, pale, cyanotic level of, management, issue especially from pain, anxiety, etc. BP, pulse, respirations

lymph nodes: fixed skin of the face: tenderness lips: cheilitis

swelling, tenderness, mobile .vs. swelling, colour, induration, actinic change, Herpes, angular

Intra-Oral general appearance: mutilated dentition) restorative difficulty oral hygiene: contaminant in preservation state of restoration: experiences mucosal surfaces: white, red, purple, gingiva: generalized the tooth in question: extraction fracture....aspiration angulation: access and path of withdrawal condition of the teeth adjacent: access, choice of technique and instrumentation ... elevators or forceps only 2. THE RADIOGRAPHIC EXAMINATION In the usual clinical situation, the clinician orders the appropriate films and then correlates the radiographic information with the history and the clinical examination. The radiographic is also systematic, starting with a critique of the film(s) and proceeding from general to specific. number of teeth (intact .vs. Angle classification: Class I, II, III spacing / crowding: surgical or amount of potential surgical site an indication of the patient's interest open carious lesions broken restorations an indication of the patient's dental ulcerations, discolouration: yellow inflammation: localized .vs. recession: periodontal disease caries: will tooth fracture during restorations: likelihood of filling

radiograph: lateral oblique, area examined normal anatomy:

type: extra .vs. intraoral, panoramic, periapical quality: exposure, focus, contrast, date: recent .vs. outdated context and orientation sinus floor, nasal floor, mandibular

canal, mental foramen adjacent teeth: caries, restorations, endodontics, periodontal disease, root proximity tooth in question: caries: occlusal, interproximal, root size: proximity to pulp restorations: crowns, large amalgams endodontics: brittleness and tendency for fracture periodontal disease: bone height & density, isolated pockets, furcation involvement, periapical radiolucency, perio-periapical combination root number: one .vs. two .vs. three .vs. more root morphology: slender, tapered, bulbous, straight, curved, dilacerated hypercementosis, ankylosis impactions: depth: level of crown, neck, root or apex of adjacent tooth angle: upright, mesio or disto angular, horizontal proximity of adjacent crown, root or apex amount of overlying bone: posterior mandible or ramus threat to normal structures: mandibular canal, mental foramen, sinus floor, tuberosity

In all cases, the clinician should correlate the clinical and radiographic information with the information gathered in the history taking process. In most cases, the findings of the clinical or radiographic examination will confirm or support the initial differential diagnosis established during history taking.