Specific areas of the mouth

Part Four

EXAMINATION

General appearance

The patient may appear nervous or relaxed, fit and well or elderly or ill, clean and tidy or dirty and disheveled. These or similar observations will guide but should not dictate treatment. It takes time to get to know people and instant judgments are unwise. For instance, a neglected general appear­ance does not necessarily mean that the person does not care about his dental health.

Factors which predispose to cross-infection

Some people — for example, drug addicts, homosexuals, or heavily tat­tooed patients - are more likely to be carriers of the hepatitis B virus and HIV (human immunodeficiency virus).

The extra-oral facial appearance

The temporomandibular joint and lymph nodes should be palpated. Any obvious asymmetry is noted and the lips are examined. Such things as inju­ries or scars on the lips may be accompanied by dental injuries. Where the patient’s problem involves appearance, the dentist will make his or her own assessment of this while listening to the patient.

The mouth in general

Oral hygiene is relevant in both periodontal disease and caries. A general impression of whether the mouth is well cared for by both the patient and previous dentists is useful, but patients do sometimes increase their dental awareness considerably and previous neglect need not imply future neglect.

Specific areas of the mouth

The soft tissues

A routine examination of the inner aspects of the lip, the tongue, and the buccal and lingual sulci should be made at all examinations since, amongst other things, early neoplastic change can be detected and early treatment can be life-saving.

The periodontal tissues

A general assessment of the state of periodontal health is always necessary. This will include oral hygiene; the presence of both supra- and subgingival cal­culus, the health and position of the gingival tissues, the presence of pockets, and whether there is bleeding on probing and mobility of teeth. In many cases a more detailed periodontal examinations needs to be undertaken.

Caries experience: past and present

Again, a general impression can be gained of the extent of carious lesions and previous restorations. It is reasonable to assume that restorations are most commonly the result of caries but, of course, other conditions may also have been responsible.

Other conditions affecting the teeth

These include trauma, tooth wear, dental defects, missing teeth, and malpositioned teeth.

The occlusion

First, the static relationship of the teeth in intercuspal position (ICP) should be examined to determine the horizontal and vertical overlap of the anterior teeth (overjet and overbite), together with the relationship of the posterior teeth. Next, and perhaps more importantly, the way in which the teeth func­tion against each other in forwards, backwards, and lateral movements of the mandible should be examined. This is often relevant to the decision as to how to restore a tooth. If a cusp functions vigorously against an opposing tooth when the jaw moves, then it may need protecting in some way by the restoration, but if it immediately discludes in all movements of the mandible, it may not.

Dentures

The presence and nature of dentures should be noted. It is important to decide whether dentures are satisfactory or in need of replacement.

Дата добавления: 2015-11-14