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Medical examination

author icon By Dr. George Ghidrai

For the patient, the medical examination is in many cases the first contact with the dentist. The medical examination (also known as clinical examination) is usually defined as the process by which a medical professional (in this case the dentist) investigates the body of a patient for signs of disease.

After concluding the examination, the professional determines the correct diagnosis and devise a treatment plan. Normally, there are 3 different procedures involved : medical history, physical examination and imaging methods.


Medical history

The medical history is a discussion with the patient, during which the physician tries to gain useful information about the patient current condition. The medically relevant complaints reported by the patient are referred to as symptoms.

The doctor may ask specific questions about various factors he considers important in formulating the diagnosis.

  • Identification and demographics - name, age, height, weight

  • The chief complaint - the major health problem or concern and its time course

  • History of the present illness - details about the most important complaints

  • Past medical history - includes major illnesses, any previous surgery/operations or any current ongoing illness

  • Review of systems - systematic questioning about different organ systems

  • Family diseases - especially those relevant to the patient's chief complain

  • Childhood diseases - mainly those relevant to the present condition

  • Social history - including living arrangements, occupation, marital status, number of children, drug use (including tobacco, alcohol, other recreational drug use), recent foreign travel, and exposure to various environmental pathogens

  • Regular and acute medications - include those prescribed by doctors, and others obtained over-the-counter or alternative medicine

  • Allergies - to medications, food, latex, and other environmental factors

History-talking may also be available in a printed set of questions that patients have to fill in.


Physical examination

The physical examination is the procedure by which the dentist investigates the oral cavity of a patient for signs of disease. It generally follows the taking of the medical history - an account of the symptoms as experienced by the patient.

Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan.

Tools

For the physical examination, the practitioner will use the specific examination instruments : the dental mirror and the dental explorer.


physical examination : dental mirror

dental mirror

physical examination : dental explorer

dental explorer


Steps

When a prosthetic restoration is planned, these are the main steps of the physical examination :


  1. The examination of all teeth, especially in the area that requires the prosthetic restoration

    The dentist investigates for tooth cavities, erosions, abrasion, color changes or other pathological conditions.

    physical examination : tooth cavity

    tooth cavity

    physical examination : dental erosion

    dental erosion


  2. The examination of the dental occlusionThe dental occlusion or the bite is the relationship between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest or the "bite"

    The practitioner examines the static occlusion (contacts between teeth when the jaw is closed and stationary) and the dynamic occlusion (contacts made when the jaw is moving) for any signs of malocclusion.

    Malocclusion is the misalignment of teeth and jaws, or more simply, a "bad bite" and can cause a number of health and dental problems.

    physical examination : malocclusions


  3. Examination of the oral hygiene of the patient

    A proper oral hygiene is very important for the prognosis of any dental restoration.


  4. Examining the level of tooth mobility

    Mobility is an indicator of bone loss around the tooth. In order to accurately evaluate mobility, two non-working ends of the dental instruments (i.e., the mirror handle and the explorer handle) or one non-working end and a finger are pressed on the buccal (external) and lingual (internal) surfaces of the tooth.

    physical examination : examining tooth mobility

    examining tooth mobility

    The amount of movement is measured and classified as :

    • Class O - Complete tooth stability
    • Class I - Tooth moves 1/2 mm buccally and 1/2 mm lingually
    • Class II - All degrees between Class I and Class III mobility of up to 1 mm in any direction
    • Class III - Tooth is terminally mobile. Greater than 1 mm in any direction and is depressible in the socket

    More information is obtained after a dental radiography.


  5. Examination of the gums (or gingiva) and oral tissues (or the oral mucosa)

    The practitioner examines for swollen or bleeding gums, gingival recession, periodontal pockets and any other mouth tissue lesions.

    physical examination : swollen gums

    swollen gums : gingivitis

    physical examination : mouth tissue lesions

    mouth tissue lesion : aphthae


  6. Careful examination of the areas where the patient signals pain, discomfort, swelling, bleeding or other signs are visible


Methods

For the physical examination, the professional utilizes several specific methods : inspection (or visual examination), palpation and percussion with the help of the examination instruments.


physical examination : dental inspection

inspection or visual examination
with the help of the dental mirror

physical examination : dental palpation

tooth palpation with the dental explorer


After the physical examination, a provisional diagnosis may be formulated. More often, the practitioner will ask for a set of imaging tests ( x-ray, CT scan, other tests ).

Sometimes, the dentist may require a second opinion or an examination performed by a general medical practitioner (when other general conditions are involved).

Last review and update: May 2019



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