Medical examination
Author: George Ghidrai, MD
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.
dental mirror
dental explorer
Steps
When a prosthetic restoration is planned, these are the main steps of the physical examination :
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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.
tooth cavity
dental erosion
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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.
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Examination of the oral hygiene of the patient
A proper oral hygiene is very important for the prognosis of any dental restoration.
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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.
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.
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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.
swollen gums : gingivitis
mouth tissue lesion : aphthae
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.
inspection or visual examination
with the help of the dental mirror
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).
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