Hard Tissue Assessment 2023 PDF

ASSESSMENT AND DENTAL HARD TISSUE CHARTING CHAPTER 17 1 Introduction Hard-tissue assessment is used to determine whether patient’s dentition is biologically sound and functional Goal of hard-tissue assessment: to recognize and document signs of dent...

ASSESSMENT AND DENTAL HARD TISSUE CHARTING CHAPTER 17 1 Introduction Hard-tissue assessment is used to determine whether patient’s dentition is biologically sound and functional Goal of hard-tissue assessment: to recognize and document signs of dental caries, acquired tooth damage, and developmental anomalies to optimize patient care 2 Documentation Dental charting: graphic representation of the condition of the patient’s teeth on a specific date Recorded date based on clinical and radiographic assessments and patient’s reported symptoms Exact location/condition of all teeth and restorations are documented on an odontogram 3 Electronic Charting Advantages: – Saves space – Readily retrievable – Allows for incorporation of digital clinical and radiographic images Disadvantages: – Expensive to implement – Steep learning curve – Infection control concerns – Time issues 4 Virtual Oral Cavity file:///Users/matildaberg/Desktop/ sketch%20fab%20/photorealistic-human- mouth- d92cfd5873ac43299c7b64cdf9725526.html 5 Tooth Classification Humans have two sets of natural teeth, commonly referred to as primary and permanent dentitions – Primary dentition: up to 20 teeth; 5 in each quadrant (2 incisors, 1 canine, and 2 molars) – Permanent (secondary) dentition: 32 teeth; 8 in each quadrant (2 incisors, 1 canine, 2 premolars, and 3 molars) 6 Quadrant and Sextant Classification Quadrant classification – Each quadrant contains between 5 and 8 teeth, depending on whether the patient has primary, mixed, or permanent dentition Sextant classification – Each sextant contains incisors and canines, and each of the posterior sextants contains premolars and molars 7  4 QUADRANT S 8  6 SEXTANT S 9 Tooth Surface Classification Root can be divided horizontally into apical third, middle third, and cervical third Tooth crown can be divided into horizontal thirds: gingival third, middle third, and incisal or occlusal third Vertically, crown of tooth can be divided from facial view, to include medial, middle, and distal thirds 10  TOOTH AND ROOT CLASSIFICATION 11 Patient Symptom Assessment The client should be encouraged to provide information about its location, duration, and postural changes, as well as characteristics of pain Questioning should begin with open-ended questions Client symptoms are essential to dental diagnosis What would be an example of an open-ended question that you would ask your client? What are some symptoms a client may present with to their appointment? 12 Tooth Assessment and Detection of Signs and Dental Caries Direct visual examination Transillumination Tactile clinical examination Radiographic evaluation Evaluation of symptoms described by the patient 13 Acquired Tooth Damage Assessment Acquired tooth damage can be caused by any process that result in a loss of integrity of the tooth – Most common form: dental caries – Other common forms: attrition, abrasion, erosion, and fractures 14 Dental Caries Assessment Dental caries: multifactorial infectious and transmissible disease; the primary factor of which is bacterial action on fermentable carbohydrates that affects mineralized hard tissues – Susceptible sites that favor biofilm retention: Pits and fissures on occlusal, buccal, and lingual surfaces Interproximal contacts Free gingiva margin Areas of recession where root surfaces are exposed 15 Types of Dental Caries Early childhood caries: observed in children under age of 5 Rampant caries: sudden, rapid destruction of many teeth and requires urgent interventions Chronic caries: slow progressive decay process that requires intervention Arrested caries: recalcified lesions resulting from remineralization that occurs when caries process halts Recurrent caries: new caries that occurs under or around restoration or its margins 16 DENTAL CARIES 17 Types of Pit and fissure caries: most frequently found in grooves and crevices of occlusal surfaces of Carious premolars and molars Lesions Proximal caries: dental caries between teeth at point of their by proximal contact Smooth surface caries are found on Location facial, buccal, lingual, mesial, and distal surfaces of dentition Root caries: dental caries that involves tooth root, cementum, or cervical area of tooth 18  BLACK’S CLASSIFICATION OF CARIES 19 ROOT CARIES 20 Classification of Dental Caries and Restorations Black Classification System: most commonly used system to describe types and locations of dental caries – Class I–Class VI Complexity Classification System: identifies dental caries and restorations by number of surfaces they involve – Simple, compound, and complex caries 21 Caries Visual assessment: evaluate location, color, and surface texture, drying the area with gauze and or Detection air to assess properly. Radiographic assessment – Bitewing radiographs – Periapical radiographs Explorer assessment: no longer recommended Emerging technologies – Intraoral cameras (IOCs) 22  Most common causes of pulpal nerve damage are bacterial infection and trauma Pulpal If bacteria reach nerves and blood Damage vessels, infection results in an abscess Endodontics: specialty of dentistry that manages prevention, diagnosis, and treatment of dental pulp and peri- radicular tissues that surround the root of tooth 23 Developmental Anomalies Tooth anomaly: developmental disorder that is usually the result of a congenital or hereditary defect or an environmental disturbance Developmental anomalies may include deviations from usual number of teeth or irregularities with specific tooth tissue Dentinogenesis Imperfecta is an example of a tooth anomaly. 24 Dentition Charting Charting tooth assessment data conducted at patient’s initial assessment appointment; updated at each subsequent appointment No set sequence is required but having a sequence may assist you in ensuring that you have checked all areas of the dentition. 25 Sequence - check all areas for each one listed below. 1. Check for all missing teeth and or extracted, count the number of teeth and ensure that you are identifying them accurately. 2. Rotations, abrasions, abfraction, erosion and attrition, you may need to dry areas to see properly if there is abfraction present. 3. Rotations you will need to determine if the tooth is rotated from the distal surface to the lingual and or the buccal direction. 4. Hypocalcification, decalcification, caries 5. Restorations, crowns, bridges, implants 6. Open and loose contacts 7. Occlusion – Classification, Overjet and Overbite 26 DENTAL CHART SAMPLE 27 Clinic Chart 28 Back side of Clinic Chart 29 Abnormalities of Number of Teeth Hyperdontia Mesiodens Hypodontia Fusion 30 Abnormalities of the Whole Teeth Macrodontia Microdontia Germination Dens in dente Dilaceration 31 Abnormalities of Enamel Formation: Enamel Dysplasia Enamel hypoplasia Dental fluorosis Syphilis-related enamel hypoplasia Hutchinson incisors Mulberry molars Peg lateral teeth Enamel hypocalcification Amelogenesis imperfecta 32 Enamel Anomalies Not Classified as Enamel Dysplasia Dons evaginatus: also referred to as tuberculated cusp Talon cusp 33 Anomalies Talon cusps Dental Fluorosis 34 Anomalie Dentinogenesis imperfecta Dentin dysplasia s of Taurodontism. - enlarged pulp chamber and roots appear smaller. Dentin Formation 35  Occlusion The contact relationship between maxillary and mandibular teeth when the jaws are in a fully closed position, as well as the relationship between the teeth in the same arch – Centric occlusion is the relation of opposing occlusal surfaces Centric relation is the relation of the mandible to the maxilla when the condyles are in their most posterosuperior unstrained positions in the fossae – Overjet – Overbite Occlusal disharmony may lead to pain and/or occlusal trauma; it may be an adverse factor in an already diseased periodontium 36 Overjet and Overbite 37 Malocclusion A deviation of the maxillary and mandibular relations of teeth and a lack of overall ideal form in the dentition while in centric occlusion Three types: – Class I – Class II – Class III 38 Class I Malocclusion Malrelationships between individual teeth or groups of teeth: – Crowding within the dental arch – Overbite – Open bite – End-to-end bite – Crossbite 39 Class II Malocclusion Classes II and III are referred to as skeletal malocclusions Class II usually displays a retrognathic facial profile – Class II division 1: maxillary incisors protrude facially from the mandibular incisors – Class II division 2: one or more of the maxillary central incisors are lingually inclined or retruded 40 Class III Malocclusion The buccal groove of the mandibular first permanent molar is situated mesial to the mesiobuccal cusp of the maxillary first permanent molar The distal surface of the mandibular permanent canine is mesial to the mesial surface of the maxillary permanent canine 41 42 Primary Occlusion Terminal plane: ideal molar relationship when the primary teeth are in centric occlusion – Flush terminal plane: primary maxillary and mandibular second molars occlude in an end-to-end relationship – Mesial step: occurs when primary mandibular second molar is mesial to primary maxillary second molar 43 Flush Terminal Plane 44 Mesial step 45 Distal step 46 Parafunctional Habits Clenching Bruxism Thumb or finger sucking Rocking of teeth 47 Trauma from Occlusion Primary trauma – Primary trauma from occlusion results from injury from excessive occlusal forces on a periodontium that have not been altered by disease Secondary trauma – Secondary trauma from occlusion is an injury that occurs from normal or excessive occlusal forces placed on a weakened peridontium The surrounding periodontium is weakened by periodontal disease with evidence of apical migration of the junctional epithelium and loss of connective tissue 48 QUESTIONS? 49