Home Random Page


CATEGORIES:

BiologyChemistryConstructionCultureEcologyEconomyElectronicsFinanceGeographyHistoryInformaticsLawMathematicsMechanicsMedicineOtherPedagogyPhilosophyPhysicsPolicyPsychologySociologySportTourism






CONTENT of the topic

Examination methods conventionally divided into basic - clinical (survey, inspection of the patient, palpation and instrumental examination) and additional - paraclinical (functional and laboratory methods).

Clinical methods of examination -spend at the patient chair. They are:

• Patient survey (collecting complaints, medical history, life history);

• Conduct visual examination;
• Examination of the temporo-mandibular joint and masticatory muscles;
• Examination of the salivary glands;
• Examination of the vestibule of the oral cavity and the actual oral cavity;
• examination of the state of the mucous membrane of the mouth;
• Examination of the state of the teeth and tooth rows;
• Examination of periodontal disease.

Chief complaints:

bleeding gums, loose teeth, spreading of the teeth with the appearance of spaces where none existed before, foul taste in the mouth, itchy feeling in the gums, relieved by a digging with a toothpick, constant dull gnawing pain, dull rain after eating, deep radiating pains in the jaws, acute throbbing pain, sensitivity to percussion, sensitivity to heat and cold, burning sensation in the gums, extreme sensitivity to inhaled air.

 

Medical history:

Patient's complaints of gastrointestinal diseases, liver disease, diabetes, rossibility of occupational disease, history of allergy, sensitivity to drugs and dental materials, rheumatic fever, heart disease, hypertension, angina pectoris, -nyocardial infarction, nephritis, abnormal bleeding tendencies, excessive rruising, infectious diseases.

Find out: when the disease was found first, communication with local irritating factors or common diseases, how was developed the disease process, whether the aggravation and its possible causes, what and when was treated disease and its effectiveness, dispensary registration.

Clinical history must be supplemented by the results of objective inspection. Doctor determines the dental status of the patient.

Overall appraisal of the patient (Dental history):

1 - the vestibule of mouth;
2 - the actual mouth.

 

Oral examination:

- oral hygiene

- mouth odors

- saliva

- lips

- oral mucosa

- floor of the mouth

- tongue

- palate

- oropharyngeal region

 

On examination the vestibule of the mouth need to mark its depth. The depth of the vestibule of the mouth - is the distance from the gingival margin to the transition fold. Determined with a graded probe or with dental mirror (diameter of mirror is equal to 20 mm). Vestibule of the mouth is shallow (small), if the depth is not more than 5 mm, medium - from 8 to 10 mm, deep - more than 10 mm.
Shallow vestibule of mouth is a risk factor of periodontitis.

 

Normal frenulum is a thin triangular fold of mucous membrane with a broad base on the lip, ending on the midline of the alveolar process by about 5 mm from the edge of the gum.

There are - medium frenulum (are attached at a distance of 1-5 mm from the interdental papilla), short (or strong) frenulum, weak frenulum.



Examination of the teeth:

- hypersensitivity

- proximal contact relations

- tooth mobility

- sensitivity to percussion

- pathologic migration of the teeth

- pathological abrasion or delayed the natural abrasion of premolars and molars

- presence of wedge-shaped defects

- form of bite(occlusion)

- the dentition with the jaws closed

- examination of functional occlusal relationships

- presence of traumatic occlusion

- the temporomandibular joint

 

The degree of mobility of the teeth due to the severity and depth of the destruction of the tooth ligaments and character of destructive process in the periodontium. Mobility characterizes the direction and degree of deviation from the normal position of the tooth. It is determined by palpation, with tweezers or special equipment

 

There are 4 degrees of pathological mobility by D.A Entin:
I degree - the mobility in bucco-lingual (palatal) or vestibular-oral direction (no more than 1 mm);
II degree - the mobility in bucco-lingual (palatal) or vestibular-oral direction (more than 1 mm) + the mobility in medio-distal direction of;

III degree - the tooth is mobile in all directions, including vertical;

IV degree - the tooth is mobile in all directions, including vertical + rotational movements about the axis of the tooth.

 

Traumatic occlusion - when a tooth or group of teeth feel traumatic stress during closing.
Traumatic occlusion is a constant symptom of generalized periodontitis and periodontal disease and is caused by disorders ligaments of the teeth and their displacement. The degree of severity of traumatic occlusion is associated with disease severity.

Occlusion-gram - getting prints of dental rows on the plastic material in the occlusal plane of the teeth (central occlusion). You can use wax plates, strips of foil, copy paper. The ratio of dental rows (dentition) and occlusal plane can define with a special registration liner (A.I. Pushenko, 1972). After biting you can see imprints of teeth both jaws on the graph paper.

To determine the density of occlusal contacts, supra-contacts are used also a horseshoe-shaped copy paper or heated plate of wax. In the areas of early contact copy paper breaks, and the tissues of the tooth are colored. in the areas of early contact the wax has deeper sagging areas

 

Complete examination the mouth- periodontal examination.

Need to visually assess such important diagnostic symptoms as: redness, swelling, gingival hypertrophy, the exposed surface of the tooth root, the presence of plaque and calculus during the inspection the vestibule and the actual oral cavity.

On examination of gums on the vestibular and lingual sides to note the color, consistency, bleeding, deep sulcus, keeping periodontal connection status and intensity of interdental papillae.

Examination gums to determine:
- Type of inflammation (catarrhal, necrotizing, hyperplastic);
- Character of the cours (acute, chronic, aggrieved);
- Prevalence (localized, generalized);
- Severity of inflammation (light, medium, heavy).

 

The color of the attached and marginal gingiva is generally described as coral unk and is produced by the vascular supply, the thickness and degree of keratinization of the epithelium, and the presence of pigment-containing cells. The color varies among persons and appears to be correlated with cutaneous pigmentation.

The attached gingiva is demarcated from the adjacent alveolar mucosa on tne buccal aspect by a clearly defined mucogingival line. The alveolar mucosa is red, smooth, and shiny rather than pink and stippled. Comparison of the microscopic structure of the attached gingiva with that of the alveolar mucosa affords an explanation for the difference in appearance. The epithelium of the alveolar mucosa is thinner, nonkeratinized. The connective tissue of the alveolar mucosa is loosely arranged, and the blood vessels are more numerous.

The contour or shape of the gingiva varies considerably and depends on the shape of the teeth and their alignment in the arch, the location and size of the area of proximal contact, and the dimensions of the facial and lingual gingival embrasures.

In inflammatory - gum becomes loose, pasty or compacted, interdental papilla hyperemic, edematous, stand out between the teeth, and their surface is glossy, shiny.
In acute inflammatory processes gum becomes bright red, chronic - stagnant-cyanotic. Pale gums with anemia, leukemia, becomes cyanotic hue with chronic inflammatory diseases, leukemia, diabetes. It can be observed congenital or acquired (in Addison's disease, poisoning by salts of heavy metals, etc.) pigmentation.

To determine the presence swelling on it gums carefully for a few seconds’ presses down with the blunt end of the instrument. After removal of the instrument at presence of swelling on the gums - a dent, which can kept for several minutes.

 

Bleeding upon probing is one of the characteristic signs of inflammation and lowered resistance of the capillaries. Abnormal bleeding from the gingiva or other areas of the oral mucosa that is difficult to control is an important finical sign suggesting a hematologic disorder. The expression of bleeding :in testify to different forms of periodontal inflammation (fig. 6). Bleeding detects the level of inflammation in the periodontal tissues. Hemorrhagic endencies occur when the normal hemostatic mechanism is disturbed. The Papilla Bleeding index (PBI) (Muhlemann and Son) is measured on the lingual surfaces of the I-st and Ill-rd quadrants and vestibular surfaces of je Il-nd and IV-th quadrants.

 

Die stage of Hemorrhage in scores The characteristic of bleeding upon probing of the periodontal pocket
absent
appears as small spots of blood
several spots or line of blood
the blood fills up the interdental space
Intensive hemorrhage after probing which spreads on the tooth and gums
  Bleeding index (I. Deeha, (1996) National Medical University of Lviv. Department of Therapeutic Dentistry).  
The stage of -emorrhage m scores The characteristic of bleeding upon probing of the periodontal pocket
absent
weak - appears at the end of probing (in 15-20 sec) as a narrow line of blood in the papilla-marginal regions of inspected tooth
Moderate - appears during probing as a small spot of blood filling the interdental spaces and the neck region of inspected tooth
strenuous - appears at the beginning or during probing as the large hemorrhage which quickly stops (in 5 -10 sec), turning into the overflowed blood stain overlaying inspected and adjacent papilla-marginal regions of gums and teeth
expressed bleeding appearing at the beginning of the probing as strongly pronounced and large hemorrhage, lasting at the same level for some time (15-30 sec) slowly decreasing and stopping. It looks like the blood is overlaying inspected and adjacent areas in the sextants.

 

 

Bleeding index (IH) is calculated as the sum of score of inspected units -c jig divided into the number of units Criteria for scoring of bleeding index 0,8-1,5 - small bleeding 1,5-2,3 - moderate bleeding 2,3-3 and more - heavy bleeding.

 

Determine the extent of the pathology of bleeding gums with a history (Kechko, 1975), using the following criteria:
1 degree - bleeding is a rare, while taking solid food;
2 degree - bleeding during tooth brushing;
3 degree - bleeding during sleep, spontaneous.
Bleeding gums can be detected visually after probing pockets.

 

Depending on the degree of proliferation of papilla distinguished
I, II and III degree of hypertrophy:
I degree - papilla and gingival margin increased slightly, rounded, thickened, raised in the form of a roller, papilla cover dental crowns at 1/3 of their height;
II degree - papilla rounded, much enlarged, covering 1/2 of the tooth crown;
III degree - there is a significant growth of tissue papilla and gingival margin, which often reaches the cutting edge or the chewing surfaces of teeth.

 

Examination of the Periodontium, with a periodontal probing as the main method of clinical examination (Fig.7,8,9):

- the plaque and calculus

- the gingiva (change in the consistency, surface texture and position of the gingiva, changes in gin­gival contour, the presence of "Stilman's Clefts" and McCall Festoons), gingival recession

- the amount of attached gingiva

- the suppuration

- the sinus formation

- the alveolar bone loss

- the trauma from occlusion

- the furcation involvement

- periodontal pockets.

Specific periodontal charting is based on a circular probing of the periodontium of all the teeth using a recommended contact pressure of approximately 0.2 N. The use of a pressure calibrated probe facilitates reproduction of the measured values. This measurement should be taken on all the surface of all the teeth, documenting the deepest value for all tooth surfaces (at least six measuring points per tooth). The pocket depth (PD) is the distance between the gingival margin to the base of the gingival pocket. "Pocket measurement" alone, however, does not provide information as regards actual loss of attachment, due to the frequent presence of inflammatory gingival oedema or gingival recession. Attachment loss should therefore be measured by also examining and recording gingival recession at the same measuring points (or gingival hyperplasia as an indication of pseudo pockets). Gingival recession or hyperplasia is recorded by measuring the distance between the present or reconstructed (e.g., from the neighbouring tooth level) cemento- enamet-junction and the gingival margin. The total of the PD and gingival recession gives the attachment level). Tooth mobility is also recorded and documented according to levels of severity (grades I-III). If occlusal trauma is suspected, a clinical functional analysis is recommended.

Assessment of the furca invasion can be undertaken using a curved periodontal probe [e.g., the Nabers probe).

Four levels of severity can be distinguished according to the loss of horizontal support: Grade I furcation involvement usually exibits suprabony pockets.:Horizontal loss of support less than 1/3 of the furcation area is classified as Grade II A defect: Horizontal loss of support more than 1/3 of furcation area is classified as Grade II B defect: The furcation can be explored completely in the case of.Grade III defect . In Grade IV defects the furcation is exposed completely and gingival recession is present. In vertical dimension (the distance between the fornix of the Nation and the bottom of the bone defect) the defects of 0-3 mm, 4-7, more then 7 mm can be distinguished.

 


Date: 2015-12-17; view: 1171


<== previous page | next page ==>
Worschatzerweiterung | Periodontal probes and Explorers
doclecture.net - lectures - 2014-2024 year. Copyright infringement or personal data (0.008 sec.)