Department of PEDODONTICS : Department of PEDODONTICS CASE HISTORY History : History Clinical history of the child is done with the logical and orderly sequence of observations and examinations procedures and in a smiling, kindly manner.
This art and science of patient evaluation is the key to treatment planning. SEQUENCE OF CASE RECORDING : SEQUENCE OF CASE RECORDING VITAL STATISTICS
CLINICAL EXAMINATION OCCLUSAL RELATIONSHIP ANALYSIS
DENTAL CARIES EVALUATION
TREATMENT PLANNING VITAL STATISTICS : VITAL STATISTICS NAME
To maintain records
To build rapport
Recording nicknames is useful SEX
Certain diseases are common in one sex such as haemophilia in males or juvenile periodontitis in females
Timing of eruption sequence earlier in females
Variation in timing of growth spurts. AGE : AGE The chronological age should be compared with other ages (dental, skeleton) so as to know whether growth and development is normal
Certain diseases occur in certain age groups like juvenile periodontitis, acute herpetic gingival stomatitis
To relate eruption and exfoliation
Behavior management techniques may vary VITAL STATISTICS : VITAL STATISTICS HOME ADDRESS
Some areas might be endemic to certain diseases
Assessing parent occupation and socio economic status Helpful to co-relate patients chronological age with mental age
Indicates about socio economic background SCHOOL ADDRESS
Helpful to co-relate patients chronological age with mental age
Indicates about socio economic background CHIEF COMPLAINT : CHIEF COMPLAINT Reason which prompted the patient to seek dental treatment.
Might be referred by another dentist
Recorded in patients own words HISTORY : HISTORY History of present illness
Type of pain (sharp, dull, continous, intermitent, mild, etc).
History of current problems should be carefully documented, which includes the onset, nature & intensity, duration,location,relieving &exacerbating factors, associated symptoms TYPE OF PAIN : TYPE OF PAIN Sharp pain – Reversible pulpitis
Shooting pain – Irreversible pulpitis
Momentary pain – Exposure of dentin from a leaking restoration or open lesion.
Persistent pain – Wide spread inflammation of the pulp Past dental history : Past dental history Previous treatment-how the child has coped with other forms of treatment.
If any preventive treatment has been undertaken.
History of previous bad experience needs careful handling PAST MEDICAL HISTORY : PAST MEDICAL HISTORY Medical history should be taken in a systematic fashion, covering all the systematic areas in the body.
systemic problems, major areas include CVS,CNS,endocrine,GIT,respiratory tract.
Past operations or treatment/medications
Immunization eg:BCG, polio, DPT, hepatitis B HISTORY : HISTORY FAMILY HISTORY
Any history of serious illness.
Attitude of parents towards oral hygiene, health and dentistry.
Hereditarily influenced development of the patient. PERSONAL HISTORY : PERSONAL HISTORY PERSONAL HISTORY : PERSONAL HISTORY ORAL HABITS HISTORY
INCLUDES RECORDING FREQUENCY,INTENSITY,DURATION OF HABITS LIKE
DIGIT SUCKING,TONGUE THRUSTING,NAIL BITING,BRUXISM,MOUTH BREATHING. BEHAVIORIAL HISTORYFrankel’s rating scale : BEHAVIORIAL HISTORYFrankel’s rating scale CLINICAL EXAMINATION : CLINICAL EXAMINATION HEIGHT-Normal,too short, too tall
WEIGHT-Over weight or under weight
BUILD-endomorph, ectomorph, mesomorph.
Nourishment-well nourished or under nourished Clinical examination : Clinical examination GAIT
MOST COMMON-weak, unsteady gait of lethargy & malaise in ill patients.
Others-waddling, equinus, scissors, hemiplegic, wobbly, staggering & ataxic gaits. SPEECH
DISORDERS CAN BE
STUTTERING OR REPITITIVE SPEECH
ARTICULATORY SPEECH DISORDERS. EXTRA ORAL EXAMINATION : EXTRA ORAL EXAMINATION FACIAL SYMMETRY/DEFORMITIES
FACIAL ASYMMETRY CAN BE PATHOLOGICAL
ABNORMAL INTRA-UTERINE PRESSURES,FIBROUS DYSPLASIA,CRANIAL NERVE PARALYSIS
OR PHYSIOLOGICAL EYES
Observation includes-action of lids,presence or absence of inflammation,swelling or puffiness around the eyes,conjunctivitis,abnormal lancination
Inflammation>maxillary teeth>orbital region>swelling>conjunctivitis SKIN : SKIN Number of primary &secondary skin lesions may be found on the face
Postponed dental visit for child who has large painful herpes lesions or other type of sore on lip or face LIPS : LIPS Lips can be competent/incompetent
Ulcers,vesicles,fissures&abrasions are frequently seen in lips
Lips protect teeth from trauma>frequent site of contrusions in child
Nutritional &allergic reactions>cause changes LYPMH NODES : LYPMH NODES Submandibular, sub mental lymph nodes are once commonly involved during dental infections
Cervical lymph nodes & others in the head and neck should be checked in routine procedure
Sub maxillary nodes enlarge>respiratory infection
Palpable nodes>oral infection or neoplasms TMJ EXAMINATION : TMJ EXAMINATION Diagnostic method
Dentist places his finger in the area of tmJ >child opens &closes his mouth slowly>from closed centric>have him move into the lateral motions>askin him to chew slowly on his back teeth
This shows the discrepancies of the tmj,muscular imbalances &anatomic deviation from the mid line
Trismus or spasm of the masticatory muscles>infection >following and permanent molar extraction INTRA ORAL EXAMINATIONSSOFT TISSUE EXAMINATION : INTRA ORAL EXAMINATIONSSOFT TISSUE EXAMINATION CHEEKS/VESTIBULE/LABIAL/BUCCAL MUCOSA
Any lesions or changes in the color or consistency should be evaluated
Any ulcerations,pallor, growth may indicate anaemia
Koplik’s spots >onset of measels
Lesions associated with HSV Palate
Childs head tips slightly backwards for correct observation
Scars on palate>evidence of past trauma or surgical repair of anomalies
Color changes>neoplasms, infections of systemis disease,trauma or chemical agents GINGIVA : GINGIVA High maxillary labial frenal attachment >abnormal spacing between central incisors
Redness or swelling >gingivitis
Draining fistulae>attached gingiva >tenderness,pain,&some tooth mobility>abscessed teeth
As tooth eruptes>overlying gingiva>swollen, painful TONGUE : TONGUE Dryness of tongue >dehydration
Pathologic enlargement> cretinism, mongolism,cyst,neoplasm
Desquamation> avitaminosis , anaemia
Short lingual frenum >tongue tie
Tongue is coated in febrile state HARDTISSUE EXAMINATION : HARDTISSUE EXAMINATION Teeth present
Determined and noted using FDI coding
For both primary and permanent teeth
Number of decayed ,missing & filled teeth is noted STAINS : STAINS Stains may be intrinsic or extrinsic
Extrinsic stains >chromogenic bacteria
Generalised discolorations of enamel and dentine >intrinsic factors (blood dyscrasias, amelogenesis & dentinogenesis imperfecta, internal resorption and drugs)
Check for plaque & calculus OCCLUSAL RELATIONSHIP ANALYSIS : OCCLUSAL RELATIONSHIP ANALYSIS Molar relationship (Angle’s class 1,2&3 for permanent teeth)
For primary teeth based on Baumes terminal plane relationship into flush terminal plane , mesial step &distal step terminal
Incisal relationship (overjet &over bite)
Midline: normal or deviated
Also check for crossbites, supernumerary teeth/congenitally missing teeth DENTAL CARIES EVALUATION : DENTAL CARIES EVALUATION BLACKS CLASSIFICATION WITH MODIFICATION PROVISIONAL DIAGNOSIS : PROVISIONAL DIAGNOSIS It is a general diagnosis formulated for every patient based on clinical impression without any lab diagnosis
It influences the final diagnosis and treat ment planning INVESTIGATIONS : INVESTIGATIONS Percussion
reveals the status of periodontium and not of the pulp
Percussed first lightly with index finger followed by the handle of the mouth mirror
Radiographic examinations(IOPA,bitewing,OPG,lateral ceph)
Other investigations if any FINAL DIAGNOSIS : FINAL DIAGNOSIS The art or act of recognizing the presence of disease from its signs or symptoms, and deciding as to its character; also, the decision arrived at.
Lab diagnosis is also considered TREATMENT PLANNING : TREATMENT PLANNING Treatment planning can be divided into four phases
Emergency phase( treatment of emergencies)
Preparatory phase (preventive phase)
Corrective phase (restorative phase)
Recall and maintenance EMERGENCY PHASE : EMERGENCY PHASE Extraction of grossly decayed painful tooth or a tooth that is severely mobile.
Management of Trauma.
Endodontic treatment of painful tooth
Developing Cross bite correction. PREPARATORY PHASE : PREPARATORY PHASE Oral Prophylaxis
Topical Flouride Application
Pit & Fissure Sealants
Patient Education & motivation CORRECTIVE PHASE : CORRECTIVE PHASE Permanent restorations
Orthodontic appliances & Treatment RECALL &MAINTAINECE : RECALL &MAINTAINECE Evaluation of effectiveness of the preventive programme
Evaluation of Restorative care
Evaluation of tooth guidance treatment