Dr. Shahzadi Tayyaba Hashmi

CLINICAL EXAMINATION AND DIAGNOSIS

CLINICAL EXAMINATION

Clinical examination: It includes both extra oral and intra oral

examination

ORAL EXAMINATION AND DIAGNOSIS

Intra oral examinationHard tissue and soft tissue examinationExtra oral examinationHead and neck examinationFace (gross abnormality)Skin(pallor , pigmentation and cyanosis)Eyes( anaemia and jaundice)Nose(nasal deviations)T M J (deviation of mandible , any mass over TMJ ,

tenderness on palpation, clicking sounds)Lymph nodes of head and neck (site , size, number,

consistency , tenderness ,fixity )Salivary gland( enlargement of major glands, dryness of

mouth, quantity and character of secretion)

ORAL EXAMINATION AND DIAGNOSIS

Following sequence is followed during clinical examinationsInspectionPalpationPercussionAuscultation

1) INSPECTIONPatient should be observed for :

unusual gait and habits (may suggest underlying systemic disease, drug or alcohol abuse)

Localized swelling,Presence of bruises,Abrasions, scars Signs of traumaDegree of mouth opening, it should be at least two

fingers

INSPECTIONDuring intraoral examination, look at the

following structures systematicallyThe buccal, labial and alveolar mucosaThe hard and soft palateThe floor of the mouth and tongueThe retromolar regionThe posterior pharyngeal wall and facial pillarsThe salivary gland and orifices

INSPECTİON (GENERAL DENTAL STATE)

• Oral hygiene status• Amount and quality of restorative work• Prevalence of caries• Missing tooth• Presence of soft or hard swelling• Periodontal status• Presence of any sinus tracts• Discolored teeth• Tooth wear and facets

PALPATİONLocal rise in temperatureTendernessExtent of lesionIndurationFixation to underlying tissues

PERCUSSİONPercussion gives information about the

periodontal status of the toothPercussion of tooth indicates

inflammation in periodontal ligament which could be due to TraumaSinusitis PDL disease

HOW CAN WE DO PERCUSSION?

Percussion can be carried out by :gentle tapping with gloved finger Blunt handle of mouth mirrorEach tooth should be percussed on all the surfaces of

tooth until the patient is able to localize the tooth with pain. Degree of response to percussion is directly proportional to degree of inflammation

PERİODONTAL EVALUATİON

Periodontal examination shows change in colorcontourformdensitylevel of attachment bleeding tendency

PERİODONTAL EVALUATİON

The depth of gingival sulcus is determined by systemic probing using a periodontal probe

A sulcus depth greater than 3 mm and the sites that bleed upon probing should be recorded in the patient’s chart

The presence of pocket may indicate periodontal disease

PERİODONTAL EVALUATİON

How can we check the mobility of the tooth:The mobility of a tooth is tested by placing a

finger or blunt end of the instrument on either side of the crown and pushing it and assessing any movement with other finger

How to check the mobility of a tooth?

PERİODONTAL EVALUATİON

Mobility grades:Slight (normal)Moderate mobility within a range of 1 mm.Extensive movement (more than 1 mm) in mesiodistal or

lateral direction combined with vertical displacement in alveolus

As a general rule, mobility is graded clinically by applying firm pressure with either two metal instruments or one metal instrument and a gloved finger

Normal mobility Grade I: Slightly more than normal (<0.2mm horizontal movement)

Grade II :Moderately more than normal (1-2mm horizontal movement)

Grade III: Severe mobility (>2mm horizontal or any vertical movement)

AUSCULTATIONIntra orally of less importanceBut useful in assessing movement of

Temporomandibular joints