Examination and Special Investigations in Dentistry

Introduction

• Presenters:
  • Zoe: Foundation Dentist, London
  • Ali: Final Year Dental Student, University of Newcastle
• Topic: Examinations and special investigations before seeing patients
• Previous Topic: Importance of taking a good patient history (refer to last week's video)
• Content Overview:
  • Extraoral and intraoral examinations
  • Charting
  • Basic Periodontal Examination (BPE)
  • Additional notes and appropriate investigations

Patient Interaction

• Starting the Examination:
  • Begin when you call the patient’s name
  • Observe general appearance, disabilities, and breathlessness
  • Implied consent obtained after explaining the examination process

Extraoral Examination

• Steps to Follow:
  • Stand behind the patient and palpate the following:
    • Temporomandibular Joint (TMJ):
      • Ask patient to open/close jaw
      • Look for deviation, clicking, or grinding
    • Muscles of Mastication:
      • Palpate masseter (clench, open) and temporalis (clench)
      • Assess for hypertrophy indicating para-functional habits (e.g., bruxism)
    • Salivary Glands:
      • Palpate parotid (below/in front of ear) and submandibular glands (below mandible)
    • Lymph Nodes:
      • Check cervical, submandibular, and submental nodes for infections or cancers
    • Skin Lesions:
      • Look for basal cell carcinomas; ask about duration and pain

Intraoral Examination

• Soft Tissues Inspection:
  • Check buccal/labial mucosa, palate, tongue, floor of mouth, gingiva
  • Look for lesions (white/red), bite marks, or ulcers
  • If uncertain about findings, refer to supervisor/oral medicine
• Procedure:
  • Use a mirror, check systematically
  • Start with denture wearers, inspect mucosa and gingiva
  • Examine the tongue and palate systematically

Hard Tissue Examination

• Charting and BPE:
  • Record each tooth’s condition (caries, missing, etc.)
  • Dry surfaces to better spot caries
  • Use loops for enhanced visibility
  • BPE should not stop at score of 4; continue to check for additional findings

BWE (Basic Erosive Wear Examination)

• Recommended after BPE to assess tooth surface loss

Special Investigations

• Radiographs:
  • Bitewings for new patients
  • Periapicals for heavily restored teeth, periodontal assessment, root canal treatment planning
  • DPT for wisdom teeth, pathologies, ortho planning
• Sensibility Testing:
  • Types: Cold, electric, and hot testing
  • Cold testing is most accurate; compare with adjacent teeth
  • Non-responsive does not mean non-vital
  • Tender to percussion testing should consider patient’s pain tolerance
• Tooth Sleuth for Cracked Tooth Syndrome:
  • Test fissures and cusps; assess pain on biting/release
• Six-point pocket charting:
  • For BPE scores of 4 or persistent 3s
• Diet Diary:
  • For high caries risk patients
• Study Models:
  • Monitor tooth surface loss, ortho treatment, indirect restoration assessments
• Diagnostic Wax-up:
  • Visualize composite build-up cases

Conclusion

• Review key points on examinations and investigations
• Document with summarized information provided in the description link
• Encourage feedback and questions in the comments
• Reminder to subscribe for future videos on related topics.