Dental Examination

Definition

A dental examination is part of an oral examination: the close inspection of the teeth and tissues of the mouth using physical assessment, radiographs, and other diagnostic aids. Dental care begins with this assessment, and is followed by diagnosis, planning, implementation, and evaluation.

Purpose

The examination identifies tooth decay and evaluates the health of the gums and other oral tissues. The fit of dentures and bridges (if any) are evaluated. The patient's bite and oral hygiene are also assessed. The dentist then recommends the best treatment options to the patient.

Precautions

Before a dental examination patients with heart-valve disease must take antibiotics to prevent bacteria that may spread into the bloodstream from causing endocarditis. Hypertensive patients may need to have their blood pressure measured. Many dentists prefer not to examine patients who have active herpes sores on or near the mouth. To maintain a sterile environment, dentists and their assistants don gloves and masks.

Description

A dental examination is part of a comprehensive oral examination to evaluate the mouth, jaw, and teeth. The American Dental Association (ADA) recommends that patients seeing a dentist for the first time receive a comprehensive examination, and that established patients be thoroughly evaluated every three years, with professional oral care and periodontal maintenance between examinations. Comprehensive evaluations are usually combined with a dental cleaning, x rays, and other diagnostic tests. If a new patient presents with an emergency, the situation will be evaluated and treated first. Once the emergency is over, an appointment for a complete oral examination will be scheduled.

The examination begins with a review of the patient's complete medical and dental history, which is usually a form or questionnaire completed by the patient. Once the dentist is familiar with any special conditions that may affect the patient during the exam—heart disease, relevant allergies, or the use of medications such as blood thinners—the examination and cleaning can proceed.

Teeth

The dentist or dental hygienist uses instruments such as a mouth mirror, periodontal probe, and explorer to examine the teeth. Every tooth is checked for cavities; the conditions and positions of the teeth, both erupted and impacted, are noted; previous treatments, such as crowns and other restorations, are evaluated. The dentist's observations are recorded on a tooth chart. The jaw joint and bite are evaluated, since an irregular bite can lead not only to excessive wear on the teeth but other dental problems as well. The fit of dentures and bridges, if worn, are inspected. Dentists frequently order other diagnostic tests such as x rays, blood tests, and dental casts as well.

Gums

The dentist or hygienist evaluates the gingiva, or gum tissue, for periodontal disease by checking for loose teeth, bone loss, and bleeding, swollen, or receding gums. A periodontal probe measures the depth of the pocket around each tooth. If the gums are healthy the pocket will be less than three millimeters deep. Pockets of four millimeters or more indicate periodontal disease. The deeper the pocket, the greater the chance for tooth loss unless treatment is begun.

Tissues of the mouth

An oral cancer screening is part of the dental examination. The dentist feels the lymph nodes on the face and neck, and checks the entire oral cavity—including the hard and soft palates, tongue, cheeks, lips, and floor of the mouth—for irregularities. If caught early, many types of oral cancer can be treated successfully.

Patient education

Oral exams often include instructing the patient in flossing and brushing techniques, the use of fluoride toothpastes, and the prevention of tooth damage from contact sports and other activities. Patient concerns can also be discussed during a counseling session.

Insurance

Oral examinations are covered by most dental insurance at 100%. Annual x rays are also covered. Panorex and full-mouth x rays are usually covered every three to five years, except for emergencies or third molar (wisdom tooth) surgery.

Preparation

The dental office prepares for an examination by sterilizing all the equipment that will be used during the examination. The patient prepares by having a complete medical and dental history available or alerting the dentist or hygienist to any health changes, and taking pretreatment medication, if necessary.

Aftercare

The patient will be advised that the teeth may be tender after a thorough cleaning and examination, and ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) may be recommended to alleviate the discomfort. This tenderness usually subsides within a day or two.

Complications

Complications from an oral examination are rare, although the tissues and teeth may be sore for a few days.

Results

An oral examination should give the dentist a good idea of the patient's oral health. Once this is established, a complete treatment program can be scheduled and maintained.

KEY TERMS

Full-mouth x rays— A set of x-ray films that show all the teeth, consisting of 14 periapicals and two or four bitewings.

Panorex— Trade name for a single panoramic x ray taken by a camera that travels around the head, it shows all the teeth and both jaws in one film. It can reveal impacted teeth, cysts or tumors of the jaw, along with possible sinus infections and temporomandibular joint dysfunction.

RDA— Registered dental assistant, a licensed professional trained to assist the dentist at chairside, including preparation and maintenance of dental instruments, preparation of dental materials, taking impressions, etc.

RDH— Registered dental hygienist, a licensed professional. RDHs evaluate patient histories, clean teeth by removing deposits such as plaque and tartar, process dental x rays, and educate patients about oral hygiene.

Health care team roles

The dental staff work as a team during the examination. The front office confirms the appointment with the patient a day ahead of time, and reminds the patient of information that will be needed for medical and dental histories. The registered dental hygienist (RDH) assesses the patient's health history, takes x rays, and cleans the teeth. Next the registered dental assistant (RDA) and dentist chart the existing conditions of the mouth and teeth, and counsel or educate the patient. This helps the patient feel comfortable and knowledgeable about the treatment required for optimum health.

Resources

ORGANIZATIONS

American Academy of Periodontology. 4157 Mountain Road, PBN 249, Pasadena, MD 21122. (410) 437-3749. 〈http://www.perio.org〉.

American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.

National Institute of Dental & Craniofacial Research. Building 45, Room 4AN-24, 45 Center Drive, MSC 6402 Bethesda, MD 20892-6402. (301) 594-9898. 〈http://www.nidcr.nih.gov/research/extramural/cranio2.htm〉.

OTHER

American Association of Pediatric Dentistry. "Regular Dental Visits." Brochure. 〈http://www.aapd.org/publications/brochures/regdent.html〉.

American Dental Association. "Baby's First Dental Visit," News release. February 2000, updated April 20, 2001; 〈http://www.ada.org/public/medica/newsrel/0002/nr04.html〉.

"Dental Check Ups." MedlinePlus Dental Health; Reuters; April 9, 2001; 〈http://www.nlm.nih.gov.medlineplus.dentalhealth.html〉.

Green, Stuart. "The Complete Dental Examination." 〈http://www.qualitydentistry.com/dental/exam/index.html〉.

Houston Chronicle.com. "Exam: Dental; Dr. Allan Bruckhiem," 2001. Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, IL 60611. 〈http://www.houston.webpoint.com/health/dentold.htm〉.

Institutes of Health. National Institute of Dental and Craniofacial Research. "First-Ever Surgeon General's Report on Oral Health." NIDCR News. 〈http://www.nidcr.nih.gov./news/052500.htm〉.

National Institutes of Health. National Library of Medicine. MedlinePlus "Dental Health." 〈http://www.nlm.nih.gov.medlineplus.dentalhealth.html〉.