The physical examination

When the patient comes for advice or treatment, the dentist must make a diagnosis, prescribe proper treatment, and may form a prognosis of the case. Diagnosis is the recognition of a disease. In order to make a correct diagnosis it is necessary to collect all available information, by questioning and by physical examination of the patient, to determine etiology and pathogenesis of the disease as well as the symptoms by which it can be revealed.

History taking is the first step helping to establish the patient's immediate complaints. It may indicate a particular dental problem or neglect dental care. The dentist looks through the past records in a patient’s card. During the interview the doctor puts appropriate questions to help him/her to reach a diagnosis: "What seems to be the problem?", "Where does it hurt?", "What tooth troubles you?", "What kind of paіn is it?", "How long does the pain last?", "Does anything make it worse?", "Is there anything else you feel at the same time?". Important dental symptoms include bleeding, pain, malocclusion, new growths, malodor of exhaled breath, and chewing problems.

Attention should be paid to the past dental history which may reveal factors of general or immediate importance. Information on oral hygiene and dietary habits must be included at this stage.

A thorough general inspection of the face, neck and mouth, and the affected areas in detail, precedes the examination with the instruments. The examiner should pay attention to the face symmetry, skin, complexion, speech, masticatory movements of the patients, the cervical lymph nodes should be also palpated.

Teeth are inspected for shape, defects, mobility, color, and presence of adherent plaque, materiaalba (dead bacteria, food debris, desquamated epithelial cells), and calculus. They are gently tapped with a tongue depressor or mirror handle to assess tenderness (percussion sensitivity).

The visual examination of the oral cavity can be carried out with the simplest aids: a good light, a dental mirror, probes, and carrying forceps for cotton wool. In many conditions of dental origin such an examination may allow to make a correct final diagnosis. Occasionally this is not enough and the dentist may use special methods of examination of greater complexity and requiring much more equipment and facilities. These procedures include the following: X-ray examination, bitewing or periapical techniques; pulp vitality tests by thermal or electrical stimulation; transillumination of the teeth, alveoli, and nasal sinuses; occlusal registration and analysis; bacteriological examination, by culture and bacterial counts; serology, blood chemistry; biochemical analysis of saliva; biopsy and histopathological examination.

Of the above tests, X-ray and vitality tests are commonly used, while the last four require hospital conditions.

Oral findings may be the first signs of the systemic diseases and may be rather helpful for other clinicians. Results of an examination should be entered into a patient’s medical record which serves for preparing a treatment plan.

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