METHODS OF EXAMINATION

• Biographical details • Medical history • Chief complaint • History of present complaint • Dental history • Social history • Extraoral examination • Intraoral examination • Special tests

1. Have you ever had Rheumatic Fever? Yes No 2. Do you have Heart Trouble or High Blood Pressure? 3. Do you have Chest Trouble? 4. Have you had Jaundice or Hepatitis, or been refused as a blood donor? 5. Have you ever had severe bleeding that needed special treatment after an injury or dental extraction? 6. Is there any family history of Bleeding Disorders? 7. Are you taking any Drugs, Tablets, or Medicines?

8. Do you suffer from any Allergies (e.g. Penicillin)? Yes No I f 'Yes' please list 9. Are you Diabetic? 10. Do you have any history of Epilepsy? 11. Have you had any a) Serious Illnesses or Operations? or b) Adverse reactions to Local or General Anaesthesia? 12. Have you come into contact with anybody who has AIDS or is HIV positive? 13. (Females only) Are you pregnant?

CHIEF COMPLAINT This is the opportunity for the general practitioner to let the patient describe a dental problem as it appears to him/her. You may start with 'Tell me about your problem' or 'How can I help?' Allowing time to listen to the patient in a busy schedule can pay dividends in reaching the correct diagnosis swiftly and avoiding embarrassing mistakes. A distressed patient will be put at ease, and conversation can then lead into more detailed discussion

HISTORY OF PRESENT COMPLAINT When did the pain or problem start? Does anything make the pain better or worse? Relieving factors. The frequency of painful episodes. Intensity. Location. Duration. Postural changes. Does anything trigger the pain? Quality of pain.

EXTRAORAL EXAMINATION

Are there any signs of acute inflammation - Facial Swelling Are there any signs of acute inflammation - heat, swelling, redness, pain, loss of function and does the patient have a raised body temperature? Does the patient feel that his/her face is swollen in any way? Ask patients to look in a mirror and point to any perceived swelling. The practitioner can assess the facial contour in profile and by looking down the bridge of the nose from above to see any asymmetry in the nasolabial folds. Facial asymmetry can be due to guarding of painful tissues.

A patient with facial swelling (arrowed).

Asymmetry in the right nasolabial folds is more visible when viewed from above.

Palpation Lymph nodes can be gently palpated with the fingertips. Lymphadenopathy of the submandibular lymph nodes could be an indication of infection in the oral cavity. Tenderness may indicate a site of acute inflammation deep to the skin

Palpation of the submandibular lymph nodes Palpation of the submandibular lymph nodes. The clinician is positioned behind the patient and palpates the nodes gently with finger tips.

Is it possible for the patient to open his/her mouth sufficiently wide for root canal treatment? If two fingers can be placed between the maxillary and mandibular incisor tips then it should be possible to instrument most teeth

Sufficient opening is required to gain access to the teeth for endodontic treatment. Two fingers' width in the i ncisor region is perfectly adequate.

INTRAORAL EXAMINATION

General condition of the mouth: Is the mouth in good health or neglected? Are there heavy plaque deposits and evidence of gross periodontal disease? Are restorations of good quality, or are the margins overhanging and poorly finished? Is there obvious recurrent caries present

A neglected mouth. The patient will need advice on oral hygiene prior to endodontic treatment.

Tooth mobility: A suspect tooth can be moved gently by finger and thumb pressure; any horizontal mobility is then gradedMobility can result from trauma, root fractures, periodontal disease and gross root resorption. Sometimes a very slight (< 1 mm) degree of mobility may be normal. For instance, a tooth that has a horizontal root fracture in the middle third could be expected to have a degree of mobility, as would teeth under active orthodontic traction. Neither would necessarily require treatment purely because of the mobility.

Testing tooth mobility by gently applying lateral forces between finger and thumb.

Tenderness to palpation: The tooth is moved vertically and side to side with finger pressure. Teeth with acute apical periodontitis will often be tender when palpated in this manner.

Percussion: Tapping a tooth with a mirror handle can help identify replacement resorption (ankylosis). A characteristic ringing sound is sometimes heard on percussion

Gently percussing a tooth with a mirror handle may elicit the classical ringing sound that occurs with replacement resorption (ankylosis).

Palpation of the buccal sulcus: Running a finger gently along the buccal sulcus will help elicit if there is any swelling or tenderness over the apex of an offending tooth

Palpating the buccal sulcus over the apices of the teeth, with a finger tip. Any tenderness or swelling is noted. Tenderness may be an indication of acute apical periodontitis.

Periodontal pocketing: Probing depths should be measured carefully with a periodontal probe. Ideally a probe with a tip of 0.5 mm should be used and pressure of no more than 25 g applied (light pressure!). Broad pockets are normally due to periodontal disease. A sudden increase in probing depth resulting in a narrow but deep pocket may indicate the position of a vertical root fracture or sinus tract lying within the periodontal ligament

The maximum periodontal probing depth on the mesial aspect was 7mm The maximum periodontal probing depth on the mesial aspect was 7mm. The pocket shape was deep and narrow.

There were 1.0-1.5 mm probing depths buccally.

The probing depth of 7mm on the distal aspect of the tooth directly opposite to that on the mesial aspect was indicative of a vertical root fracture.