1. CLINICAL EXAMINATION AND DIAGNOSIS Dr. Shahzadi Tayyaba Hashmi shahzadi@inaya.edu.sa

2.  Clinical examination: It includes both extra oral and intra oral examination CLINICAL EXAMINATION

3.  Intra oral examination Hard tissue and soft tissue examination  Extra oral examination Head and neck examination Face (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

6. Following sequence is followed during clinical examinations – Inspection – Palpation – Percussion – Auscultation ORAL EXAMINATION AND DIAGNOSIS

7. Patient 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 trauma – Degree of mouth opening, it should be at least two fingers 1) INSPECTION

9. During intraoral examination, look at the following structures systematically – The buccal, labial and alveolar mucosa – The hard and soft palate – The floor of the mouth and tongue – The retromolar region – The posterior pharyngeal wall and facial pillars – The salivary gland and orifices INSPECTION

10. 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 INSPECTİON (GENERAL DENTAL STATE)

11. Local rise in temperature Tenderness Extent of lesion Induration Fixation to underlying tissues PALPATİON

14. Percussion gives information about the periodontal status of the tooth Percussion of tooth indicates – inflammation in periodontal ligament which could be due to Trauma Sinusitis PDL disease PERCUSSİON

15. Percussion can be carried out by : gentle tapping with gloved finger Blunt handle of mouth mirror Each 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 HOW CAN WE DO PERCUSSION?

16. Periodontal examination shows change in – color – contour – form – density – level of attachment – bleeding tendency PERİODONTAL EVALUATİON

17. 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

19.  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 PERİODONTAL EVALUATİON

20. How to check the mobility of a tooth?

21.  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) PERİODONTAL EVALUATİON

22. Intra orally of less importance But useful in assessing movement of Temporomandibular joints AUSCULTATION