Examination Phase

The next part of the assessment that will aid in the development of the care plan includes a comprehensive examination to help determine a patient’s needs and address what the patient desires in the future. The examination will consist of photographs, radiographs and a clinical examination including hard and soft-tissue evaluations.

Photographs provide visual communication to our patients about their current dental status. A full-frontal, retracted-lip photograph will allow the clinician and patient to view the facial-anterior portion of a patient’s mouth. Occlusal photos will enable the patient to see their current posterior dental status from the clinician’s point of view. Broken teeth, fractures, restorations and occlusal wear can be visualized and documented.

Figure 2. Failing occlusal amalgam.
Figure 3. Failing occlusal amalgam with fractured enamel.
Figure 4. Failing interproximal amalgam fillings.
Figure 5. Crowded lower anterior crowding leading to periodontal issues due to inability to effectively clean area.

A full series of radiographs based on ALARA principles will determine active areas of decay, bone level and the radiographic interpretation of current restorations. Identifying areas of concern such as overhangs, irregular contacts and bridge issues using radiographs will give the clinician information to determine future risk for the patient.

The dental hard-tissue examination enables the clinician to visualize older restorations and determine if they are at risk for failing. It is during the clinical examination that oral habits such as wear from grinding and clenching, toothbrush abrasion and mouth breathing will be addressed. The patient will understand through education these issues are not only cosmetic but also functional problems with the potential to impact performance of their teeth and affect their overall health.

Providing a “Caries Management by Risk Assessment (CAMBRA)” exam, including a pH test, salivary assessment and obtaining a caries history can determine a patient’s future risk for dental decay.

Periodontal health is vital for a solid foundation for future dental work. Periodontal examinations include a 6-point periodontal probe depth reading of the entire dentition, measurements of clinical attachment loss, bleeding points, recession, furcations and mobility. A salivary test such as MyPerioPath® can determine the quantity of pathogenic bacteria present in a patient’s mouth. Risk factors such as smoking, hormonal changes and diabetes as well as a family history of periodontal disease, influence a person’s susceptibility for periodontal disease and should be questioned as well.

Periodontal pathogens have been found in various parts of the body and are associated with bacterial endocarditis (an inflammation of the inner lining of the heart), brain abscess, cavernous sinus infection, endophthalmitis (inflammation involving the entire eye), lymphadenitis (inflammation of a lymph node), septic arthritis, osteomyelitis (infection and inflammation of the bone or bone marrow), pneumonia, empyema (accumulation of pus in a cavity of the body), prosthetic joint infections and respiratory infections.8-16,25 A soft-tissue treatment plan will be created to reduce the oral bacterial levels. This would include removing hard and soft deposits through root debridement therapy (scaling and root planing), creating a biofilm reduction plan for a patient to carry out when at home and prescribing a systemic antibiotic to reduce the bacteria levels after in-office periodontal therapy is completed.

During the clinical examination home care will be assessed. The amount of biofilm will be analyzed and locations determined so a home care plan can be created. Patients will also need to be educated about plaque biofilm and its potential to create dental caries, periodontal disease and peri-implantitis. Additional education should also be provided about the links between oral and systemic diseases if the patient has a history of a chronic disease.