Physical Evaluation and Treatment Planning in Dental Practice

The authors Géza T. Terézhalmy, DDS, MA, is Professor and Dean Emeritus in the School of Dental Medicine at Case Western Reserve University in Cleveland, Ohio, USA. Michaell A. Huber, DDS, is Adjunct Professor in the Department of Comprehensive Dentistry at UT Health San Antonio School of Dentistry in San Antonio, Texas, USA. Lily T. García, DDS, MS, FACP, is Professor and Dean of the University of Nevada, Las Vegas, School of Dental Medicine in Las Vegas, Nevada, USA. Ronald L. Occhionero, DDS, is Professor and Associate Dean for Administration at Case Western Reserve School of Dental Medicine in Cleveland, Ohio, USA.

Preface to the Second Edition ix

Preface to the First Edition xi

List of Contributors xiii

About the Companion Website xv

1 Introduction to the Clinical Process 1

1.1 Essential Elements of the Clinical Process 1

1.2 Quality Management in the Clinical Process 2

1.3 Patient–Doctor Communication in the Clinical Process 3

1.4 Characteristics of the Patient–Doctor Relationship 6

1.5 Documentation of the Clinical Process 6

1.6 Designations and Abbreviations 10

1.7 Summary 18

Suggested Reading 18

2 The Historical Profile 19

2.1 Patient Identification 20

2.2 Chief Complaint (Problem) 20

2.3 Dental History 21

2.4 Medical History 21

2.5 Family History 22

2.6 Social History 22

2.7 Review of Organ Systems 23

2.8 Summary 35

Suggested Reading 36

3 Basic Procedures in Physical Examination 39

3.1 Inspection 39

3.2 Palpation 53

3.3 Percussion 53

3.4 Auscultation 54

3.5 Olfaction 54

3.6 Evaluation of Function 54

3.7 Summary 61

Suggested Reading 61

4 Examination of the Head and Neck 63

4.1 Examine the Head and Face 63

4.2 Examine the Ears and Temporomandibular Joints 98

4.3 Examine the Nose 99

4.4 Examine the Eyes 101

4.5 Examine the Hair 106

4.6 Examine the Neck 109

4.7 Examine the Lymph Nodes 113

4.8 Conclusion 116

Suggested Reading 117

5 Examination of the Oral Cavity 123

5.1 Examine the Vermilion of the Lips 123

5.2 Examine the Labial and Buccal Mucosa 131

5.3 Examine the Hard Palate 142

5.4 Examine the Soft Palate and Tonsillar Area 149

5.5 Examine the Tongue 152

5.6 Examine the Glossopharyngeal (IX) and Vagus (X) Nerves 157

5.7 Examine the Floor of the Mouth 158

5.8 Examine the Gingivae 161

5.9 Examine the Teeth 168

5.10 Summary 171

Suggested Reading 172

6 Radiographic Examination 177

6.1 Radiographic Examination of the New Patient 178

6.2 Radiographic Examination of the Recall Patient 179

6.3 Introduction to Radiographic Interpretation 180

6.4 Radiographic Manifestations of Common Conditions 181

6.5 Conclusion 201

Suggested Reading 201

7 Laboratory Methods 203

7.1 Hematology Screening 204

7.2 Evaluation of Hemostasis 205

7.3 Biochemical Tests 208

7.4 Tissue Studies 211

7.5 Summary 214

Suggested Reading 214

8 Diagnostic and Treatment Planning Considerations for Orofacial Pain 215

8.1 Subjective Information 216

8.2 Objective Findings 217

8.3 Plan: Treatment Options 221

8.4 Summary 224

Suggested Reading 224

9 Evidence-Based Treatment Planning in Restorative Dentistry 227

9.1 Historical Perspective 227

9.2 Etiology of Dental Caries 228

9.3 Caries Lesion Detection, Assessment and Diagnosis 230

9.4 Primary Caries Lesion Diagnosis and Risk Assessment 234

9.5 Developing a Minimally Invasive Evidence-Based Treatment Plan Predicated on Caries Risk 235

9.6 Diagnosis and Treatment of Root Caries Lesions 241

9.7 Clinical Detection and Diagnosis of Secondary or Recurrent Caries Lesions 242

9.8 Repair Versus Replacement of Direct Restorations 243

9.9 Summary 244

Suggested Reading 244

10 Periodontal and Peri-Implant Examination 249

10.1 Periodontal Evaluation 250

10.2 Establishing a Periodontal Diagnosis 256

10.3 Basic Principles of Periodontal Treatment Planning 262

10.4 Peri-Implant Examination and Diagnosis 264

10.5 Summary 264

References 265

11 Oral and Maxillofacial Surgery 269

11.1 Introduction 269

11.2 Medical History 270

11.3 Chief Complaint (CC) 270

11.4 History of Present Illness (HPI) 270

11.5 Past Medical History 271

11.6 Past Surgical History 271

11.7 Medications 271

11.8 Allergies 271

11.9 Social History 272

11.10 Last Meal 272

11.11 Review of Systems (ROS) 272

11.12 Physical Examination 272

11.13 Medical Status 275

11.14 Anesthesia Requirements 276

References 294

12 Endodontic Evaluation 295

12.1 Introduction 295

12.2 Pulp Status 297

12.3 Periradicular Status 299

12.4 Imaging Assessment 302

12.5 Additional Clinical Evaluations 303

12.6 Diagnosis 304

12.7 Endodontic Treatment Planning 306

12.8 Concluding Remarks 311

References 311

13 Prosthodontic Restoration 313

13.1 Documenting Patient Health Histories 313

13.2 Documenting Clinical, Radiographic, and Photographic Findings 315

13.3 Designing Prosthodontic Treatment Plans 320

13.4 Summary 338

References 340

14 Exam, Diagnosis and Treatment Planning in Pediatric Patients 343

14.1 The Complete History and Examination 343

14.2 Diagnosis 360

14.3 Treatment Planning 361

14.4 Risk Based, Age Appropriate Diagnosis and Treatment Planning 370

Recommended Textbooks and Additional Reading 384

References 384

15 Orthodontics for the General Practitioner 387

15.1 Introduction to Orthodontics 387

15.2 Diagnosis and Malocclusion Classification 388

15.3 Orthodontic Interventions Commonly Accomplished by the General Practitioner 399

15.4 Management of the Mixed Dentition 402

Recommended Resources and Textbooks 404

References 404

16 Putting It All Together 407

16.1 Rational Approach to Treatment Planning 407

16.2 Putting It All Together 410

16.3 Presentation of the Treatment Plan 411

16.4 Consultations and Referrals 412

16.5 Conclusion 413

Suggested Reading 414

Index 415