1. PRESENTED BY;ABDUL VAJID M

2.  To provide best treatment and patient
satisfaction , thorough clinical history
, examination and diagnostic aids are
required.
 Diagnosis is defined as utilization of scientific
knowledge for identifying a disease process
and to differentiate from other disease
process.

3.  The diagnostic process actually consists of four
steps;
 First step ; assemble all the available facts
gathered from chief complaints, medical and
dental history, diagnostic test and investigations.
 Second step ; analyze and interpret assembled
clues each and the tentative or provisional
diagnosis.
 Third step ; make differential diagnosis of all
possible disease.
 Fourth step ; select the closest possible choice.

4.  Case history is defined
as;planned,professional conversation
between the patient and the clinician in
which the patient reveals his/her
symptoms fears, or feelings to the
clinician so that the nature of the real
or suspected illness and mental attitude
to it may be determined.
 The purpose of recording patients history and
conducting a clinical examination is to arrive
at a logical diagnosis to the patients chief
compliant and to institute a suitable
treatment plan.

5.  It is the description of the problems for which
the patient seeks treatment.
 It should be recorded in patients own words
and should not be recorded in medical
terminology.

6.  It is the detailed description of chief complaint.
 Examples for the type of questions asked by
clinician include
1. How long you had the pain?
2. Do you know which tooth it is?
3. What initiate pain?
4. How would you describe pain?
5. When was the problem first noticed?
6. Mode of onset
7. Associated symptoms etc..

7.  The most common toothache may arise either
from pulp or from PDL.
 Mild to moderate type of pain can be of
pulpal or periodontal origin.
 If pain from PDL ,teeth will be sensitive to
percussion.
 Pulpal pain will be sharp and depends on the
pulpal fibres involved.

8.  This helps to know any previous dental
experience, and past restorations.

9.  For a proper medical history, importance
should be given to the following;
1. Allergies and medications(allergic to local
anaesthetics)
2. Communicable diseases(HIV , hepatitis)
3. Systemic diseases( valvular heart
diseases, oral lesions
, immunocompromised patients)
4. Psychological problem associated with
aging.(gingival recession,staining,decreased
salivary flow)

10. CHECKLIST FOR MEDICAL HISTORY(SCULLY AND CAWSON)
BLEEDING DISORDER
CARDIORESPRIRATORY DISEASES
ENDOCRINE DISEASES
GASROINTESTINAL DISTURBANCES
INFECTIONS
JAUNDICE
KIDNEY DISEASES
PREGNANCY
DRUG TREATMENT AND ALLERGIES

11. 1. Diet.
2. Oral habits like smoking and alcohol.
3. Bowel and bladder.
4. Apatite.
5. Oral hygiene methods.

12.  Patient is asked about the health of other
members of his/her family.
 Genetic and hereditary diseases are ruled out.
1. Diabetes
2. Hypertension
3. Bleeding disorder
4. Flurosis etc..

13. Clinical examination- extra oral and intraoral
examination.

14. 1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Exploration

15.  Intraoral examination include;
1. Hard tissue examination
2. Soft tissue examination
Extra oral examination(head & neck )

16.  Face (gross abnormality)
 Skin(pallor , pigmentation and cyanosis)
 Hair(alopecia ,hirrusitism )
 Nails(clubbing)
 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)

17. Palpating submandibular salivary gland Palpation of T M J

18. 1. Teeth present
2. Missing teeth
3. Dental caries
4. Dental caries with pulpal involvement
5. Root stumps
6. Wasting diseases
7. Mobility
8. Occlusion
9. Deposits
10. Fractured teeth
11. Others (hypoplasia , malposition etc…)

19. ABRASSION
EROSION
ATTRISION

20.  Percussion of tooth indicates inflammation in
PDL due to trauma, sinusitis or PDL disease.
 PERCUSSION OF A TOOTH
1. Tapping over tooth using blunt handle of
mouth mirror
2. Each tooth to be percussed on all surfaces
of tooth.
3. Degree of response to percussion is directly
proportional to degree of inflammation.

22.  Intraoraly of less importance.
 But useful in assessing movement of
tempromandibuar joints.

23.  Clinical examination of tooth is done by using
explorer or a probe.

24.  Periodontal condition can be assessed by
palpation , percussion, mobility of tooth and
probing.
 Periodontal examination shows change in
colour , contour,form,density,level of
attachment and bleeding tendency.

25.  Grade0-physiological mobility.
 Grade 1-faciolingual
 Grade2-faciolingual with mesiodistal
direction.
 Grade3-apical direction

26. 1. Visual changes in tooth surface
2. Tactile sensation while using explorer
3. Radiography
4. Transillumination

27.  Radiograph help to diagnose
tooth related problems like
caries, fracture , root canal
treatment , previous
restorations, abnormal
appearance of pulpal or
periradicular diseases,PDL
diseases etc…
 Uses of radiograph
1. Establishing diagnosis
2. Determining prognosis of
tooth
3. Thickness of PDL
4. Status of lamina dura
5. Lesion associated with toot
6. Status of root canals
7. Obstructions of pulp space

28.  Study casts are used as adjuvant to develop
the proper treatment plan . study cast help in
study of following;
1. To educate patient
2. Occlusal relationship
3. Cross bite
4. Tilted teeth

29.  Most common investigations include;
1. TLC
2. DLC
3. BT
4. CT etc…

30.  This test diagnose both vitality and
pathological status of pulp.
 Various test include;
1. Thermal test
2. Electric pulp testing
3. Test cavity
4. Anaesthesia testing
5. Bite test

31.  Response of pulp to heat and cold
is noted.
 Here patients respond to thermal
stimuli and reports sensation.
 Cold test
 Perfumed using;
1. Spraying with cold air
2. Pellet saturated with ethyl
chloride
3. Dry ice
Heat test
1. Warm air
2. Heated gutta percha stick
3. Deliver warm water

32.  Electric pulp tester is used for evaluation of
condition of pulp by electrical excitations by
neural elements within pulp.

33.  Used when all other methods are
inconclusive.
 Here a cavity within the tooth is made with a
bur without anaesthetized.
 Patient is asked to respond if at all there is
any sensation.
 Sensitivity indicates pulp vitality.

34.  Used when other methods are inconclusive.
 Main objective of this test is to anesthetise a
single tooth at a time until the pain is
eliminated.
 If the pain persist even after tooth has been
fully anaesthetised repeat the procedure to
next tooth.

35.  This test help if patient complaints of pain on
mastication.
 Patient is allowed to bite over the surface of
tooth prick or orangewood stick.
 Sensitivity indicates vital pulp.

36. 1. LASER DOPPLER FLOWMETRY
2. PULP OXIMETRY
3. DUAL WAVELENGTHH
SPECTROPHOTOMETRY
4. MEASURMENT OF TEMPRATURE OF TOOTH
SURFAVE
5. XENON 133
6. GAS DESATURATION
7. ELECTROMAGNETIC FLOWMETRY

39. Consists of many phases;
1. Urgent phase
2. Control phase
3. Holding phase
4. Definitive phase
5. Maintenance phase

40.  Aims in providing relief from symptoms.
 Example incision and drainage of an abscess
for acute irreversible pulpits,

41.  Aims in halting the progress of primary
disease.
 Example-caries or periodontal problem by
removing etiological factors.
 Helps in long term prevention of dental caries

42.  Comes between control phase and definitive
phase.
 Advice patient to have home care habits'
 For example-advice an amalgam restored
patient not to have food with restored part
for 24 hrs.

43.  Regular recall, examination of the patient is
done.
 Helps in prevention of recurrence of the
condition
 Recall visit depends on severity of disease
among various patients.

44.  Includes procedures like endodontic
,orthodontic , periodontic,operative
procedure prior to further treatment.

45. All procedures done from initial to final stage
has to recorded with date.
Maintenance of record is also a legal
document.