Diagnosis and clinical examination/ oral surgery courses

Clinical examination,Diagnosis and
Treatment Plan for Complete Denture
Patients
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTS
Introduction
Definition
Communicating with the patient
History taking
Examination
Supplemental diagnostic aids
Treatment plan
Conclusion
References

INTRODUCTION
The goal in clinical examination is to recognize normal
anatomy and physiology, normal variations, and early signs
and symptoms of any disease. A through, comprehensive
examination also allows modification or possible deferment
of treatment when indicated.

Examination: Scrutiny or investigation for the
purpose of making a diagnosis or assessment
-GPT
Diagnosis: The determination of the nature of the
disease- GPT
Treatment plan: The sequence of procedures
planned for the treatment of a patient after
diagnosis-GPT
DefinitionDefinition

Diagnosis is derived from a Greek word
which means
Diag - to know
Osis – condition
“To know a condition”

History taking and
examination

Ask the patient to fill
the medical history form

HAND SHAKEHAND SHAKE

DEAD FISH VICE LIKEDEAD FISH VICE LIKE

Seat the patient in the
dental chair

“we should meet the mind of the
patient before we meet the
mouth of the patient”

Let the patient talk--.the dentist listens

 NameName
 AgeAge
below 40 yearsbelow 40 years
above 40 yearsabove 40 years
 SexSex
malemale
femalefemale

OCCUPATIONOCCUPATION
• socioeconomic statussocioeconomic status
• estheticsesthetics
• phoneticsphonetics
• functionfunction

RACERACE

ADDRESS AND TELEPHONE NOADDRESS AND TELEPHONE NO

Chief complaintChief complaint
MasticationMastication
EstheticsEsthetics
PhoneticsPhonetics
FunctionFunction

Patient expectationsPatient expectations

MEDICAL HISTORYMEDICAL HISTORY
• Cardiovascular diseaseCardiovascular disease
• DiabetesDiabetes
• Respiratory disorderRespiratory disorder
• Rheumatic heart diseaseRheumatic heart disease
• Blood dyscrasiasBlood dyscrasias
• Neurological diseaseNeurological disease
• Skin disordersSkin disorders
• Bone disorder / arthritisBone disorder / arthritis
• Transmissable diseasesTransmissable diseases
• Immune disordersImmune disorders

Chair Side ExaminationChair Side Examination
• Once the patient is seated on the chair the following conditionsOnce the patient is seated on the chair the following conditions
are observed :are observed :
• Mode of breathing (for respiratory disorders).Mode of breathing (for respiratory disorders).
• Pallor (for anaemia).Pallor (for anaemia).
• Edema (for heart disease or renal failure).Edema (for heart disease or renal failure).
• Blood pressure, pulse (for hypertension).Blood pressure, pulse (for hypertension).
• Wide pupils ( Glaucoma )Wide pupils ( Glaucoma )

DRUG HISTORYDRUG HISTORY
• InsulinInsulin
• Anti hypertensiveAnti hypertensive
• Anti anxietyAnti anxiety
• DiureticsDiuretics
• AnticoagulantAnticoagulant
• CorticosteroidsCorticosteroids

• Nutritional statusNutritional status
• HabitsHabits

Patients psychologyPatients psychology
• Philosphical
• Exacting
• Hysterical
• Indifferent

2ndclassification (Freud)2ndclassification (Freud)
1.1. Philosophical ..-understandingPhilosophical ..-understanding
2.2. Indifferent ..no interestIndifferent ..no interest
3.3. Critical ..looking for faultsCritical ..looking for faults
4.4. Skeptical ..unwilling to believeSkeptical ..unwilling to believe

1.Co-operative
2.Apprehensive
3.Unco-operative
Simplest classification-Simplest classification-

DENTAL HISTORYDENTAL HISTORY
• Reasons for loss of teethReasons for loss of teeth
cariescaries
periodontalperiodontal
congenitalcongenital
• Sequence of loss of teethSequence of loss of teeth
anterioranterior
posteriorposterior
• Duration of complete edentulousnessDuration of complete edentulousness

border extensions,
stability,
retention,
esthetics,
the vertical dimension of occlusion,
inter occlusal distance,
phonetics,
Denture hygiene
Para functional habits
occlusion.
If the patient has previous completeIf the patient has previous complete
dentures,examine thedentures,examine the

Previous extraction recordsPrevious extraction records

Examination
extra oral examination

• GaitGait
• Physical deformitiesPhysical deformities

BODY BUILDBODY BUILD
• AesthenicAesthenic-(thin physique)They possess narrow dental arches-(thin physique)They possess narrow dental arches
• PletoricPletoric-(obese) = they possess large square dental arches-(obese) = they possess large square dental arches
• AthleticAthletic -(normal built) = they have normal sized arches-(normal built) = they have normal sized arches

2ndclassification (SHELDON)2ndclassification (SHELDON)
1.1. EndomorphicEndomorphic-(Tall and thin) : they posses large square dental-(Tall and thin) : they posses large square dental
archesarches
2.2. Mesomophic-Mesomophic-(average physique) : they have normal sized(average physique) : they have normal sized
archesarches
3.3. EctomorphicEctomorphic (short and obese)-They possess narrow dental(short and obese)-They possess narrow dental
archesarches

SYMMETRYSYMMETRY

Face formFace form

Williams classification

Face profileFace profile

COMPLEXIONCOMPLEXION

Clinical examination,Diagnosis and
Treatment Plan for Complete Denture
Patients

PERIORAL STRUCTURESPERIORAL STRUCTURES
lip examination:lip examination:
1.1. Lip supportLip support
2.2. Lip thicknessLip thickness
3.3. Lip lengthLip length
4.4. Lip cracking orLip cracking or
fissuringfissuring

1.1. Nasolabial foldNasolabial fold
2.2. PhiltrumPhiltrum
3.3. MuscleMuscle

Examination of the TMJExamination of the TMJ
TendernessTenderness
CrepitusCrepitus
Mandibular movementsMandibular movements

SOFT TISSUES EXAMINATIONSSOFT TISSUES EXAMINATIONS
MUCOSAMUCOSA
ColourColour
ConditionCondition
Thickness of mucosaThickness of mucosa

Thickness of mucosaThickness of mucosa
Class I class I I class I I I

Tongue positionTongue position

Tongue sizeTongue size

FLOOR OF MOUTHFLOOR OF MOUTH

Genial tuberclesGenial tubercles

SALIVASALIVA
• serousserous
• mucousmucous
• xerostomiaxerostomia

MUSCLE ATTACHMENTSMUSCLE ATTACHMENTS

Frenal attachmentsFrenal attachments

Arch formArch form

Arch sizeArch size

Ridge contourRidge contour

Palatal vaultPalatal vault
U shape V shape Flat

SOFT PALATESOFT PALATE

Gag reflexGag reflex

PALATAL THROAT FORMPALATAL THROAT FORM

LATERAL THROAT FORMLATERAL THROAT FORM

RIDGE PARALLELISMRIDGE PARALLELISM

RIDGE RELATIONSHIPRIDGE RELATIONSHIP

INTERRIDGE DISTANCEINTERRIDGE DISTANCE

INTER ARCH SPACEINTER ARCH SPACE

TORITORI

RADIOGRAPHSRADIOGRAPHS

Treatment planTreatment plan
• Elimination of infectionElimination of infection
• Elimination of pathologyElimination of pathology
• Pre-prosthetic surgeryPre-prosthetic surgery
• Tissue conditioningTissue conditioning

Review of literatureReview of literature
Thomas j mc garry n etal gave classification system forThomas j mc garry n etal gave classification system for
complete edentulism. J PROSTHODONT 1999; 8; 1; 27-39complete edentulism. J PROSTHODONT 1999; 8; 1; 27-39

Classification System for the
Completely Edentulous PatientClass I
Class II
Class III
Class IV
Diagnostic Criteria
1. Bone height--mandibular
2. Maxillomandibular
relationship
3. Residual ridge morphology-
maxilla
4. Muscle attachments
Ideal or minimally
compromised
Moderately
compromised
Substantially
compromised
Severely
compromised

conclusionconclusion
““the most important thing you can do for your patient isthe most important thing you can do for your patient is
to make the correct diagnosis.it is the foundation for success .to make the correct diagnosis.it is the foundation for success .
nothing is more critical to success than beginning with anothing is more critical to success than beginning with a
necessary data”necessary data”

REFERENCESREFERENCES
1.1. Complete Denture Prosthetics – John P. SharryComplete Denture Prosthetics – John P. Sharry
2.2. Essentials of complete denture – Sheldon winklerEssentials of complete denture – Sheldon winkler
3.3. Syllabus for Complete Dentures – Charles HeartwellSyllabus for Complete Dentures – Charles Heartwell
4.4. Treatment Planning for Edentulous Patients – BoucherTreatment Planning for Edentulous Patients – Boucher
5.5. Dental clinical of north America vol 40 ; no 1 ; janDental clinical of north America vol 40 ; no 1 ; jan
1996.1996.
6.6. Classification system for complete edentulism.Classification system for complete edentulism.
J PROSTHODONT 1999; 8; 1; 27-39J PROSTHODONT 1999; 8; 1; 27-39

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