9

PRELEMINARY

MEDICAL, DENTAL HISTORY AND CLINICAL EXAMINATION

1. Medical and dental history.

2. Inspection.
3. Palpation.
4. Auscultation-
5. Exploration.
6. Radiographs.
.
7. Percussion.
8. Transillumination.
9. Vitality test.
10. Study cast.
11. Laboratory test.
12. Photography
The Examination Methods:


Medical history
It helps to alter or modify the treatment plan in accordance to the child’s systemic condition.

It’s started from pregnancy

1. during pregnancy
2. during birth
3. during infancy

Nutritional disorders

Drugs history: Teratogens may cause abnormal development of the fetus and some drugs like tetracycline may cause discoloration of the teeth.
Diseases: Viral infections are said to cause cleft lip or palate. German measles during first trimester may result in cleft lip and cleft palate.

It includes history of the mother during her pregnancy period and includes about:

Accidents/trauma:
Trauma may result in orofacial deformity, due to damage to the growth centers.
Abnormal fetal position may result in abnormal pressure on some part of the face leading to facial asymmetry.

Injury to the temporomandibular joint

at the time of birth such as may occur during forceps delivery can affect growth of the condyle and, in turn, the mandible.


It includes the time at birth

Cyanosis at birth may indicate congenital cardiac defect.

Rh incompatibility that may lead to erythroblastosis fetalis.

type and duration of feeding

habits, nutritional disturbances.
Trauma

childhood diseases

History of immunization.

History of the early infant period of the child

The history briefly includes:
recent hospitalization or medication:

Drug

allergy: Children normally tend to be more allergic to drugs, food items, etc. than adults and it suppresses as they grow.

When there is an acute or chronic systemic disease or anomaly:

dentist should consult the child’s physician to learn the status of the condition, long range prognosis and the current drug therapy.

Treatment must be

postponed

if the patient is suffering from acute illness such as mumps, chicken pox, etc.

recording the
frequency,
intensity,
duration
of the habits such as finger/thumb sucking, nail biting/lip biting, tongue thrusting, bruxism, mouth breathing, etc.

habits

This will help us during management of the child's behavior during the procedure.
History of psychological problems


Brushing:
Number of times and
method of brushing.

History regarding’ brushing the teeth is very important especially in children less than 5 years.

history related to the maintenance of oral hygiene.

Brush: Type of brush and how often it is changed.

Other oral hygiene aids used like flossing, rinses, etc.

Ideal method would be to record a full diet history in a week

It is possible to determine whether an individual’s growth is progressing normally or abnormally by comparing his/hers height and weight with the standard height and weight chart.
A brief survey of the entire body

History of rhinitis,

repeated cold,
adenoidectomy,
and tonsillectomy

persisting nasal obstruction before undertaking orthodontic treatment with appliance.

should be carefully examined for evidence of

Dentist should be alert to identify

Potential communicable infections conditions that threaten the health of the patient and others as well.

Then it is advisable to postpone nonemergency dental care.

Infectious diseases in the family such as tuberculosis should be carefully dealt with.

• Patients with cardiac defects should be referred to a pediatrician.

Antibiotic prophylaxis must be given prior to any treatment to minimize the risk of development of subacute bacterial endocarditis (SABE).

During anticoagulant therapy, adjustment of anticoagulant dosage may be required.

Drug allergy or interactions

Extra-oral examinations

Notice the skin of the patient in the face and neck

Figure shows a Lesion on forehead above left eyebrow is caused by ringworm infection. Several fungal species may cause the lesions on various areas of the body.
The dentist may identify lesions on the head, face, or neck of a patient during a routine clinical examination.

Figure shows: Characteristic lesions of impetigo

(A) on the lower face
(B) on the right ear
These lesions occur on various skin surfaces, but the dentist is most likely to encounter them on upper body areas.
The infections are of bacterial (usually
streptococcal) origin and generally require antibiotic therapy for control.
The child often spreads the infection by scratching
the lesions.

Notice the hair

Figure shows: Evidence of head lice infestation.
Usually the insects are not seen, but their eggs, or nits, cling to hair filaments until they hatch.







Figure A and B, Observation and palpation of temporomandibular joint function. C and D, Palpation of the neck and submandibular areas.

Intra-oral examination

Inspection and palpation


Figure : Inspection and palpation of (A), the buccal tissues (B), the lips and (C) the floor of the mouth

Examine all the soft tissue including

All oral mucosa
Palate
Floor of the mouth
Cheeks
Tongue
Gingivae around all teeth
Soft tissue examination


All the surfaces of the teeth should be examined
Record all lesions you can see
Caries
Anomalies
Traumatized teeth
Defective fillings
Dental examination

Primary teeth

The upper right quadrant starts 51
The upper left quadrant starts 61
The lower left quadrant starts 71
The lower right quadrant starts 81
Permanent teeth
The upper right quadrant starts 11
The upper left quadrant starts 21
The lower left quadrant starts 31
The lower right quadrant starts 41

UNIFORM DENTAL RECORDING

When indicated, radiographic examination for children must be completed before the comprehensive oral health care plan can be developed,

RADIOGRAPHIC EXAMINATION

because of trauma,

toothache,

suspected developmental disturbances,

proximal caries.

Carious lesions appear smaller on radiographs than they actually are
Radiograph needed

dental care for children has been designed primarily to

prevent oral pain and infection,
the occurrence and progress of dental caries, the premature loss of primary teeth, the loss of arch length,
and the development of an association between fear and dental care
EARLY EXAMINATION

The goals

of pediatric dental care therefore are primarily preventive.
The dentist’s opportunity to conduct an initial
oral examination and parental consultation during the patient’s infancy is a key element in achieving and maintaining these goals.
1. discuss with expectant mothers the importance of good nutrition during pregnancy and practices that can influence the expected child’s general and dental health.


• inquire about medication that the expectant mother is taking.
• It is known that the prolonged ingestion of tetracyclines may result in discolored,
pigmented, and even hypoplastic primary teeth.

3. The expectant mother should be encouraged to visit her dentist and to have all carious lesions restored.

The presence of active dental caries and accompanying high levels of Streptococcus mutans can lead to transmission by the mother to the infant and may be responsible for the development of carious lesions at a very early age (early childhood caries)

Dentistry guidelines on infant oral health care include the following recommendations:

1. All primary health care professionals who serve mothers and infants should provide parent/caregiver education on the etiology and prevention of early childhood caries (ECC).
INFANT DENTAL CARE

2. The infectious and transmissible nature of bacteria that cause ECC.

3. Every infant should receive an oral health risk assessment from his or her primary health care provider or qualified health care professional by 6 months of age.

4. Parents or caregivers should establish a dental home for infants by 12 months of age.

5. Health care professionals and all who participated in children’s health should support the identification of a dental home for all infants at 12 months of age.


Thus it is appropriate for a dentist to perform an oral examination for an infant of any age, even a newborn, and an examination is recommended anytime the parent or physician calls with questions concerning the appearance of an infant’s oral tissues. Even when there are no complain

It is not always necessary to conduct the infant oral examination in the dental operatory, but it should take place where there is adequate light for a visual examination.

The dentist may find it convenient to conduct the examination in the private consultation room during the initial meeting with the child and the parents.
Where to examine the infant

The oral examination of the infant starts from 6 months of age

Figure A, One method of positioning a child for an oral examination in a small, private consultation area. The dental assistant is nearby to record findings
B, If space allows three people to sit in a row, this method may be used to make it easier for the dental assistant to hear the findings dictated by the dentist. The dental assistant also helps restrain the child’s legs.

Drug abuse problems interact directly with the dental care of a patient.

Obtaining and maintaining a satisfactory history is important.


It is also important to know if the patient is taking drugs at the time of the dental visit because there could be an interaction with drugs, such as nitrous oxide, that may be given in the dental office.
If the patient is under the influence of an abused substance, dental treatment should be postponed until a time when the patient is not “high.”
DETECTION OF SUBSTANCE ABUSE

a. Physical.

Intentional, not accidental.

Common injuries include bruises, welts, lacerations, burns, and fractures.

50% of physical abuse is in the craniofacial
region.

25% of physical abuse is in the oral region.

Types.

b. Emotional

(1) Dificult to identify a causal link between
parental behaviors and harm to the child.

Examples of emotional abuse include denial

of affection, isolation, extreme threats, and
corruption.


c. Neglect.
Generally defend as willful negligence to provide for the basic needs of a child, such as
food, shelter, clothing, medical care, supervision, protection, and guidance.

Defnition from the AAPD—

“willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.”

All too often a patient’s initial dental appointment is prompted by an emergency situation.

the emergency appointment tends to focus on and resolve

a single problem or a single set of related problems

Once the emergency problem is under control, the dentist should offer comprehensive services to the patient or parents.
EMERGENCY DENTAL TREATMENT