ABCD’S & G

ABCD’S & G

Outlines• Introduction • Technique and material• Visual inspection• Detection of caries• Treatment planning considerations• Detection of pulpal disease• Mobility testing• Evaluation of the occlusion • Diagnostic casts• Radiographs• Recording of finding • References

Introduction

• Each individual tooth had specific important function within the dentition .Although each tooth is susceptible to variety of diseases

• One must consider Not only how to treat the individual tooth but also how that treatment will affect the entire person

Techniques and Materials

Tools 1) Basic tools

Con.1) Additional tools

Con.

-Radiograph and diagnostic casts are additional aids used to make a final diagnosis

Visual inspection 

• The systematic observation of entire dentition as a unit can be performed with a dental mirror and a good light source

• ( It should begin prior any thing ) Why?

To note the level of home care

• Information we need to know

Con.

• The normal adult dentition consist of 32 teeth , each of which has a characteristic shape , color , location and position in the arch and a specific eruption pattern

• It is neither possible nor necessary to be able to recall the name of all possible pathologic condition or variations of normal

The important thing is : • Have a fundamental knowledge of what is normal

NOTE:Con.

Inflammation

• The distribution of plaque and inflammation of gingiva may provide several clues !

IF ..• Generalized Patient home care and / or dental

awareneces may need to be addressed

Inflammation

• Loclaized May Be Existing Caries Or Of A Tooth That Is Out Of Its Normal Alignment ..SO.. Has Surfaces That Are Difficult To Reach With Normal Home Care.

If There Restoration !May Be Loclaized Gingivitis Due To : Deficiency In Contact Overhanging Restoration Recurrent Caries

Caries pattern

Con.

Missing teeth

Con.

Size, Color and Structural changes

Detection of caries

Con.The examiner must follow a routine from patient to patient to ensure that areas are not overlooked why?

Because it is necessary to record a large amount of information , the routine usually follow the record system used

Probing

Is the use of an explorer or probe to detect the caries or any abnormality the tooth surface .

Con.

1. Pits and fissure caries

• Detected with sharp explorer that is pressed into the pit perpendicular to the occlusal plane .

• Carious tooth structures is not displaced , and its leathery elasticity causes the explorer to meet resistance on being withdrawn .

Con.• Use the 3rd to the 4th finger as a fulcrum rest near the

tooth examined , helps one to exert enough pressure without losing control

Sings of decay

Con.

Con.

Radiographic examination :

2. Smooth surface caries on buccal or lingual

surfaces : -Begins with white decalcification in the enamel along cervical margins .

-Dry the surface to be evident .

-These calcification areas may have surface breaks where the enamel has eroded but may still be caries free .

Con.

-Controlling the explorer is especially important in this area because it has tendency to slide over the smooth curved surfaces of the teeth and injure the gingival .

Radiographic examination :

-Are not particularly helpful in visualizing the extent of these lesions .

Con.

3. Root Caries

Con.

Radiographic examination :

Con.

4. Interproximal smooth lesions

-In posterior teeth are difficult to explore because one one must distinguish between the explorer sticking in the caries from the explorer wedged by the contact area .

Radiographic examination :

-Radiographic evidence of caries should be relied on for early lesions .

Con.

-In advanced lesion , a white chalkiness or opalescent discoloration appears beneath the enamel of the marginal ridge and is especially evident with transillumination .

Con.

AND

Transillumination • The technique of

transillumination depends upon placing an intense small spot of light directly on the structure under examination .

• It is not necessary to darken the room completely.

Con.•The transilluminator tip is placed on either the facial or lingual surface of the tooth .

• Direct vision or a dental mirror may be used for viewing.

•Transillumination is helpful to determine interproximal carious and fracture of enamel .

It involves techniques similar to those for detecting a new caries :

Evaluation of recurrent caries

1-Inspection and propping of

restoration margins

2-Transillumination of class III and IV restoration .

3-Radiographs

Pulp Testing :Detecting of pulp

disease 1- Electrical pulp test

Con.

2- Application of heat and ice :

Con.

NOTE:

In early pulpitis pain persists when stimulus has been removed ,but in healthy pulp the sensation disappears within 5 seconds .

Identifying of cracked tooth

Con.

•Biting pressure produce the pain

•Light reflected from various direction maybe used to see the fracture .

Percussion -Tapping the teeth lightly with mirror

handle or pulp testing Response Pain

• Ankylosis can be detected from the sound of percussion

• Positive response to percussion of posterior maxillary teeth my be due to maxillary sinusitis

Con.NOTE:

Mobility testing

• Move the tooth with tow rigid instruments such as mirror handles

• Mobility subjective scale from zero to 3

Con.

Evaluation of occlusion

Static occlusion -Viewed by having the patient place the teeth in maximum intercuspation and to determine the relationship of the first molars or the canines

Con.Calss 1 Class 2 Class 3

Mesial buccal cusp of maxillary first molar rests on the buccal groovge of mandibular first

molar

Mesial buccal cusp of maxillary first molar rests between the mandibular 2nd premolar and 1st molar

Mesial buccal cusp of maxillary first molar rests between mandibular 1st molar and 2nd molar

Normal Abnormal Abnormal

Con.

Functional occlusion

1-Centric occlusion

• Is that position when teeth are intercuspation

• Seen when the patient swallows

2-Centric relation

Is that position of the mandible determined by muscles and ligaments

3-Protrusive excursion

Is achieved when the mandible is protruded

4-Lateral excursion

Is achieved by having the patient begin with the teeth in centric occlusion and moving the jaw laterally to engage the teeth to the side where the jaw is moved

Evaluation of occlusion

• Mounted diagnostic casts

• Articulating paper

• Waxes • Mylar tape

Recording of finding

-A perfect examination of the teeth is meaningless unless the finding are recorded in such a way that the examiner and others to whom the patient may be referred can understand them

Reference

• Oral Diagnosis, Oral Medicine and Treatment Planning

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