CLINICAL EXAMINATION AND

DIAGNOSIS

Dr. Shahzadi Tayyaba Hashmi

shahzadi@inaya.edu.sa

Clinical examination: • It includes both extra oral and intra oral examination

CLINICAL EXAMINATION

Intra oral examination• Hard tissue and soft tissue examination Extra oral examination• Head and neck examination• Face (gross abnormality)• Skin(pallor , pigmentation and cyanosis)• 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)

ORAL EXAMINATION AND DIAGNOSIS

• Following sequence is followed during clinical examinations– Inspection– Palpation– Percussion– Auscultation

ORAL EXAMINATION AND DIAGNOSIS

• Patient should be observed for :– unusual gait and habits (may suggest underlying

systemic disease, drug or alcohol abuse)– Localized swelling,– Presence of bruises,– Abrasions, scars – Signs of trauma– Degree of mouth opening, it should be at least two

fingers

1) INSPECTION

• During intraoral examination, look at the following structures systematically– The buccal, labial and alveolar mucosa– The hard and soft palate– The floor of the mouth and tongue– The retromolar region– The posterior pharyngeal wall

and facial pillars– The salivary gland and orifices

INSPECTION

• Oral hygiene status• Amount and quality of restorative work• Prevalence of caries• Missing tooth• Presence of soft or hard swelling• Periodontal status• Presence of any sinus tracts• Discolored teeth• Tooth wear and facets

INSPECTİON (GENERAL DENTAL STATE)

• Local rise in temperature• Tenderness• Extent of lesion• Induration• Fixation to underlying tissues

PALPATİON

• Percussion gives information about the periodontal status of the tooth

• Percussion of tooth indicates– inflammation in periodontal ligament which could

be due to • Trauma• Sinusitis • PDL disease

PERCUSSİON

• Percussion can be carried out by :• gentle tapping with gloved finger • Blunt handle of mouth mirror• Each tooth should be percussed on all the surfaces of tooth until

the patient is able to localize the tooth with pain. Degree of response to percussion is directly proportional to degree of inflammation

HOW CAN WE DO PERCUSSION?

• Periodontal examination shows change in – color– contour– form– density– level of attachment – bleeding tendency

PERİODONTAL EVALUATİON

• The depth of gingival sulcus is determined by systemic probing using a periodontal probe

• A sulcus depth greater than 3 mm and the sites that bleed upon probing should be recorded in the patient’s chart

• The presence of pocket may indicate periodontal disease

PERİODONTAL EVALUATİON

How can we check the mobility of the tooth:• The mobility of a tooth is tested by placing a

finger or blunt end of the instrument on either side of the crown and pushing it and assessing any movement with other finger

PERİODONTAL EVALUATİON

How to check the mobility of a tooth?

Mobility grades:– Slight (normal)– Moderate mobility within a range of 1 mm.– Extensive movement (more than 1 mm) in mesiodistal or lateral direction

combined with vertical displacement in alveolus• As a general rule, mobility is graded clinically by applying firm pressure with

either two metal instruments or one metal instrument and a gloved finger• Normal mobility Grade I: Slightly more than normal (<0.2mm horizontal

movement)• Grade II :Moderately more than normal (1-2mm horizontal movement)• Grade III: Severe mobility (>2mm horizontal or any vertical movement)

PERİODONTAL EVALUATİON

• Intra orally of less importance• But useful in assessing movement of

Temporomandibular joints

AUSCULTATION