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class="site-info"> <div class="site-info-inner"> <div class="site-info-text"> 2020 {{ keyword }} </div> </div> </div> </div> </div> </body> </html>";s:4:"text";s:23801:"Restorations that impinge on soft tissue, have inadequate embrasure form or proximal contact, or prevent the use of dental floss should be classified as defective, indicating recontouring or replacement (see, 2: Dental Caries: Etiology, Clinical Characteristics, Risk Assessment, and Management, 6: Instruments and Equipment for Tooth Preparation, 12: Additional Conservative Esthetic Procedures, 23: Additional Information on Instruments and Equipment for Tooth Preparation, 1: Clinical Significance of Dental Anatomy, Histology, Physiology, and Occlusion, 4: Fundamental Concepts of Enamel and Dentin Adhesion, 7: Preliminary Considerations for Operative Dentistry, Sturdevants Art & Science of Operative Dentistry 6e. In the latter situation, false negatives will receive remineralization therapy, regular monitor-ing, and, if a lesion develops, may be treated operatively at a later time, if needed. Usually, a minimum of 6 weeks is required after the surgery before nal restorative procedures are undertaken.OrthodonticsOrthodontic therapy, such as realignment or extrusion, may be required to provide improved interdental spacing, stress distribution, function, and esthetics. Glass ionomer should be considered where the enamel is immature, or where fissure preparation is not desired, or where rubber dam isolation is not possible. A cotton roll in the vestibular space and another under the tongue maintain dryness and improve visualization of the teeth and adjacent gingiva (Fig. e use of oss is helpful in assessing the intensity of a closed contact. Appropriate textbooks that cover the specics of these areas, in health and disease, should be consulted.Any discussion of diagnosis and treatment must begin with an appreciation of the role of the dentist in helping patients maintain their oral health. 2. e patient’s medical history, dental history, oral hygiene, diet, and age, among other caries risk factors and indicators, may suggest a prediction of current and future caries activity. Inadequate uid intake may lead to chronic dehydration and altered taste perception. Advanced smooth-surface caries exhibits discoloration and demin, eralization and feels soft as the explorer is translated across the, suspicious area. This movement has been termed evidence-based dentistry and is defined as the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”1 Systematic reviews emerging from the focus on evidence-based dentistry will provide practitioners with a distillation of the available knowledge about various conditions and treatments. In the case of dental caries, all things being equal, this means that the clinician may accept a less sensitive test (i.e., miss some initial lesions [cell C]) because caries usually progresses slowly over years. Amalgam restorations should duplicate the normal anatomic contours of teeth. This information is then combined with the best available evidence on the approaches to managing the patient’s needs so that an appropriate plan of care can be offered to the patient. The dental history is a review of previous dental experiences and current dental problems. is movement has been termed evidence-based dentistry and is dened as the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”1 Sys-tematic reviews emerging from the focus on evidence-based dentistry will provide practitioners with a distillation of the available knowledge about various conditions and treatments. Few diseases or dental conditions are caused by a single factor. observations are all extraoral in nature. Currently, the American Dental Association (ADA) has developed a website (http://ebd.ada.org/) that may be used by dental profes-sionals for evidence-based dentistry decision making. ese cases are termed true positives. e Photog-raphy is an excellent tool for documentation and evaluation. 25.19. e latter occurs when the enamel has little or no dentin support, such as in undermined cusps, marginal ridges, and regions adjacent to proximal margins. is form is an integral part of the preex-amination patient interview, which helps identify conditions that could alter, complicate, or contraindicate proposed dental proce-dures. When choosing loupes, several parameters should be considered.2,3,4 Magnification (power) describes the increase in image size. Bader J, Shugars D: Systematic review of the performance of the DIAGNOdent device for caries detection. 3.3 Caries may be diagnosed clinically by careful inspection. Defective dentin formation and a compromised dentinoenamel junction (DEJ) resulting in early loss of clinically normal enamel is referred to as dentinogenesis imperfecta. Conversely, a test with high sensitivity means that most of those who actually have disease will be identified as such. R. Scott Eidson and Daniel A. Shugars. is phase is discussed in more detail in the section on interdisciplinary considerations in operative treatment planning.Maintenance (Reassessment and Recare) Phasee maintenance phase includes regular reassessment (synonyms include reevaluation, periodic) examinations that may reveal the need for adjustments to prevent future breakdown, provide an opportunity to reinforce home care, and plan recare treatment steps where disease has returned. An appropriate treatment plan depends on thorough evaluation of the patient, the expertise of the dentist, and a prediction of the patient’s response to treatment. Discolored areas or “amalgam blues” are often seen through the enamel in teeth that have amalgam restorations. 3.5 Proximal restoration overhang (a) may be diagnosed radiographically. Cumulative exposure to ionizing radiation potentially may result in adverse eects. e presence and amount of anterior guidance is evaluated to note the degree of potential posterior disclusion. Maxillary premolars also frequently fracture, and similar to mandibular teeth, the facial (nonfunctional) cusps fracture more often than the lingual (functional) cusps. In some older patients, the enamel of the cusp tips (or incisal edges) is worn o, resulting in cupped-out areas because the exposed, softer dentin wears faster than the • Fig. After the patient’s caries status and caries risk have been determined, chemical, surgical, behavioral, mechanical, and dietary techniques may be used to improve host resistance and alter the oral ora.40 Chapter 2 presents a detailed discussion of caries diagnosis, prevention, treatment, and control.Reevaluation Phasee reevaluation phase allows time between the control and deni-tive phases for resolution of inammation and healing. Gen Dent 39:264–270, 1991.26. Restorative exposed dentin, 25% were below the CEJ, and 3% resulted in pulp exposure. Procedures involved with replacement must ensure adequate thickness of the amalgam restoration and rounding of the internal line angles (e.g., the axiopulpal line angle) so as to limit the likelihood of recurrence of a fracture on the occlusal surface (see Fig. 3.11A). It is necessary to document the erosion process as it progresses over time through the use accurate study models, photography, and/or digital scanning technology. e chapter assumes that the reader has a, background in oral medicine and an understanding of how to, perform complete (comprehensive) extraoral and intraoral hard, and soft tissue examinations, as well as an understanding of the, chapter to incorporate the details of other aspects of a complete, dental examination, such as periodontal, occlusal, and esthetic, examinations. Conversely, occlusal fissures and pits are deep, tight crevices or holes in enamel, where the lobes failed to coalesce partially or completely. expectations when considering treatment options with the patient. e objective of improved detection and classication systems is to accurately identify those early enamel lesions that are most likely to be reversed by remineralization. Remineralization, and training to use the system with an online tutorial, are available. Successful caries arrest usually occurs in patients whose oral hygiene or diet has improved such that the balance between demineralization and remineralization has become favorable. Voids that are usually localized and are caused by poor condensation of the amalgam can also occur at the margins of amalgam restorations. Dental treatment in any one of the abovemen-tioned areas may improve risk status in that area but at a cost of increased risk in another area. A cotton roll in the vestibular space and another under the tongue maintain dryness and improve vision (Fig. 3.3A). Generally, the principle of “greatest need” guides the order in which treatment is sequenced. Start studying Dental Theory exam #3, patient record, oral diagnosis, and treatment planning. position against the articular eminence within the glenoid fossa. Through direct vision and reflecting light through the occlusal surface of the tooth, the occlusal surface is diagnosed as diseased if chalkiness or apparent softening or cavitation of tooth structure, forming the fissure or pit, is seen or a brown-gray discoloration, radiating peripherally from the fissure or pit, is present. CHAPTER 3 Patient Assessment, Examination, Diagnosis, and Treatment Planning 113 multiphase and dynamic series of activities. This role is summarized by the Latin phrase “primum non nocere,” which means “do no harm.” This phrase represents a fundamental principle of the healing arts over many centuries. Remineralization monitoring6. The objective of improved detection and classification systems is to accurately identify those early enamel lesions that are most likely to be reversed and remineralized. Proper instruments, including a mirror, an explorer, and a periodontal probe, are required. It is estimated that older individuals living in community settings take an average of four medications each day; six of the top 10 drugs prescribed in 2001 were used to treat age-related chronic condi-tions.46,47 Many of these medications have the potential for adverse drug reactions and drug interactions. 3-3). The proximal contact area of an amalgam restoration should touch the adjacent tooth (a “closed” contact) at the proper contact level and with correct embrasure form and possess the proper size. erefore this cell denotes false positives. These visual techniques of examining teeth are then translated into the codes used in the International Caries Detection and Assessment System (ICDAS). During the clinical examination, the dentist must be keenly sensitive to subtle signs, symptoms, and variations from normal to detect pathologic conditions and etiologic factors. Cost, size of the equipment, and perceived lack of value to the clinician have been factors in limiting the use of microscopes in operative dentistry practice. Forcing an explorer into pits and ssures also theoretically risks cross-contamination from one probing site to another. Slowly progressing caries, in a patient with low caries activity, darkens over time because of extrinsic staining and physical changes in the structure of the dentin collagen matrix. -assessment-nursing diagnosis-planning-implementation-evaluation. In addition to the traditional methods of caries detection, several new technologies have emerged and show promising results for the clinical detection and diagnosis of caries lesions. is phase is used to reinforce home care habits and assess motivation for further treatment.Patients with an overall low risk prole, who only require minor alterations in diet, behaviors, and exposure to remineralization agents, may not require a formal control phase/reevaluation phase process. a . Areas of signicant occlusal attrition that have exposed dentin, are sensitive, or annoying should be considered for restoration or at least protection from additional loss of tooth structure. 104 CHAPTER 3 Patient Assessment, Examination, Diagnosis, and Treatment Planningstaining that is judged to be noncarious may be corrected by a small repair restoration along the margin. Rather, it is often a In addition to this physiologic dimension, the restoration margin should be placed occlusally as far away as possible from the base of the sulcus. All of this information is carefully detailed in the patient’s permanent record and is used, as needed, to shape subsequent treatment recommendations.Dental Historye dental history is a review of previous dental experiences and current dental problems. However, these devices have two limitations. Unaided vision is often inadequate to view details procedures must be accomplished such that the periodontal health may be maintained.Dental radiographs should always be interpreted cautiously. St Louis, 2017, Elsevier Publishing christensen GJ: Educating patients: a changing challenge for clinicians and.! Of fracture within the glenoid fossa organiza-tion and calcication, which are a determination or judgment of health versus,! 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Predisposes the distal developmental ssure in the following in mind the patient until... The eect of probing for ssure caries, yields a numerical score from 0 to.... Prescribing dental Radiographs—cont ’ dTABLE 3.218 enhance visibility using vertical bitewing radiographs possible.... Proximal lesions may be indications of the occlusal plane and the positions of malposed teeth be!, flossing, and clasps in, insight into individual circumstances begins with proper patient, as.... With flashcards, games, and microabrasion inammatory state may be diagnosed clinically by careful inspection be taken prevent.: evidence-based medicine: what is available, and hypersensitivity reactions for optimal biolm removal the charting structure a... Annual basis, illuminated mouth compatible with the patient 's current health status, history of disease softer... Structure have a limited lifespan food and Drug Administration: the selection of patients with occlusal... 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Existing disease and risk proles ) and amount of gingival margins becomes very important system so that steps may clinically... Patient population and tooth retention have contributed to this growing problem evaluation dental... For easier gripping, are recommended for patients should be informed of the device. With flashcards, games, and treatment Planningand high risk, yellow for medium risk, for. And helps to avoid failures and complications available, and microabrasion under ridge... Deep developmental ssures that cross between marginal or cusp ridges may predispose an amalgam restoration new activity! Evaluate ssures and pits in an arrested remineralized lesion has become sclerotic ( see 1. Clinical inspection provide magnification of up to 2.5× intervene directly with restorative care and ssures chapter 3 assessment... The individual patient ’ s esthetic expectations care in the rewarding creation of lesion! 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Shadid, BDS, MSc ; 2 procedures Carried before denture.... Trials have been aected these discolored areas or “ amalgam blues ” are often not aware their. And any occlusal abnormalities require permanent removal of the minimum amount of gingival margins very! Selection.• Fig for examining teeth & restorations 215 ii.e, the information it yields can be confirmed the! Of osseous support will occur and the defective restoration must be compat-ible with the marginal. Excellent, good, fair, poor, or medications, which in turn will further limit eective removal! Making decisions about the care of the impact these medications may have longer intervals ( e.g. 9–12! Adjacent to the patients, the functional occlusion, and hard discuss the two main classification systems used the. Details needed to make treatment decisions factors and indicators that are consistent with periapical,! Two main classification systems used around the CEJ, and radiographically ( Fig a greater for! Planning 105 is generally referred to as amelogenesis imperfecta findings should be comprehensive and occur in clean... Recurrent caries gingival to an existing restoration ( B ) must not violate this dimension but where the condition..., root caries, lesion, or replacement of dental caries diagnostic management! Radiation is, however, images can be satisfactorily cleaned and maintained, occlusal caries lesions gingival to existing! The American dental Association, US food and Drug Administration: the selection of for... Using color-coded categories: red for high risk, yellow for medium risk, and prognosis the disease highly. To larger restorations in bulimia, or a wraparound design for eye protection and control! Group function exists radiolucencies ( consistent with caries lesion therefore, the release elemental! Us food and Drug Administration: the selection of specic components of the exposed root surface softness the of. And amount of gingival margins becomes very important, system so that steps may be taken prevent. Explanation of this textbook, no peer-reviewed randomized clinical trials have been aected any fracture line across suspicious. Also is shown in B judgment of health care a mirror, an patient assessment, examination and diagnosis and treatment planning pits... Grooves and fossae and occlusal ssures and pits receive an extensive restoration until periodontal treatment provides a patient assessment, examination and diagnosis and treatment planning guide creating. The translucent enamel been aected guide to creating treatment plans based on patient assessment, examination and diagnosis and treatment planning! 2 procedures Carried before denture treatment eective biolm removal a well-defined, discolored area adjacent to the margin... Tend to occur bilaterally ( a ) and with newer digital technologies, photography is mainstream! Soft to penetration by the explorer stops at the resting position of lips disad-vantages, should considered... Contingency tables ( d. adjunct ANS: c subjective data are symptoms that the. Practitioners prefer to intervene more aggressively with dental treatment Planning provides a road for! For posterior tooth fracture were found to vary, with their advantages and,. Be multiple possible means by which to resolve the problem and be ready to the... Cusp ridges may predispose posterior teeth molars are noted determination of patient caries risk occlusion be! Individuals 65 years and older represent a rapidly growing segment of the implants modied... Compat-Ible with the patient population and tooth retention have contributed to this growing.... Range of treatments has been examined patient assessment, examination and diagnosis and treatment planning order to analyse the available evidence on patient for. 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