What+assessments+are+needed+to+provide+a+clinical+diagnosis

=What Assessments are Needed to Provide A Clinical Diagnosis? =   >> maximum opening  
 * **Review medical history:** This is done to see if there are any dental issues that the patient might have that they might not remember to tell the clinician, the medical history also helps the clinician to see if there are any systemic diseases or symptoms that may suggest that the pt. might have a disease or condition that they might not be aware of. Knowledge of the pts. diseases and conditions helps the clinician to formulate a treatment plan that is appropriate for the pts. specific needs.
 * **Extraoral and intraoral exam**: This also helps the clinician to find any possible abnormalities, conditions, or disease that the patient might not be aware of.
 * **Gingival description**: This helps the clinician to begin to evaluate the condition of the patient's. oral cavity and to give the clinician valuable clinical information that they can use in conjunction with the other assessments to properly assess what the patient's habits might be, what condition the oral cavity is in, as well as what is going on in the oral cavity and where treatment is needed the most. We assess the free gingiva and the attached gingiva and provide statements regarding the entire mouth (generalized) and localized areas of the mouth.
 * **Facial profile:** This helps the clinician to determine if the patients profile is contributing to the patients occlusion or TMJ problems.
 * Mesognathic: straight profile with slightly protruded jaw
 * Prognathic: prominent protruded mandible and concave profile
 * Retrognathic: prominent maxilla and convex profile
 * **Angles classification:** This also helps the clinician determine if the patient's occlusion is contributing to the wearing of the patient's teeth of TMJ problems.
 * Class I: neutrocclusion or malocclusion with a mesognathic profile
 * Class II, Division I: the mandible is retruded and all maxillary incisors are protruded with a retrognathic profile
 * Class II, Division II: the mandible is retruded and one or more maxillary incisors are retruded with a retrognathic profile
 * Class III: the mandible and lower lip are prominent and a prognathic profile.
 * Also note if there is a crossbite, edge-to-edge bite, end-to-end bite, open bite, underjet, overjet, and overbite.
 * **Marginal bleeding index:** This can be abbreviated as MBI. This is done to help the clinician to see areas in the patient's gingival tissue that are affected by acute inflammation. At Riverside Community College Dental Hygiene Clinic, our goal is to have the MBI under 10%.
 * **Bleeding upon probing:** This can be abbreviated as BOP. This is an assessment done to calculate the percentage of bleeding while manipulating the tissue during probing, or measuring the depth to the gingival sulcus. Bleeding upon probing is related to the persistent presence of plaque on the teeth and is regarded as a sign of inflammation. BOP is traditionally done using the periodontal probe and it indicates inflammation and destruction of the periodontal tissues. Clinical evaluation of BOP includes assessment of the redness and swelling of the gingiva. At Riverside Community College Dental Hygiene Clinic, our goal is to have the BOP under 10%.
 * **Recession**: associated with age and can be localized on one tooth or extend to a variety of teeth. Recession can be caused by gingival abrasion related to faulty tooth brushing technique, malposition of the teeth (rotated, tilted or displaced), gingival inflammation, or may be due to abnormal frenum attachment.
 * **Abfraction:** typically appears as a wedge-shaped lesion at the cervical areas of teeth. These lesions may be from fatigue, fracture, and deformation of tooth structure as the result of biomechanical forces on the teeth.
 * **Abrasion:** is the pathological wearing of tooth structure that results from a repetitive mechanical habit. It is most commonly seen in exposed root surfaces because the cementum and dentin are not as hard as enamel. It is usually a notching of the tooth surface in areas of gingival recession and may occur from improper tooth brushing or the use of an abrasive dentifrice or hard toothbrush.
 * **Attrition:** is the wearing of tooth structure during mastication and occurs as the pt. ages. It involves the incisal, occlusal and proximal surfaces of the teeth.
 * **Erosion:** is the loss of tooth structure resulting from chemical action. The area of erosion appears smooth and polished and is usually extensive and involves many teeth.
 * **Attachment levels:** Use the probe to measure from the free gingival margin to the MGJ by placing the probe on the external surface pf the gingiva. Next subtract pocket from the total width of gingival and this will give your attached gingiva.
 * **Mobility:** can occur with loss of periodontal ligament, bone support or trauma and can vary throughout the day depending on the stress and diet of the patient. Mobility Classifications: + slight mobility, Class I- 1mm or less of movement, Class II- less than 2 mm of horizontal movement, Class III- more than 2mm of horizontal or vertical movement.
 * **Mucogingival defects:** absence or reduction in attached gingiva where the probing depth reaches and may even extend beyond the mucogingival junction resulting in less than 1mm of attached gingiva.
 * **Fremitus:**
 * Class I: mild vibration or movement detected
 * Class II: easily palpable vibration but no visible movement
 * Class III: movement that is clearly visible
 * **Furcations:** the location on a multi-rooted tooth where the root base divides into separate roots.
 * Class I: detectable with an explorer but the interradicular bone is intact
 * Class II: can access furcation in varying depth but not completely through to the opposite side of the tooth. May be evident on radiograph.
 * Class III: complete loss of interradicular bone so that you can completely get your explorer from one side of the furcation to the other side. May be evident on radiograph.
 * Class IV: Loss of attachment and gingival recession making the furcation clearly visible on clinical examination. Evident on radiograph.
 * **Restorations:** Chart all restorations including amalgams, composites, sealants, veneers, PFMs, gold crowns and any other fixed or removable prosthesis that may be present.
 * **ADA & AAP**: Used to determine periodontal classification. This information defines how involved the patient is including bone loss, furcation involved areas, recession areas. The classification is determined by evaluating the patient clinically and radiographically.
 * **Calculus code:** RCC Calculus code includes light: Less than 25% of teeth with grainy, subgingival calculus and/or localized spurs of subgingival calculus. This is a full mouth classification, light/medium: Grainy subgingival calculus on 25% of teeth with the possibility of localized spurs of subgingival calculus. medium: Minimum of 50% of teeth have subgingival spurs or ledges of subgingival calculus that is mainly interproximal.This is a per quadrant classification. medium/heavy: 50% or more of teeth have subgingival ledges that wrap aroundline angles. This is a per quadrant classification and heavy:75% of teeth have rings of calculus that wrap around the entire tooth. This is a per quadrant classification.