Intraoral examination

Bismillah..

Baru2 ini aku ada post berkaitan dengan  extraoral examination.

Kali ini kita bincang pasal intraoral examination pula..:)

Ada step yang nak kena follow:
mneumonic yg aku buat :SOTO/SOGTO (sebab skg ni tgh raya kan..asyik fikir makan aje la..hehe)

S: Soft tissue
G: gingiva
T: teeth
O: occlusion

Soft tissue

abnormal appearance pada soft tissue ni boleh indicate systemic disease or nutritional deficiency.

mungkin ada juga oral pathology, jadi sgt penting untuk examine palate, throat, cheeks, noting any colour changes, ulceration,swelling
kena check juga kat frenal attachment or tongue tie yg boleh mengganggu speech, chewing and eating.

kena tahu juga impression of salivary flow rate and consistency.

Gingival and periodontal tissue

periodontal disease jarang berlaku kat budak2.

kena take note kalau ada colour changes ke, swelling ke, ulceration ke, spontaneous bleeding ke, atau recession.

kalau ada gingival inflammation in the absence of gross plaque deposits, lateral periodontal abscess, prematurely exfoliating teeth @ mobile permanent teeth- indicate a more serious underlying problem.

during inspection, assessment of cleanliness kena buat, and kena take note presence of any plaque or calculus.

Indices- to provide an objective record of oral cleanliness.

contoh: the oral debris index ( Green and Vermillion index 1964)
perlukan disclosing agent prior to an evaluation of the amount of plaque on selected teeth (1st permanent molar, upper right and lower left central incisor.

scale

0: no debris or stain present

1: soft debris covering not more than 1/3 of tooth surface being examined or the presence of extrinsic stains without debris regardless of surface area covered

2: soft debris covering more than 1/3 but not more than 2/3

3: soft debris covering more than 2/3 of exposed tooth surface.

contoh lain: Gingival Index ( Loe 1967): created untuk assessment of gingival condition and records changes in the gingiva . It scores the marginal and interproximal tissues separately on basis of 0-3

0: normal gingiva
1: mild inflammation: slight change in colour and slight edema but no bleeding on probing.
2: moderate inflammation: redness, edema and glazing, bleeding on probing.
3: severe inflammation: marked redness and edema, ulceration with tendency to spontaneous bleeding.

Specific periodontal probing-   jarang pada young children.kecuali kalau ada specific problem.

Type of examination

Bismillah..

Examination yang dentist selalu buat ada dua.
1.Extraoral (luar mulut) examination
2. Intraoral (dalam mulut) examination

Tapi untuk post kali ini aku nak bincang tentang extraoral examination. Jom kita discover apa yang dentist buat.:)

Extraoral examination terbahagi kepada 4
a. General examination
b. The head and neck
c. Facial examination
d. Speech assessement

a) General examination

Dentist nak tahu child's overall health, development or even habits can often be determined by noting.
-height: kena buat standard growth chart
-weight: ada eating disorder tak/ adakah GA tak berkesan sebab child's obesity/ ada endocrine problem x?
-skin: ada injury x
-Hands

b) The head and neck
-head: note size, shape, facial symmetry
-hair: sparse, quality, quantity
-eyes: ada visual impairment @ abnormality pd sclera x
-ears:
-skin
-muscle of mastication
-Lymph nodes
-Lips

c)Facial examination
-buat ni selalunya as part of orthodontic evaluation
-do the evaluation in three spatial planes: anteroposterior, vertical and transverse

Antero-poterior termasuklah
* description of overall facial pattern
*position of mandible and maxilla
*vertical facial relationship

*position of lips( competent/incompetent)
*facial symmetry and maxillary dental midline is located relative to the facial midline.

Facial profile can be examined by drawing
-Line connecting: Midpoint between eyebrows + base of the nose + lowest point of chin

Facial profile classify into:

*straight profile: in patient with class I occlusion.
*convex profile with retronagthic mandible / protracted maxilla with class II malocclusion
*concave profile: retronagthic maxilla/ protracted mandible with class III malocclusion.

Vertical relation

should be evaluated for the steepness of mandibular angle ( angle between Frankfort and mandibular plane)

a large mandibular angle  indicates- long lower face height ( open anterior bite )

a small angle: short lower face height (deep anterior bite )

Transverse relation

-presence of cross-bite and evident as a deviation in the mandible in some cases

d) Assessment of speech

-assess the ability to talk and pronounce letters properly, no marked lips

-esp pt with: cleft, down syndrome, mentally retarded and deaf patient

 

Dental examination.

Bismillah..

First impression masa jumpa patient tu penting. Dentist boleh tengok reaksi patient bermula daripada first greeting lagi. Dentist boleh lihat physical appearance dgn cara:

-general health: dia nampak sihat ke tak
-overall physical/mental development: dia ni nampak normal tak dgn budak2 yang sebaya dgn dia
-weight: underweight/overweight
-coordination: dia ada abnormal gait atau motor impairment tak
-tgk dia punya rambut, kepala, muka, leher, tangan,
-cold, clammy hands(tangan berpeluh) or bitten fingernails: petanda awal abnormal anxiety
- unusual clean digit : persistent sucking habit.
-clubbing of fingers or bluish colour: congenital heart disease.
-variation in the size, shape,symmetry or function of head and neck structures sbb boleh indicate syndrome lain.

Dentist pun kena buat unofficial assesment dari segi cooperation of the patient itself.

Category of prospective young patients..

1) Happy and confident

2) A little anxious or shy but displaying some rapport with dental team.
-boleh je buat rawatan selepas dipujuk

3) A very frightened, crying, clutching their parent, avoiding eye contact or not responding to direct questions.
- susah untuk terima conventional treatment..kena pujuk lagi.

4) severe behavioural problem or learning disability
-kena guna sedation atau general anesthesia

Techniques of examination of children

 infant and toddlers ( less than 2 years)
- dentist and parent are seated face to face with their knees touching (knee-to-knee position)
-Their upper arms dijadikan examination table utk child
-the child's leg straddle the parents' body, which allow the parent to restrain the child legs and hands.

young children ( 2-6 years)
-parents sit in the dental chair and the child lies across her or his lap. The child's head positioned in the parents arm

older children ( >6 years)
-child sit on the dental chair

What should dentist do during first meeting with patient?

Bismillah

First and foremost dentist should ask about their patients' history

What are the component of history?
1) Chief complaint
-the reason patient comes to the clinic
(routine checkups, referral, toothache pain, aesthethic,swelling)

2) History of chief complaint
-if the chief complaint was pain, then you should know these information about the pain
( location, onset, duration,, nature, frequency, aggravating factors, relieving factors, awake from sleep, day or night, severity, radiation to other parts, temperature.

3)Medical history: systemic review.

a- CVS;congenital heart disease, risk of bacterial endocarditis.
b- respiratory; asthma, hay fever, infections
c- Hematological; anemia, bleeding, bruising
d- Gastrointestinal; hepatitis, jaundice
e- endocrine; diabetes
f- CNS; epilepsy, mental and physical handicap
g- urogenital; renal disease
h- skin; thin, fragile.

Dentist need to check:

*immunization
*medication
*hospitalization
*allergies (allergy for latex (rubber material)

Dentist need to know the birth details of the patient

Prenatal
-Mum health during pregnancy
-any complication, trauma, infection, drugs taken
-gestational age (premature birth)
-delivery (oxygen deprivation)

Neonatal
-Birth weight, height and defect
-jaundice
-rhesus
-incompatibility

Perinatal/postnatal
-bottle or breast fed, bottle content
-immunization
-childhood illnesses


Dentist must know about:
# growth: height, weight, growth charts
#family history

Dental History, social history, behaviour

Sayangilah dr gigi sejak dari kecil ;)

Bismiillah...

 Dalam pergigian sendiri ada satu bidang khusus yang memang fokus pada bayi dan kanak2. Nama bidang ini pediatric. Kebanyakan orang perempuan suka pada bidang ini tapi mungkin tidak bagi aku..hee..aku tak berapa minat layan budak2. Mungkin sebab aku anak bongsu kot..

kaitan? haha

Walau pediatric ini bukanlah bidang aku, tapi kena kuasai juga ilmu Allah ini. Kena ikhlaskan hati :)

Soalan cliche:
Bila sepatutnya kanak2 dibawa jumpa dentist?
> apabila bdk itu dah tumbuh gigi pertamanya. Kebiasaannya umur 6-7 bulan tu dah tumbuh gigi pertama.

Kebanyakan ibu bapa tidak tahu akan fakta ini. Atau mungkin mereka tahu cuma tidak tahu apa kepentingan untuk jumpa dgn dentist. Dengan kata lain, kurangnya kesedaran dalam kalangan masyarakat tentang penjagaan gigi sejak dari kecil. Aku juga tidak tahu tentang perkara ini sebenarnya tetapi bila aku mendalami bidang ini baru aku tahu betapa pentingnya untuk jaga gigi sejak bayi.

Jadi, kenapa mesti jumpa dentist seawal usia 6 bulan?

Secara umum, aku lihat ini adalah salah satu langkah pencegahan. Pencegahan lebih baik daripada mengubati kan? Kerana kondisi gigi kita tidak sama untuk setiap orang. Ada kecacatan gigi yang boleh kita betulkan sejak bayi. Jadi, ia tidak memerlukan kos yang banyak pun untuk mencegah berbanding merawat. Dentist boleh merancang rawatan awal untuk mengatasi masalah tersebut.

Sebagai contoh, kebanyakan rahang (jaw) orang Asia kecil dan bergigi besar. Jadi kemungkinan untuk gigi bertindih (crowding) itu sangat lah tinggi. Sekiranya perkara ini dirujuk sejak daripada bayi, dentist ada cara untuk mencegah masalah ini tanpa perlu menelan kos yang tinggi. Tetapi jika perkara ini dibiarkan sehingga kanak2 itu meningkat dewasa, maka ia perlu untuk memakai braces. Memakai braces pula memerlukan sekurang-kurangnya 5k dalam tangan. Mungkin kalau pergi ke klinik kerajaan boleh dapat harga yang lebih murah, tetapi perlu tunggu giliran untuk tempoh masa yang panjang. Takut2 jika terlambat nanti, akan menyebabkan berlakunya masalah yang lain pula.

kebaikan untuk kanak2
> memperkenalkan kanak2 dengan dunia penjagaan gigi
>membina hubungan dengan kanak2 dengan bertanya soalan (history) secara direct.
>untuk mengurangkan rasa takut pesakit kepada prosedur dentist dengan memulakan rawatan yang mudah
>sebagai motivasi buat kanak2 dengan memupuk sikap positif pada dental care.

kebaikan untuk ibu bapa
> membina hubungan yang baik dengan ibu bapa
> sebagai emotional support pada pesakit.
> success rate yang meningkat.

kebaikan untuk dentist
> untuk diagnose dan merancang rawatan yang terbaik untuk pesakit.