How to perform a thorough dental exam
An oral examination on a conscious patient is important, but you are often limited to a visual inspection and digital palpation. This initial examination involves more than just the oral cavity. Be sure to palpate the facial bones and zygomatic arch, temporomandibular joint, salivary glands, and lymph nodes. Also be sure to evaluate the dental occlusion, which can be done by gently retracting the lips to look at the soft tissue, the occlusion (bite), and the buccal aspects of the teeth.Anesthetized examination
If patients have large amounts of calculus on their teeth, you may need to remove these deposits to accurately access the periodontium. Calculus (tartar) is mineralized plaque. Using calculus removal forceps is recommended to remove supragingival calculus, but take care to ensure that the gingiva and tooth crown are not damaged.
Record the amount of calculus and plaque observed on the teeth for future reference before cleaning. The amount of calculus and plaque can be recorded as mild, moderate, or heavy (Figure 1). Because plaque is the soft, gelatinous matrix of bacteria and bacterial by-products that lead to gingival irritation and gingivitis, it may be necessary to use a disclosing agent to visualize. Calculus can only be removed by hand scaling or using a power scaler.
When evaluating the periodontium, you will need a periodontal probe, a dental explorer, and a dental mirror. Evaluate the following seven indices for each tooth in each patient.
The gingival index is a measurement of gingival health. To assess a patient's gingival health, gently place a periodontal probe into the gingival sulcus (the area between the tooth and free gingiva), and guide the probe around the tooth. Score the assessments of gingival changes by using the following criteria: