Thepresenceofworndentition,especiallywornanterior.docVIP

Glenn E. DuPont, D.D.S.  THE EXAMINATION PROCESS There are seven essential steps in a complete examination. 1. The patient interview. Take time to develop a relationship that makes your patient comfortable with you as a person. (a) Review the medical history (b) Chief complaint (c) Esthetic concerns (d) Anything else? 2. TMJ screening history and examination. Muscle examination, movements, and joint examination are essential. You must verify centric relation or adapted centric posture before you can analyze the occlusion. Load testing is an essential step. If you can’t load without any sign of tenderness or tension, you must find out why. Classify every TMJ (Piper classification). 3. Soft tissue exam. Examine the orofacial structures for any abnormalities. Do a cancer screening exam. 4. Occlusal evaluation. After determining that the TMJs are OK, evaluate occlusal relationship. Look for signs of occlusal disease. Classify occlusion (Dawson classification) and note it in the record. 5. Teeth. Note that the teeth are one of the last things you examine. Now you can relate any signs of instability to occlusal factors or periodontal factors. If a tooth is loose or worn, show the patient how it interferes with jaw closure in centric or in excursions. Point out overhangs on margins and relate them to swollen gums. Let the patient see what you see. Then help the patient to understand that there is a problem. Show decay, cracks, abfractions, and defective restorations so the patient clearly sees and understands each problem that is present. 6. Supporting structures. Do complete perio evaluation. Examine sulcular depth and evaluate access for clean ability on every tooth. Patient should watch in mirror or on video screen as you point out every problem. Be sure to start perio exam by showing what healthy tissue looks like and what normal sulcus depth is. Make this part of the exam particularly informative. 7. Photos and rad