• Initial interview and case history
• Clinical Examination
• Behavior assessment
• Emergency examination
• Diagnostic Aids
Initial examination
Objectives
1- First visit, introducing dentistry to the child in a pleasant manner. - familiarize the child and dental staff to each other.
2- Allow the dentist to observe the growth and development of the child.
Objectives of initial examination
3- Detect any abnormality or deviation from normal.
4- Observe the over all health of the child.
5- Provide complete head and neck examination.
6- Evaluate the dental status of the child.
Initial interview and case history ( The patient information and detailed medical and dental history )
a- Personal data including name, age, gender, race….
b- Physician name.
c- Reason of bringing the child- emergency, routine or recall.
d- Chief complaint recorded in parent own words.
e- Previous dental history.
f- Medical history
• Is he being treated by a physician presently?
• Is he taking any medication now?
• Has he ever been hospitalized?
• Child immunization
• Has he had any difficulty in school?
• Relevant health history
i- Allergies
ii- Asthma
iii- Bleeding disorder
iv- Blood transfusion
v- Heart disease
vi- Seizures
g- Family history.
Infectious diseases in the family …tuberculosis
h- Attitude of parents.
i- Social history :
❖ Oral hygiene habits.
❖ Dietary habits.
• j. Prenatal History
• k. Natal History
• l. Postnatal History
2- Clinical Examination
i- General appraisal
a- Gait
b- Speech
c- Hands
d- Height and weight
e- Pulse
f- blood pressure
ii- Extra oral examination
Any deviation from normal with respect to:
a. Symmetry
b. Color
c. Form
d- Surface characteristics
➢ Skin
➢ Eyes
➢ Lips
➢Ears
➢ Regional lymph nodes
➢ TMJ
iii- Intra oral soft tissues
Lips Mucosa Frenum
Floor of the mouth Gingival tissues
iv- Oral Habits
Digit sucking
Tongue thrust
• Mouth breathing
• Nail biting
• Bruxism
v- Facial profile
vi-Occlusion The contact of the maxillary and mandibular teeth and the position of the teeth within the arch.
Primary dentition
• Terminal plan relationship
• Canine relationship
• Overbite
• Overjet
• Midline.
• Amount of spacing.
• Functional irregularities.
Mixed dentition
• First permanent molar relationship
• Canine relationship
• Overbite
• Overjet
• Midline
• Adequacy of arch circumference
• Malalignments
• Functional irregularities
vii- Teeth
➢ Observe size, colour and any malformation in teeth ➢ Individual tooth examination includes :- teeth present , caries, restorations or any pathology
viii-Oral hygiene assessment
Plaque index
3- Behavior assessment
Frankels Behavior Rating Scale
• Definitely negative -Extreme negative
• Negative -Uncooperative
• Positive-Accept treatment but at a time cautious
• Definitely positive- Good rapport, interested, in dental procedure
4- Emergency examination
a. Focus on the site of complaint.
b. Enlist diagnostic aids.
c. Reappointment for a complete examination after alleviating the emergency condition.
5- Diagnostic Aids
1. Radiography
2. Photography
3. Study cast
4. Space analysis
5. Vitality test
6. Laboratory test
Infant oral examination
A. The first dental visit should be within 6 months of eruption.
B. At the first visit:
1. Record a thorough medical and dental history.
2. Complete oral examination.
3. Assess risk of diseases.
4. Provide anticipatory guidance.
Diagnosis and Treatment plan
• Final diagnosis is achieved by analyzing all the available data including the results of investigations.
• Treatment planning is the orderly arrangement of the various treatment needs of the patient to provide maximum benefit to the patient as a whole.
Advantages of treatment planning
a) Re-diagnosis at every visit is avoided.
b) Provide step by step guidelines to follow.
c) Helps the staff plan in advance the materials and equipment for treatment.
d) It provide an estimation of the time of each appointment and its number.
e) Help parents to schedule appointment arrangement.
➢Treatment plan is discussed with the parents and permission taken before performing any treatment on the child.
➢Always discuss three main areas:1. Preventive needs. 2. Restorative needs. 3. Orthodontic evaluation.
Guidelines for treatment plan
1- Minimize the number and the length of appointment.
2- In questionable diagnosis, plan for the more extensive treatment alternative.
3- Use quadrant dentistry.
4- Treat posterior teeth before anterior teeth.