CLINICAL EXAMINATION
AND
RADIOGRAPHIC INTERPRETATION
LEARNING OBJECTIVE:
1. That the student will understand the need for an efficient clinical and radiographic
examination
process that allows for the collection of clinically relevant information
key concepts:
correlation with
process, efficiency, relevance, diagnosis, complexity,
historical findings
1. THE CLINICAL EXAMINATION
A systematic approach is very useful. If one performs the same steps in the same
order, EVERY TIME, one is much less likely to forget a step and miss something.
Particular attention to a specific area (eg. a tongue ulcer) is integrated into your
habitual, systematic examination routine. The examination requires palpation as well
as retraction and inspection ............... it is a hands on process.
General Appearance (general health)
robust .vs. feeble
disability:
colour:
anxiety:
children
distress:
vitals:
eg. wheelchair bound
flushed, pale, cyanotic
level of, management, issue especially with
from pain, anxiety, etc.
BP, pulse, respirations
General Head & Neck
neck stiffness:
arthritis, muscle spasm, deformity
Extra-Oral
jaw alignment:
TMJ:
muscles of mastications:
muscles of facial expression:
lymph nodes:
skin of the face:
lips:
retro .vs. prog .vs. orthognathic
clicks, pops, trismus
muscle spasm, trismus
Bell's palsy
swelling, tenderness, mobile .vs. fixed
swelling, colour, induration, tenderness
actinic change, Herpes, angular cheilitis
Intra-Oral
general appearance:
difficulty
oral hygiene:
preservation
state of restoration:
mucosal surfaces:
yellow
gingiva:
the tooth in question:
number of teeth (intact .vs. mutilated dentition)
Angle classification: Class I, II, III
spacing / crowding: surgical or restorative
amount of potential surgical site contaminant
an indication of the patient's interest in
open carious lesions
broken restorations
an indication of the patient's dental experiences
ulcerations, discolouration: white, red, purple,
inflammation: localized .vs. generalized
recession: periodontal disease
caries: will tooth fracture during extraction
restorations: likelihood of filling
fracture....aspiration
technique
forceps only
angulation: access and path of withdrawal
condition of the teeth adjacent: access, choice of
and instrumentation ... elevators or
2. THE RADIOGRAPHIC EXAMINATION
In the usual clinical situation, the clinician orders the appropriate films and then
correlates the radiographic information with the history and the clinical examination.
The radiographic is also systematic, starting with a critique of the film(s) and
proceeding from general to specific.
radiograph:
oblique,
normal anatomy:
mental foramen
adjacent teeth:
disease,
tooth in question:
fracture
type: extra .vs. intraoral, panoramic, lateral
periapical
quality: exposure, focus, contrast, area examined
date: recent .vs. outdated
context and orientation
sinus floor, nasal floor, mandibular canal,
caries, restorations, endodontics, periodontal
root proximity
caries: occlusal, interproximal, root
size: proximity to pulp
restorations: crowns, large amalgams
endodontics: brittleness and tendency for
isolated
periapical radiolucency,
root number:
root morphology:
dilacerated
impactions:
adjacent tooth
periodontal disease: bone height & density,
pockets, furcation involvement,
perio-periapical combination
one .vs. two .vs. three .vs. more
slender, tapered, bulbous, straight, curved,
hypercementosis, ankylosis
depth: level of crown, neck, root or apex of
angle: upright, mesio or disto angular, horizontal
proximity of adjacent crown, root or apex
amount of overlying bone: posterior mandible or
ramus
threat to normal structures:
tuberosity
mandibular canal, mental foramen, sinus floor,
In all cases, the clinician should correlate the clinical and radiographic information
with the information gathered in the history taking process. In most cases, the
findings of the clinical or radiographic examination will confirm or support the initial
differential diagnosis established during history taking.