L1 Mouth Examination - 221017 - 115536

Pedodontics Dr.
Sheren Sameer
5th stage
Lec. 1
Examination of the Mouth and Other Relevant Structures

A good diagnosis should evaluate all the aspects of a child's appearance
and behavior before arriving at any conclusions concerning his oral
condition.
From the moment a child walks into the office for the first time, until the
termination of his appointment, the clinician can elicit a great deal of
pertinent information. The gait and stance of the child may be an
indication of medical problems, as may be his complexion, hair, and other
physical features. It is important to get into the habit of always noting
these obvious physical characteristics before narrowing down to the area
of particular Interest to the dentist, which is the oral cavity. Such
evaluation is not necessarily time-consuming if the observer is perceptive.
A dentist is traditionally taught to perform a complete oral examination of
the patient and to develop a treatment plan based on the examination
findings.
The dentist then makes a case presentation to the patient or parents,
outlining the recommended course of treatment.
This process should include the development and presentation of a
prevention plan that outlines an ongoing comprehensive oral health care
program for the patient and establishment of the “dental home.”
Question: At what age the recommended first examination for the child
can be done?
The first examination for the child be done at the time of the eruption of
the first tooth and no later than 12 months of age.
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Pedodontics Dr. Sheren Sameer
5th stage
Early detection and management of oral conditions can improve oral
health and, in turn, the general health and well-being of the child.
Obtaining accurate data in a child is very difficult. The reasons may

be any of the following:
1) Most of the times, it is the parent or the guardian who will be
providing the required data about the child and not the child himself
or herself.
2) It is impossible to observe everything a child does or says and make
accurate records of what goes on.
3) Most children do not behave in the dental clinic the same way as
they do at home or with their friends or teachers.
4) Data reported by parents and teacher may be inaccurate.
5) Information provided by parents or guardians is dependable on their
emotional maturity.
6) Unless reports are made immediately after the observation, the
parents may forget to mention minor yet important findings.
7) There may be a deliberate distortion by the observer to show the
child or the parent in a favorable light
 The history facilitates the diagnosis of many conditions, even before

the hands-on examination. Because there are often specific
questions pertinent to a child’s medical history that will be relevant
to their management, it is desirable that parents be present.
 The successful practice of pediatric dentistry is not merely the
completion of any operative procedure but also ensuring a positive
dental outcome for the future oral health behavior of that individual
and family.
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5th stage
Treatment planning:
Treatment planning is the orderly or sequentially arrangement of the
various treatment needs of the patient to provide maximum benefit to the
patient as a whole.
The plan should include recommendations designed to correct existing
oral problems (or halt their progression) and to prevent anticipated future
problems.
It is essential to obtain all relevant patient and family information, to
secure parental consent, and to perform a complete examination before
embarking on this comprehensive oral health care program for the
pediatric patient. Anticipatory guidance is the term that often used to
describe the discussion and implementation of such a plan with the patient
and/ or parents.
Advantages of Treatment Planning
1) Avoiding the re-diagnosis at every visit.
2) Give serial appointments on the first day as the patient' s treatment
needs that are already planned in a sequential order (step-by -step
guideline).
3) Instruments can be prepared well in advance before the patient's
arrival for the treatment.
4) Estimation of the time and no. of appointments required as well as
the total fee.
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5th stage
Treatment plan must be discussed with the parents and permission taken
before performing any treatment on the child.
The followings information must be taken:
 Dental need of their child including the treatment as well as the
preventive measures.
 Amount of time required to perform the treatment and the total cost.
Treatment planning may be modified during the procedure based on

the following:
1) Estimation of cooperation from the patient and parents.
2) Assessment of the condition of the teeth and the oral hygiene.
3) Whether extraction is needed or not.
4) Nature of tooth movement and type of appliance required.
THE DIAGNOSTIC METHOD

A thorough history, detailed examination and an accurate diagnosis, all
of them are very essential for successful outcome of any treatment.
Diagnosis and treatment planning thus includes assembling all the
relevant facts obtained through history and examinations should be collect
and then to analyze each of them for determining the course of treatment.
Before making a diagnosis and developing a treatment plan, the dentist
must collect and evaluate the facts associated with the patient’s or parents’
chief concern and any other identified problems that may be unknown to
the patient or parents.
Some signs may lead to an almost immediate diagnosis. For example,
obvious gingival swelling and drainage may be associated with a single,
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5th stage
badly carious primary molar. Although these associated facts are collected
and evaluated rapidly, they provide a diagnosis only for a single problem
area.
On the other hand, a comprehensive diagnosis of all of the patient’s
problems or potential problems may sometimes need to be postponed until
more urgent conditions are resolved.
For example, a patient with necrotizing ulcerative gingivitis (NUG) or a
newly fractured crown needs immediate treatment, but the treatment will
likely be only palliative, and further diagnostic and treatment procedures
will be required later.
A thorough examination of the pediatric dental patient includes an

assessment of the following:
• General growth and health
• Chief complaint, such as pain
• Extraoral soft tissue and TMJ evaluation
• Intraoral soft tissue
• Oral hygiene and periodontal health
• Intraoral hard tissue
• Developing occlusion
• Caries risk
• Behavior
Additional diagnostic aids are often also required, such as radiographs,

study models, photographs, pulp tests, and, infrequently, laboratory tests.
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5th stage
Components of oral examination and diagnosis
• Recording the history
• Examination of the patient
• Provisional diagnosis
• Special examination
• Final diagnosis
• Treatment plan (including medical referrals).
1-Recording the history: Recording the history (medical, dental and

familial). So to get a correct diagnosis, gathering complete and
comprehensive Information about the followings should be done:
• Vital statistics (demographic information about the child like: birth,
recognition, and social structure).
• Chief complaint and History of present illness (This is concerned about
what made the patient to visit the dentist or what they are seeking from
treatment).
• Family (social) history and pre- and postnatal history about the child
(provides relevant information about the social background of the child
and his family).
• Medical and drug history. It may affect the child's growth and
development (social and psychological) as well as the type of diet taken
by the child.
(Various diseases or functional disturbances may directly or indirectly
cause or predispose to oral problems and may affect the delivery of oral
care).
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5th stage
Information regarding the child's social and psychological development is
important. Accurate information reflecting a child's learning, behavioral,
or communication problems is sometimes difficult to obtain initially,
especially when the parents are aware of their child's developmental
disorder but are reluctant to discuss it. Mentally retarded child can be
determined by asking question about the learning process and the child's
behavioral and communication problem.
• Drug history (Details of the drugs being used for systemic ailments, any
adverse reaction to drugs, and any drugs already used for the condition)
• Behavioral history (Include any behavior problems in the dental office,
which are often related to the child's inability to communicate with the
dentist and to follow instructions may call upon the need for behavior
management or shaping).
• Diet history (Type of meal, Habits of snacking between meals should
be evaluated as they may be cariogenic. In case of high cariogenic
patients, a diet diary with number of sugar exposures should be noted
while taking diet history).
• Past dental history (Previous care (treatment) in the dental office, Oral
hygiene, habits, Previous and current fluoride therapy).
2- CLINICAL EXAMINATION
Includes: General Examination, Extra - and Intraoral examination.
General Examination
General well-being of the child can be examined by a brief survey of the
entire child' s body. In addition to examining the oral cavity structures,
the dentist may in some cases wish to note the patient's size, stature, gait,
or involuntary movements. The first clue to malnutrition may come from
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5th stage
observing a patient's abnormal size or stature. Similarly, the severity of a
child's illness, even if oral in origin, may be recognized by observing a
weak, unsteady gait of lethargy and malaise as the patient walks into the
office.
General examination includes the examination of the followings:
1) Head, hair, face, neck and hands
2) Temporomandibular joint
3) Lymph nodes
4) Lips, Chin and tongue
1) Head, hair, face, neck and hands

The dentist can gather useful information while being acquainted with a
new patient. After the patient seated in the dental chair, attention to the
patient's hair, head, face, neck, and hands should be among the first
observations made by the dentist, because abnormalities in size, shape,
symmetry, function of head and neck indicate various syndromes that may
be associated with oral abnormalities.
Inspection and palpation of the patient's head and neck are indicated.
Unusual characteristics of the hair or skin should be noted. The dentist
may observe signs of problems such as head lice, ringworm, or impetigo
during the examination. Proper referral is Indicated immediately, because
these conditions are contagious.
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Ringworm
Impetigo
The patient’s hands may reveal information pertinent to a

comprehensive diagnosis (how?):
1) The dentist may first detect an elevated temperature by holding the
patient’s hand.
2) Cold, clammy hands or bitten fingernails may be the first indication
of abnormal anxiety in the child.
3) A callused or unusually clean digit suggests a persistent sucking
habit.
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5th stage
4) Clubbing of the fingers or a bluish color in the nail beds suggests
congenital heart disease, which may require special precautions during
dental treatment.
2) Temporomandibular joint evaluation

The dentist should evaluate temporomandibular joint (TMJ) function and
the associated musculature by palpating the head of each mandibular
condyle and by observing the patient while the mouth is closed (teeth
clenched), at rest, and in various open positions.
Movements of the condyles or jaw that do not flow smoothly or that
deviate from the expected norm should be noted. Any crepitus (that may
be heard or identified by palpation) as well as any other abnormal sounds
or clicking should be noted.
Sore masticatory muscles (that may have detected by pain, deviation and
restricted mouth opening) may also signal TMJ dysfunction. Such
deviations from normal TMJ function may require further evaluation and
treatment.
There is a consensus that temporomandibular disorders in children can be
managed effectively by the following conservative and reversible
therapies: (patient education, mild physical therapy, behavioral therapy,
medications, and occlusal splints).
Mouth opening (which is normally 40–45 mm) is also related to TMJ
function and should be examined.
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5th stage
3) Lymph nodes
The extra oral examination continues with palpation of the patient's neck
and submandibular area and any deviations from normal, such as unusual
tenderness or enlargement, should be noted and follow up tests performed
or referrals made as indicated.
4) Lips, Chin and tongue

If the child is old enough to talk, speech should be evaluated.
The positions of the tongue, lips, and perioral musculature during speech,
while swallowing, and at rest may provide useful diagnostic Information.
Chin prominence is related to mandibular position.
Lips normally should be competent (touch each other lightly or with 0-1
mm of gap). When the lips do not approximate each other at rest, they are
termed as incompetent.
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Pedodontics Dr.

Examination of the Mouth and Other Relevant Structures

Obtaining accurate data in a child is very difficult. The reasons may

 The history facilitates the diagnosis of many conditions, even before

Treatment planning may be modified during the procedure based on

THE DIAGNOSTIC METHOD

A thorough examination of the pediatric dental patient includes an

Additional diagnostic aids are often also required, such as radiographs,

1-Recording the history: Recording the history (medical, dental and

1) Head, hair, face, neck and hands

The patient’s hands may reveal information pertinent to a

2) Temporomandibular joint evaluation

4) Lips, Chin and tongue

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