Hard tissue examination.pptx

final year part 1 OMR presentation

1. Hard tissue examination Anishma Krishnan

2. Introduction Hard tissue 2 A Hard Tissue Intraoral Exam is a complete cavity check, performed tooth by tooth, and is recorded in a detailed dental chart. During a hard tissue examination of the oral cavity, the dentist will thoroughly evaluate the hard structures within the mouth, including the teeth and jawbones . This examination may involve several procedures:

3. Visual Examination : The dentist will visually inspect the oral cavity, looking for any abnormalities or irregularities. They will check for signs of decay , such as cavities or dark spots on the teeth, as well as any fractures , chips , or wear on the tooth surfaces. Palpation : The dentist may gently press on the jawbones and surrounding tissues to feel for any abnormalities, such as swelling, tenderness, or irregularities in bone structure. This can help detect any underlying issues, such as jawbone infections or tumors. Percussion; done by gently tapping the occlusal or incisal surfaces of the suspected tooth and adjacent tooth using the end of mirror handle , to check for involvement of periapex and periodontium 3 Hard tissue

4. Dental Probing : The dentist may use a dental probe, to measure the depth of the pockets around each tooth. Deep pockets can indicate gingival disease or periodontal diseases. Dental Radiographs : X-rays provide a detailed view of the teeth and surrounding structures that may not be visible to the naked eye. X-rays can reveal cavities, tooth root infections, impacted teeth, jawbone abnormalities, and other hard tissue problems. 4 Hard tissue

5. Bite Evaluation : The dentist will assess how the upper and lower teeth come together when biting and chewing. This evaluation helps identify any issues with the bite alignment, such as malocclusions or problems with the TMJ. Occlusal Analysis : The dentist may use articulating paper or bite registration materials, to evaluate the contact between the teeth in different jaw positions. This assessment helps identify areas of uneven pressure or premature contacts that may lead to bite problems or tooth damage. Transillumination : In some cases, a transillumination device may be used to examine the teeth. This involves shining a light through the tooth to detect cracks, fractures, or other structural abnormalities that may not be visible otherwise. Regenerate response 5 Hard tissue

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7. content Hard tissue examination 7 12. Examination of maxilla & mandible

8. i )Teeth present 3 tooth numbering systems are generally used - UNIVERSAL (adopted by ADA) - The FDI system Federation Dentaria International - The Zsigmondy-Palmer system

9. Universal system Hard tissue 9 Numbering of permanent teeth: 1-32 Numbering of deciduous tooth; A-T Here each tooth is assigned a number

10. The fdi system presentation title 10 It is a two number system First digit indicate ; Quadrant Second digit indicate ; tooth in that quadrant Quadrants ; permanent dentition 1-4 Quadrants ; deciduous dentition 5-8

11. Zsigmondy-palmer system 11 Hard tissue Quadrants identified by horizontal and vertical line Tooth identified by numbers / alphabets assigned

12. 2)Teeth MISSING

13. 3)DENTAL CARIES It is a irreversible microbial disease of calcified tissues of teeth characterized by demineralization of inorganic and destruction of organic substance of teeth which lead to cavitation

14. TYPES OF DENTAL CARIES HARD Tissue 14 PIT AND FISSURE CARIES Occlusal surface of molars and premolars Deep narrow pits and fissures favor the retention of food and debris along with microbes result in caries SOOMTH SURFACE CARIES Can develop on the proximal surface of the tooth On the surface on the tooth ROOT SURFACE CARIES Caries on cementum Usually occur in older age group with significant gingival recession and exposed root surface CERVICAL CARIES Seen on the buccal ,lingual and labial surfaces It is a crescent shaped cavity which occur in the proximal surface as a roughened chalky area that gradually become excavated

15. HARD Tissue 15 NURSING BOTTEL CARIES Occurs in deciduous dentition Most commonly occur in maxillary incisors followed my molars Upper tooth decay RADIATION CARIES Caries encircling the neck of the tooth Brown discoloration of the tooth Spot depression which spread on tooth surface ARESSTED CARIES They do not show the tendency to progress RAMPANT CARIES Sudden , rapid and uncontrollable destruction of multiple primary tooth

16. 16 HARD TISSUE

17. TENDERNESS/PERCUSSION TEST Hard tissue 17 VERTICAL PERCUSSION HORIZONTAL PERCUSSION pressure is transferred to apical periodontal tissue Positive in periapical pathology pressure is transferred to lateral periodontal tissue Positive in periodontium associated problems done by gently tapping the occlusal or incisal surfaces of the suspected tooth and adjacent tooth using the end of mirror handle

18. 4)Tooth mobility It is the movement of the teeth in its socket resulting from an applied force Normally all healthy teeth have a physiological tooth mobility EXAMINATION; Applying firm pressure with either two metal instruments or one metal instrument and gloved finger SYMPTOMS; There can be diurnal variations seen morning-mobility is found to be more- due to lack of chewing or deglutition during the sleep time Mobility decreases as the chewing starts

19. Causes of tooth mobility trauma from occlusion periodontitis Endo- Perio lesion pathologies like cyst , tumour, osteomyelitis, fracture After periodontal surgery Mobility is increased in females after pregnancy, use of contraceptives, menstruation 19 HARD TISSUE

20. MILLERS CLASSIFICATION OF TOOTH MOBILITY 20 HARD TISSUE

21. 5)OCCLUSION MOLAR RELATION CANINE RELATION OVERJET AND OVERBITE CROSSBITE OPENBITE DEEPBITE

22. Angle’s Class 1 molar relation 22 Hard tissue Mesiobuccally groove of maxillary first permanent molar occludes in the buccal groove of mandibular first permanent molar

23. Angle’s Class II molar relation 23 Hard tissue mandibular arch distal to the normal in its relationship to maxillary arch Distobuccal cusp of maxillary first permanent premolar occludes in the buccal groove of mandibular first

24. Angle’s Class III molar relation 24 Hard tissue mandibular arch in mesial in normal relation to maxillary arch Mesiobuccal cusp of maxillary first permanent molar occludes in the interdental space between mandibular first and second molar

25. CANINE RELATION 25 Hard tissue

26. OVERJET &OVERBITE OVERBITE OVERJET 26 Hard tissue The condition where the teeth on your upper jaw rest at an outward angle , causing them to extend far in front of the teeth on your lower Overjet refers to the horizontal distance between the upper and lower front teeth when the jaws are closed Overbite refers to the vertical overlap between the upper and lower front teeth when the jaws are closed. It is the amount by which the upper front teeth vertically cover the lower front teeth.

27. 6)WASTING DISEASE It is defined as any gradual loss of tooth substance characterized by formation of polished surface, without regards to the possible mechanism of the loss Types ATTRITION ABRASION EROSION ABFRACTION

28. TYPES OF WASTING DISEASES 28 Hard tissue ABRACTION It is the pathological wearing away of tooth substance through some abnormal mechanical process V shaped groove and the cervical third of tooth with some gingival recession ATTRISION It is the physiological wearing away of tooth as a result of a tooth to tooth contact, as in mastication Small polished facet on the cusp tip or flattening of the incisal edge EROSION It is the irreversible loss of dental hard tissue by a chemical process that does not involve bacteria smooth shiny and flat facets surface with exposed dentin &loss ofocclusal morphology ABFRACTION loss of tooth structure that result from repeated tooth flexure caused by occlusal stress Wedge shaped defects with sharp margins and sharp internal angles

29. 7)Dental calculus Dental calculus consist of mineralized bacterial plaque that forms on the surface of the natural teeth and prosthesis TYPES ; SUPRAGINGIVAL CALCULUS SUBGINGIVAL CALCULUS

30. Supragingival calculus calculus present on the clinical crown coronal to the margin of the gingiva and visible in the oral cavity Appearance- white chalky \ creamy – yellow or gray may be stained by tobacco or food Subgingival calculus calculus present on the clinical crown apical to the margin of the gingiva , usually in periodontal pockets Not visible on oral examination Appearance- light to dark brown , dark green, or black stains 30 Hard tissue

31. 8)Tooth fracture CROWN FRACTURE Craze line Cuspal fracture Cracked tooth Split tooth Horizontal fracture Oblique fracture Vertical fracture ROOT FRACTURE Horizontal fracture Oblique fracture Vertical fracture Coronal1/3rd Middle 1/3rd Apical1/3rd

32. 32 Hard tissue Craze line these are tiny cracks that affects only outer enamel They are common in adult teeth and cause no pain and require no treatment They are observed due to wear and tear of tooth Cuspal fracture The cusp become weakened and will fracture Depending on the extend of fracture the pulp could be also damaged and would need endo treatment Cracked tooth This type of crack extend chewing surface, vertically towards the root and even below the gum line It is not a complete split into two segments Split tooth It is a cracked tooth , where there are 2 distant segments that can be separated from one another

33. Ellis classification for anterior teeth 33 Hard tissue

34. 34 Hard tissue

35. Bennett’s classification Class 1 -Taumatized tooth without coronal or root fracture class 1a- tooth firm in alveolus class 1b-Tooth sublexed in alveolus Class2 -Coronal fracture class 2a-involving enamel class 2b- involving enamel and dentin Class3 -Coronal fracture with pulp exposure Class4 -Root fracture Class 4a-without coronal fracture Class 4b- with coronal fracture Class5 -Avulsion to the tooth 35 Hard tissue

36. 9)Discolored teeth Tooth discoloration is a frequent dental finding associated with clinical and aesthetic problem. It differs in etiology ,appearance, composition, location and severity 2 types EXTRINSIC DISCOLORATION INTRINSUC DISCOLORATION

37. Extrinsic discoloration It is defined as discoloration located on the outer surface of the tooth and is caused by topical or extrinsic agents CAUSES; Dietary components Beverages like tea coffee Tobacco, pan chewing Chromogenic bacteria Mouth rise like chlorhexidine Medication containing iron ,manganese ,copper, nickel Smoking stain Intrinsic discoloration occurs following a change to the structural composition or thickness of the dental hard tissues CAUSES; Amelogenesis imperfecta Dentinogenetic imperfecta Dentin hypoplasia Dental fluorosis Hyperbilirubinemia Trauma Localized red blood cell break down Medication- tetracycline Interna resorption 37 Hard tissue

38. 38 Hard tissue

39. 39 Hard tissue Smoking stain Tetracycline stain Chromogenic stain

40. 40 Hard tissue fluorosis Amelogenesis imperfecta Traumatic tooth stain

41. 10)Partially erupted teeth

42. Usually observed in the third molars Pericoronal flaps covering the partially erupted 3rd molar- can cause food lodgment and lead to infection called- PERICORONITIS Which can further lead to pericoronal abscess and cellulitis 42 Hard tissue

43. 11)Other anomaly SUPERNUMERARY TEETHS MICRODONTIA/MACRODONTIA FUSION GEMINATION TALONS CUSP TURNRES SYNDROME/SINGLE TOOTH HYPOPLASIA AMELOGENESIS IMPERFECTA DENS IN DENTE DENSE EVAGINATUS RETAINED DECIDUOUS TOOTH 43 Hard tissue

44. Examination of maxilla &mandible Examine the Size- prognathism /Retrognathism Shape –u shaped arches Contour-check for surface irregularities , exostosis and other lesions Mandibular tori

45. conclusion Hard tissue 45 Hard tissue examinations help the dentist assess the health of the hard tissues in the oral cavity, diagnose any problems, and develop an appropriate treatment plan if necessary. Regular hard tissue examinations are essential for maintaining good oral health and preventing potential dental issues

46. reference Peeyush Sivahare 2 nd edition Odell's clinical problem solving Ravi Ongole 2 nd edition 46 Hard issue

47. Thank you Anishma Krishnan CLINIC A | AMRITA DENTAL SCHOOL