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• Assessment

  The first stage in the dental hygiene process of patient care
• Assessment

  • Essential to the overall quality of care provided
  • Provides the basis for the consequent diagnosis, planning, implementation, and re-evaluation of dental and dental hygiene care
• Documentation

  • Reference tool
  • Historical record
  • Patient educational resource
  • Important medicolegal function as a record of your care
• Assessment protocol

  1. Chief complaint

  2. Medical and dental histories

  3. Clinical examination

  4. Radiographic examination

  
• Medical History

  • Obtained at the initial appointment
  • Evaluated or revised at each following visit
• Medical History

  • Patients need to understand the importance of sharing their medical history
  • They MUSTN'T ignore information that they may consider unimportant to their dental health
• Medical History

  • Evaluating oral manifestations of systemic disease
  • Finding systemic conditions that may affect the periodontal tissue response
  • Exposing systemic and infectious conditions requiring special precautions and modifications in treatment procedures
• Medical History Questionnaires

  • Remain up-to-date with growing links between overall health issues and dental and periodontal health
  • Ensures patient safety, health, and well-being
• • All patient responses should be documented in the patient record
  • No unanswered questions on the medical history form!
• Supplementing in consultation with other health care providers is vital for complete patient care
• Patient vital signs

  • Blood pressure
  • Pulse
  • Respiration
• Dental History

  • Patients are asked to identify their chief complaints or reasons for seeking oral health care
  • Dental hygienist must assist patient's in make available vital details required for the dental diagnosis

  
• Important information in dental history

  • Specific location of chief complaint
  • Stimulus that elicits pain
  • Duration of stimulation
  • Frequency of occurrence
  • Date of the initial problem
  • Changes in the problem since the initial identification

  
• Important elements of dental history

  • Previous dental experiences
  • Current oral hygiene practices
  • Attitudes toward dentistry
  • Patient's family
  • Social history (familial, occupational, and recreational aspects)
  • Habits (e.g., Caffeine consumption, tobacco of alcohol use)
• Gathered dental history information

  Affects planning and delivery of oral health care, and patient education

  
• Patients may be unwilling to fully disclose health history information because they think it is irrelevant to dental care or they have concern for personal privacy
• Interviews are important for gathering information that patients may not realize are important to their care plan
• Patient prevention and educational strategies

  • Plaque biofilm removal
  • Periodontal disease
  • Dental caries prevention
  • Diet modification
  • Use of fluorides
• Recommendations of preventive protocols are documented in the patient record
• Clinical Examination

  1. Extraoral and Intraoral examination

  2. Oral mucosal examination

  3. Oral hygiene examination

  4. Periodontal examination

  5. Dentition examination

  
• Extraoral and Intraoral Examination

  • Head, neck, and oral cavity are examined using visual and tactile techniques
  • Lymph chains and salivary glands are palpated to identify swelling or masses
• Extraoral and Intraoral Examination Findings

  • Support the development of dental and dental hygiene treatment plan and patient education plans
  • Identify a need for dental specialty referral and for medical consultation and/or referral

  
• Oral Mucosal Examination

  • Requires an understanding of the normal clinical features of the intraoral soft tissues
  • 3 types of oral mucosa line the oral cavity: masticatory mucosa, specialized mucosa, and lining mucosa
  • The health status of the gingiva can be determined by considering color, contour, consistency, and texture
• Oral Hygiene Examination

  • Includes a clinical evaluation of the presence of plaque biofilm, calculus, and stain
  • Collected data help dental hygienist to make connections with the clinical periodontal and dentition assessments, develop a dental hygiene treatment plan, design patient education strategies, and evaluate the outcome of oral hygiene instruction

  
• Plaque Biofilm

  A structured and functioning synergistic community of bacteria that support their combined metabolism and together enhance their overall bacterial virulence
• • 85% of all dental treatment is related to the diagnosis, treatment, and prevention of plaque biofilm–related diseases
  • 75% of all extractions are due to periodontal disease and dental caries

  
• • Identifying and documenting plaque biofilm location on the teeth to educate patients on specific oral hygiene prevention needs
  • The plaque biofilm can be stained with a red disclosing solution to help patients see it

  
• • Supragingival calculus is observed directly
  • Subgingival calculus is detected using an explorer by carefully examining each tooth surface

  
• • Radiographic images of interproximal calculus deposits
  • Calculus is usually present in greater amounts on the teeth than can be seen on the two-dimensional images

  
• Extrinsic Stains

  • Pigmented deposits on the tooth surface
  • Mainly aesthetic problems resulting from the pigmentation of acquired pellicular and dental plaque biofilm
  • Vary in color, composition, and firmness of adherence to the tooth surface
  • Often associated with poor oral hygiene

  
• Intrinsic Stains

  • Occur within tooth structure and cannot be mechanically removed by scaling or polishing
  • A commonly recognized cause is discoloration from pre-eruption and post-eruption drug interactions (e.g., tetracycline or minocycline stains)

  
• Brown Stain

  • Most commonly occurring stain
  • A thin, translucent, acquired, bacteria-free pigmented pellicle
  • Frequently associated with poor oral hygiene and not using dentifrice
  • Can be very diffuse and variable intensities in the dentition
  • Discoloration is usually greater on irregular tooth surfaces
  • Often caused by tannin, found in coffee, tea, fruits, and red wine
  • Tobacco produces firm dark brown or black surface deposits and brown discoloration of tooth structures
  • Staining is not necessarily proportional to the amount of tobacco used
• Chlorhexidine

  • A general antiseptic with broad antibacterial action against gram-positive and gram-negative bacteria and yeasts
  • Has a denaturing effect on proteins resulting in increased staining
  • Undesirable side effect is the yellow-brown to brown color to oral cavity tissues
• Stannous fluoride

  • Anti caries benefits
  • Control of plaque biofilm formation, gingivitis
  • Dentinal hypersensitivity
  • Imparts a yellow-brown or golden discoloration (primarily stannous sulfide) of the tongue and teeth
• Black Stain

  • Usually occurs as thin black lines on facial and lingual tooth surfaces near the gingival margin, or as diffuse patches on proximal surfaces
  • Firmly attached
  • More common in women
  • May occur in mouths with excellent hygiene
  • Recurs, and in some cases a 3- or 4-month recall program is required for patient's aesthetic concerns
• Green Stain

  • A green-yellow stain, sometimes of considerable thickness
  • Often associated with children
  • Discoloration attributed to fluorescent bacteria (Penicillium) and fungi (Aspergillus)
• Fluoride uses

  • Anti caries benefits
  • Control of plaque biofilm formation, gingivitis
  • Dentinal hypersensitivity
  • Imparts a yellow-brown or golden discoloration (primarily stannous sulfide) of the tongue and teeth
• Dr. AbdelRahman Murtada AbdelRahman Ramadan BDS, MSc., PhD, FSMSB, GBOI, JMHPE

  09/03/2024
• Black Stain

  • Usually occurs as thin black lines on facial and lingual tooth surfaces near the gingival margin
  • Diffuse patches on proximal surfaces
  • Firmly attached
  • More common in women
  • May occur in mouths with excellent hygiene
  • Recurs, and in some cases a 3- or 4-month recall program is required for patient's aesthetic concerns

  
• Green Stain


  • A green-yellow stain, sometimes of considerable thickness
  • Often associated with children
  • Considered to be stained remnants of the enamel cuticle - Unsubstantiated!
  • Discoloration attributed to fluorescent bacteria (Penicillium) and fungi (Aspergillus)
  • Usually occurs on the gingival half of the facial surfaces of anterior teeth
  • Associated with poor oral hygiene