Clinical Examination

Clinical Examination
The clinical examination is perhaps the most important part of the diagnostic process. A thorough examination  of a patient who has had injury to the dentoalveolar structures should not focus only on that structure. Concomitant injuries may also be present; the history may
direct the dentist to examine .other areas for signs of injury. Vital signs such as pulse rate, blood pressure, and respiration should be measured. Such tests can usually be obtained during the taking of the history .. The mental state of the patient is also assessed throughout the taking
of the history and while performing the clinical examlnation by observation of the manner in which. the patient reacts to the .examination and responds ·to the questioning. During the clinical examination, the following areas should routinely be examined 1. Extraoral soft tissue wounds. Lacerations, abrasions, and contusions .of the skin are all common with dentoalveolar.injuries and should be noted. If a lacerationis present, ‘the depth of it should also be-determined.Does the laceration extend through the entire thickness of the lip or cheek? Are there any vitalstructures, such as the parotid duct or facial nerve,crossing the line of the laceration? An oral and maxillofacialsurgeon best treats major lacerations, such asthese.
2. Intraoral soft tissue wounds. Injuries to the oral soft tissues are very commonly associated with dentoalveolarinjuries. Before a thorough examination, it may be necessary to remove blood clots, irrigate with sterile saline, and cleanse the oral cavity. Areas of bleeding usually respond to pressure applied under gauze sponges. Soft tissue injuries should be noted, and an examination should ascertain whether any foreign
bodies, such as tooth crowns or teeth, remain within the substance of the lips, floor of mouth, cheeks, or other areas. The dentist should also note areas of extensive loss of soft tissues; blood supply to a segment
of tissue may thereby be lost .

3. Fractures of the jaws or alveolar process. Fractures of the jaws are most readily found on palpation. However, because pain may be severe after the injur.y, examination can be difficult. Bleeding into the floor of the
mouth or-into the labial vestibule may indicate a fracture of the jaw. Segments of alveolar process that have been fractured are readily’ detected by visual examination and palpation.
4.•Examination of the tooth crowns for the presence of fractures or pulp exposure. For adequate examination ‘the teeth should be cleansed of blood. Any fractures should be noted. It is important to note the depth of
the fracture. Does it extend into dentin or into the pulp?
S. Displacement of teeth. Teeth can be displaced in any direction. Most commonly they are displaced in a buccolingual direction, but they may also be extruded or intruded. In the most severe type of displacement, the
teeth are avulsed-that is, totally displaced out of their alveolar process. Observation of the dental occlusion may provide assistance in determining minimal degrees of tooth displacement.
6. Mobility of teeth. All teeth should be checked for mobility  in both the horizontal and vertical directions. A tooth that does not appear to be displaced but that has considerable mobility may have sustained a root fracture. If adjacent teeth move with the tooth being tested,
a dentoalveolar fracture (in which a segment of alveolar bone and teeth are separated from theremainder of the jaw) should be suspected.
7. Percussion of teeth. When a tooth does not appear to be displaced but pain is felt in the region, percussion determines whether the periodontal ligament has undergone some injury.
8. Pulp testing of teeth. Although rarely used in acute injuries, vitality tests (which induce a reaction from the teeth) may direct the type of treatment the teeth will receive once the injury is over. False-negative results
may occur, s  the teeth should be retested several weeks
later and before endodontic therapy is performed.

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