Hello, my name is Dr. Eva Anadioti. I'm a prosthodontist and an Assistant Professor at the Department of Preventive and Restorative Sciences at Penn Dental Medicine. [MUSIC] Today, I will give you an overview of the procedures that take place during the first appointment at a dental office. The purpose of this presentation is to familiarize you with the process, and to answer potential questions on the rationale behind each step. Let's begin by briefly reviewing the basic sequence in patient care. The first step is the comprehensive examination that will take place at the first appointment. The completion of the examination and the information collected will lead to a proper diagnosis. Based on that, the dentist will create a treatment plan. After the treatment is completed, patients enter the recall system, in which periodic dental appointments are established for prevention and maintenance. As you realize, each step leads to another in order to ensure success and longevity of the dental therapy. Each step along the way is necessary and equally important. Now, we will focus on the first step. The comprehensive examination includes a thorough examination of intra- and extraoral structures, along with a detailed collection of relevant information. A comprehensive examination will be done the first time you visit a dental office. Even if you had had regular care under a different dentist, the new dentist will want to become familiar with your oral and medical health. At the first appointment, the dentist will interview the patient, in order to gather data on the patient's medical history, dental history, and chief complaint. Then the dentist will perform a thorough physical extraoral and intraoral examination, radiographic examination, and in addition to those, other diagnostic tools, such as consults, records, and dental impressions may be required. During the review of the medical history, the dentist will ask if you have been diagnosed with any diseases, if you have had any surgeries, or if you're taking any medications, prescriptions and over-the-counter. It is important to tell the dentist about all medicines you take. Even diseases that seem to be unrelated to the mouth may require a different approach to dental treatments or prevention. The dental history review will include questions on your oral hygiene habits, like how often you brush your teeth or floss, mouth habits like grinding or clenching your teeth, frequency of dental visits, past dental treatments and experience. The dental and medical histories should be considered by the dentist to identify medications and predisposing conditions that may affect prognosis, progression, and management of oral health condition. Chief complaint is the main reason that you're visiting the dentist at that particular moment. The dentist will document in the patient's own words the reason why you are seeking treatment, because this information, along with the diagnosis, will be use to create an appropriate treatment plan later. The chief complaint may be as specific as, my tooth on the lower right side broke off, or, I don't like my smile. But it can also be something broader and vague like, my teeth are in bad shape, or, I just need a cleaning. After the dentist has collected the data, the physical examination will begin. First of all, the vital signs will be recorded and documented, such as blood pressure and pulse. Extraoral examination includes head and neck palpation to identify lymph nodes, asymmetries, temporomandibular joint disorders, structural or functional anomalies, and signs of physical abuse. Let's move on to the intraoral examination, which is the check and evaluation of anatomical structures in the entire oral cavity or the inside of the mouth. First of all, the dentist will perform an oral cancer screening. It is a thorough examination of the tongue, the inside of the lips and cheeks, the floor and the roof of the mouth, to identify the presence of abnormalities or disease. Then we move on to the periodontal examination. This includes a detailed check of the gingiva, or gums, and supporting structures of the teeth. With this examination, we record the pocket depths around the teeth, mobility, and bleeding, to identify the presence of disease in the tooth's supporting structures, which is called gingivitis or periodontitis, based on the affected anatomical structures. The dental examination includes the exam and evaluation of each individual tooth and tooth surface. The dentist will document missing or fractured teeth, presence of disease, which is called caries or tooth decay, any existing restorations such as fillings, crowns, bridges, and removable dentures, and other dental conditions like wear and erosion. Lastly, the dentist will check the occlusion, how well your teeth fit together when you bite down and move your jaw side to side. The number and type of radiographs or images required to provide information for diagnostic purposes will vary according to the needs of the individual patient, and will be determined by the dentist. Most commonly, the radiographs used for dental purposes may be divided into two categories. Intraoral radiographs are small and give great detail for each individual tooth and its bone support. Those are called periapical when the root of the tooth is included, and bite wings when only the crowns of the teeth are shown, and are used to detect carries and lesions related to the teeth. Extraoral radiographs provide information for all teeth together in relation to other anatomic structures, like the panoramic radiograph. All the above radiographs provide two-dimensional representation of the three-dimensional structures, teeth and bone. Nowadays, the cone beam computed tomography, CBCT, that provides a three-dimensional image, is routinely used in dentistry. One of the most common indications for a CT scan is the surgical planning of dental implants, in order to assess the bone volume at adjacent anatomical structures such as nerves and roots, for a very predictable and successful treatment. What is discussed until now are the most common diagnostic tools. Many times, though, depending on the dental complexity of the particular patient, additional information may be required. That includes photographs. Intraoral and extraoral photos with a digital camera, provide a baseline record for the dentist, and are also a communication tool with the patient, laboratory technicians, and other members of the health care team. The dental impression is a negative imprint of hard and soft tissues in the mouth from which a positive reproduction, that is called cast, can be produced. Those are the same impressions that we take in order to make crowns, bridges, dentures, and night guards or bleaching trays. At this stage of the treatment, though, we call them diagnostic impressions, and are used to more easily detect problems with the bite that are difficult to see inside the mouth, and also to use them while discussing and planning with other dental specialties or technicians. Today, with the advancements in digital technology, the digital intraoral scanners have been introduced in the dental office. With those scanners, the dentist can very quickly scan all surfaces of the teeth and the bite, and instantly the image will appear on the screen. This digital impression, along with the digital radiographs and photographs that we described above, can be used to diagnose and accurately plan very complex dental treatments. Lastly, when the dentist considers it necessary, other dental or medical specialists should be consulted to acquire additional information. When all subjective and objective information is collected, the dentist will analyze the data in order to form patient-specific diagnoses and risk assessment. Then we'll formulate the treatment plan that best addresses the patient's dental needs. The American Dental Association has established patient centered approach for the treatment decisions which provides personalized dental care based on the most current scientific knowledge. Evidence-based dentistry integrates the dentist's clinical expertise, the patient's needs and preferences, and the most current, clinically relevant evidence. All three are part of the decision-making process for patient care. We should keep in mind that, depending on the complexity of dental needs of each particular patient, there may be more than one possible treatment options. In such a case, after the dentist presents the options, a discussion follows on the advantages and disadvantages of each option, the priorities and expectations of the patient, and the required timeframe and cost of each option. The patient then makes an informed decision as to which plan best meets their needs and desires. The dentist may also refer the patient to other dental specialists to complete parts of the treatment, if it's determined that it's in the best interest of the patient. Finally, let's look at the phases of a dental treatment. Phase one, disease control. Appropriate treatment is rendered in order to establish oral health, that usually includes prophylaxis, meaning tooth cleaning, and caries removal. Phase two, restorative treatment. When the oral cavity is free from disease, the restorative phase begins, which involves the replacement of missing tooth structure with biocompatible materials in order to restore optimum aesthetics and function. Phase three, maintenance. It is of great importance to understand that when the dental treatment is completed, the patient should establish a recall system with the dentist for maintenance of provided treatment, prevention, and early detection of oral diseases. The frequency and type of evaluation should be determined by the dentist, depending on the patient's risk factors and treatment complexity. To quickly summarize, in this presentation, we showed the procedures that take place during the first appointment at a dental office, which is the comprehensive examination that includes discussion with the patient, physical and radiographic examination. By thoroughly collecting all the necessary information, the dentist will properly diagnose and plan the evidence-based treatment that best meets each patient's dental needs. I hope you enjoyed your first visit to the dental office, and thank you for watching.
