Examination and Diagnosis
Prior to examining the patient we should get them to complete a caries risk assessment form. This could be carried out electronically with, say, the safe use of an electronic tablet. This would be done with the social distancing protocols. I suggest this to be completed with EVERY patient as with medical history forms. It could de easily developed to give us a traffic light warning system and alert us to dietary and social factors that might be affecting their disease status. It would be undertaken with the essential backing and support of your dental team. Conveying to your patients that having the attitude of “one filling is one filling too many” will not go amiss either.
Special tests using devices such as DIAGNOdent, & SoproLife as we all know that radiographs can often be difficult to read, whether they be conventional or digital. How often are we unsure of a lesion? How often have we miss diagnosed decay on a radiograph or? With the new guidelines it is more crucial that ever to correctly diagnose caries and at the earliest stage possible thus resulting in utilising the MID principles. Research has shown SoproLife having a high sensitivity and specificity. We should be offering our patients a more reliable diagnosis by using these newer diagnostic devices and techniques. They will not replace the older methods, but give us added knowledge allowing us to make sound evidence based clinical decisions.
Transillumination is also becoming increasingly more routine with even the simple use of fibre optic light enabling us to spot inter proximal caries. This can be used alongside the aforementioned devices. Bruxing, tooth clenching, grinding, TMJ disorders are massive problems these days and we must look for their signs at the same time as other forms of oral disease. Again the earlier that you diagnose this and the sooner the patient is informed the easier your job shall be. Treatment is far more predictable and the prognosis greatly increased. Treatment may involve the provision of a dual laminate appliance or a simple gum shield at the early diagnostic stages. Once we have confirmed the presence of disease we must inform the patient of “their” problem and how “together” we can treat it. You are working together and the responsibility does not rest 100% on the clinician’s shoulders.This will involve educating our patients and showing them home care products and practices that can treat their existing disease and reduce the risk of further disease developing.
Special tests using devices such as DIAGNOdent, & SoproLife as we all know that radiographs can often be difficult to read, whether they be conventional or digital. How often are we unsure of a lesion? How often have we miss diagnosed decay on a radiograph or? With the new guidelines it is more crucial that ever to correctly diagnose caries and at the earliest stage possible thus resulting in utilising the MID principles. Research has shown SoproLife having a high sensitivity and specificity. We should be offering our patients a more reliable diagnosis by using these newer diagnostic devices and techniques. They will not replace the older methods, but give us added knowledge allowing us to make sound evidence based clinical decisions.
Transillumination is also becoming increasingly more routine with even the simple use of fibre optic light enabling us to spot inter proximal caries. This can be used alongside the aforementioned devices. Bruxing, tooth clenching, grinding, TMJ disorders are massive problems these days and we must look for their signs at the same time as other forms of oral disease. Again the earlier that you diagnose this and the sooner the patient is informed the easier your job shall be. Treatment is far more predictable and the prognosis greatly increased. Treatment may involve the provision of a dual laminate appliance or a simple gum shield at the early diagnostic stages. Once we have confirmed the presence of disease we must inform the patient of “their” problem and how “together” we can treat it. You are working together and the responsibility does not rest 100% on the clinician’s shoulders.This will involve educating our patients and showing them home care products and practices that can treat their existing disease and reduce the risk of further disease developing.
