1. Basic inspection method
(1) Preparation before inspection
1) The consultation room is clean and quiet, with plenty of natural light.
2) Dress neatly, with white coats, hats and masks.
3) Check that all parts of the oral comprehensive treatment bed function normally.
4) Check disinfection and correct use of instruments.
5) Disinfect your hands, cut your nails short, wash your hands with soap, rinse them with clean water or wear disposable medical gloves.
6) Adjustment of doctor-patient status.
(2) Inquiry: Collecting medical history through inquiry is the first step of disease diagnosis.
1) Content: Ask the chief complaint, current medical history, family history and systematic medical history.
① Chief complaint: including the location of the disease, main symptoms and duration.
② Past history: Understand the time when the disease started, symptoms and their influencing factors, the process of disease development and the course of treatment.
③ Systematic history: To know the patient's systemic disease history, medication history and bleeding history; Women's menstrual period and pregnancy.
④ Family history: Some hereditary oral diseases have obvious family history, so asking questions is helpful for diagnosis.
2) Method
(1) Doctors should ask questions in a friendly tone and in a language that patients can understand; Ask the medical history simply and systematically.
② In the process of consultation, we should be good at grasping the key points and asking questions one by one according to the chief complaint, current medical history, past history and family history.
③ Pay special attention to asking questions related to disease diagnosis and differential diagnosis. For example, pain is a prominent symptom of pulpitis, and its nature, attack mode and duration are of great diagnostic significance. The main contents of the inquiry shall include:
The attack mode of pain: spontaneous pain and excitement pain, biting pain, tenderness and chewing pain;
The location of pain: whether it can be clearly located is called involved pain;
Nature and degree of pain: such as severe pain, dull pain, stabbing pain, swelling pain, throbbing pain or tearing pain;
Pain time: paroxysmal, persistent, severe pain at night, etc.
Factors that aggravate or relieve pain: cold stimulation aggravates, heat stimulation aggravates, and heat pain relieves cold.
(3) Visual diagnosis
1) examination contents: including general condition, oral and maxillofacial condition, teeth, dentition and oral soft tissue.
① General situation: general situation of body development, posture, facial expression, limbs and skin.
② Oral and maxillofacial conditions: normal development, symmetrical face, swelling or deformity, skin color change, scar, sinus, etc. If you want to check the facial nerve function, pay attention to whether the nasolabial groove disappears, let the patient close his eyes and whistle, and observe whether his eyes are closed and his mouth is skewed.
③ Teeth and dentition: the color, shape, texture, size, quantity, arrangement and contact relationship of teeth; Tooth defects, coloring, tartar, soft scale and tooth filling. ; Integrity and defect of dentition, restoration.
④ Oral soft tissue: the characteristics of gingiva related to teeth and its complications, such as the changes of gingival color, shape and quality, the degree and scope of swelling, and whether there is sinus; Changes in the color and integrity of oral mucosa in other parts, whether there are edema, ulcers, scars or tumors.
2) Inspection method: First, check the chief complaint site, because this is the most concerned issue for patients. Then check other parts in a certain order (such as upper right → upper left → lower left → lower right).
(4) exploration
1) exploration contents: location, range, depth, soft and hard texture, sensitivity and pulp exposure of tooth defect; The edge, tightness, secondary caries and overhang of the filling body; Sensitive points, accurate position and sensitivity of tooth surface; The feeling of skin or mucous membrane, the allergy or dullness of feeling, the effect of anesthesia; Exploration of the passage and periodontal pocket of skin or mucous membrane fistula.
2) Probe method: the doctor probes with a dental probe by holding a pen, and selects a probe with a sharp tip; Lightweight and fulcrum. Check the chief complaint teeth and suspicious teeth first, and then check them one by one in order; Do not forcibly probe into the suspected medullary cavity, so as not to bring unnecessary severe pain and psychological pressure to the patient; A blunt probe should be used to explore fistula, and the probe should be pushed forward conveniently without too much force.
(5) percussion
1) Contents of percussion: The health status of apical and periapical periodontal membranes can be distinguished by whether the affected teeth have pain after percussion and whether the sound made during percussion is clear or turbid; Checking the position of cracked teeth can be judged by the pain after percussion in different directions.
2) Percussion method: the tools are flat-headed metal hand-held instruments, such as the handle end of stomatoscope and flat-headed tweezers; Tap direction: vertical tap and lateral tap; Knock the normal control teeth first, and then knock the affected teeth, generally taking the adjacent teeth as the control; The percussion strength should be light before heavy, and the percussion strength that normal teeth do not cause pain is the appropriate strength.
3) The response of affected teeth to percussion: According to the comparison with normal teeth, it can be divided into: percussion pain (-): the response to proper percussion is the same as that of normal teeth; Percussion pain (+/-): discomfort caused by percussion with appropriate force; Knocking pain (+): heavy knocking causes light pain; Percussion pain (++): severe pain caused by percussion; Percussion pain (++): Percussion pain reaction is between (+) and (++).
(6) Consultation
1) Consultation contents: tooth mobility, range and fluctuation of tenderness and swelling of gingiva, exudation of periodontal pocket, texture of oral mucosa, range, edge and mobility of tumor, size, pain, mobility or adhesion of lymph nodes, etc.
2) interrogation method: oral interrogation should use a single finger, wear a fingertip, and move gently; Inside, two fingers touch the abscess, and two fingers touch the lips and cheeks; Two-handed interrogation is often used for extraoral interrogation. When asking about the "functional mobility" of teeth, put the index finger on the neck and gingival margin of the affected tooth and an adjacent normal tooth at the same time, so that the patient can do median and non-median movements, and the index finger can feel the abnormal mobility of the affected tooth: 0 degree: the same as the normal tooth, without abnormal mobility; 1 degree: only one bit of mobility is abnormal; 2 degrees: abnormal fluidity in more than two locations.
(7) Tooth looseness inspection method: clamp the pit and fissure on the cutting end or abutment surface with tweezers, and make the lip (cheek) and tongue (palate) move in the direction of near-far-middle and push (shake) up and down. According to the different mobility, it is recorded as: L-degree looseness: looseness of lips (cheeks) and tongue (palate), or the looseness range is less than lmm；; Second loosening: the lip (cheek) and tongue (palate) are loose in the near and far direction, or the loosening range is between 1 ~ 2mm; ⅲ degree looseness: the lip (cheek) and tongue (palate) are loose, and the proximal, distal and vertical directions are also loose, or the looseness range is greater than 2 mm
(8) Dental pulp temperature test method: Normal dental pulp does not feel pain in water close to oral temperature at 20 ~ 50℃, and 10 ~ 20℃ cold water and 50 ~ 60℃ hot water rarely cause pain, so it is cold stimulation below l0℃ and hot stimulation above 60℃. When endodontic disease changes, it may be sensitive or slow to cold and hot stimuli. Because there may be some false reactions, its diagnostic value is relative. It is necessary to measure the control teeth first, then the affected teeth, and make a comprehensive judgment according to other inspection results. Whether it is cold diagnosis or hot diagnosis, the test site should be at 1/3 of the labial surface or buccal surface of the tooth, because the enamel there is relatively complete, causing similar reactions:
1) cold test method: use cold air or cold water from three guns on the comprehensive treatment table or use a small popsicle (5 ~ 6 ㎝ plastic pipe with one end closed is filled with water for freezing). Put a small popsicle in the middle of 1/3 of the complete glaze on the labial (buccal) or lingual surface of the tooth to observe the patient's reaction.
2) Thermal measurement: use a heated gutta percha stick or inject hot water with a syringe. Put one end of the gutta percha stick on an alcohol lamp and heat it to soften it, but don't make it smoke and burn (about 65 ~ 70℃), and immediately put it in the middle of the lip (cheek) or tongue surface of the tooth to be tested to observe the patient's reaction.
3) Expression and clinical significance of temperature test results: The test results are compared with patients' own normal and healthy teeth, and cannot be simply expressed by (+) and (-). The specific performance is as follows:
① Normal: The reaction degree and time of the tested teeth are the same as those of the control teeth.
② Sensitivity: "Transient sensitivity": Transient pain reaction occurred immediately during the test, and the pain disappeared after the stimulus was removed for several seconds. Combined with the medical history, there is no spontaneous pain, which indicates that the pulp may be in a reversible inflammatory state at this time. "Sensitivity": Temperature stimulation causes pain response, with intense pain and rapid stimulation response. The pain lasted for a period of time after the stimulus was removed, indicating that the tested teeth had irreversible pulpitis. Sometimes temperature stimulation can cause severe pain, even sporadic pain, indicating that the pulpitis of the tested teeth is in an acute stage. The special reaction of "acute suppurative pulpitis" is extremely sensitive to thermal stimulation. Cold stimulation can relieve pain.
(3) Dull: The response caused by the same degree of hot and cold stimulation is much smaller than that of the control teeth. The sensory response of the tested teeth is slightly slower than that of the normal control teeth, indicating that the affected teeth may have chronic inflammation, pulp degeneration or partial pulp necrosis. "Delayed pain": that is, after the stimulus is removed, the painful reaction will appear after a period of time, indicating that the affected tooth may be chronic pulpitis or most of the pulp necrosis.
④ No response: The tested teeth did not respond to stimulation, indicating that the pulp may be necrotic or degenerated.
2. Selective examination and diagnosis methods
(1) test method for electrical activity of dental pulp
1) clinical significance: it is helpful to determine the vitality of dental pulp. If the patient can feel the electrical stimulation of the electrometer, it is considered that the pulp has some degree of vitality. However, vitality test can not be used as the basis for diagnosis, because there is the possibility of false reaction, and comprehensive analysis must be combined with medical history and other examination results to make a correct judgment.
2) Operation: explain the purpose of the examination to the patient, eliminate unnecessary fears and obtain the cooperation of the patient. Ask the patient to raise his hand when he feels tingling. Strictly isolate saliva from the teeth to be tested, blow dry or air dry, and apply a little conductive agent on the surface of the teeth. Put the working end of the adjusted instrument on the tooth surface to ensure that the patient has no heart disease. Let the patient support the metal rod part of the working end with one hand. When the patient feels, remove the working end from the tooth surface and record the reading.
3) Results: It is meaningful to indicate that there is a certain difference between the teeth and the control teeth by numbers (the specific difference varies with different products from different manufacturers, please refer to the instructions). If there is still no response, it means that the pulp is necrotic.
4) Precautions: Measure the control teeth first, and then the affected teeth. Each tooth was measured 2 ~ 3 times, and the average value was taken as the result; It is forbidden for patients with pacemakers to do electrical activity tests. Please note that false positives or false negatives may occur.
5) Reasons for false reaction: The reasons for false positive reaction are as follows:
① The probe or electrode contacts a large area of metal restoration or gum, so that the current flows to the periodontal tissue.
② The tested teeth were not sufficiently wet or dry, which made the current leak into the periodontal tissue.
③ The liquefied and necrotic pulp may conduct current to the periapical area, and when the current is adjusted to the scale, the patient may have a slight reaction.
④ Patients are very nervous and anxious, and they will respond when the probe just touches the tooth surface or is asked about their feelings.
6) Causes of false negative reaction
① The patient has used analgesics, anesthetics or alcoholic beverages in advance, and cannot perceive electrical stimulation normally.
② The probe or electrode failed to contact the tooth surface effectively, which hindered the conduction of current to the pulp.
③ The pulp of newly erupted teeth whose apical part is not fully developed usually does not respond to electrical stimulation.
④ The pulp of teeth with excessive calcification in root canal usually does not respond to electrical stimulation, which is more common in some elderly teeth.
⑤ The newly traumatized teeth may not respond to electrical stimulation.
(2) bite diagnosis
1) contents of occlusal diagnosis: check the location of early contact points of root cusp periodontal ligament tenderness, tooth occlusal contact and occlusal interference.
2) the method of bite diagnosis
① Empty bite method: instruct patients to clench their upper and lower teeth or do various chewing exercises, and pay attention to the changes of tooth looseness and gum color.
② Physical bite method: Choose a cotton roll or cotton swab with a tooth width, check the normal teeth first, then check the affected teeth, and determine the position of the affected teeth according to whether they are painful or not.
③ Occlusal paper method or wax bite method: When used to check patients' occlusion, thinner occlusal paper should be used to diagnose median and non-median occlusion respectively. If it is used to diagnose the interference site of a single tooth, a piece of occlusal paper with a thickness of 2 ~ 3 layers and a width of half a cusp can be placed on the inclined surfaces of different cusps, and checked in the order of center and non-center. The obvious deep spot coloring of occlusal pain of the affected teeth is the interference.
(3) Staining method: used to check cracked teeth. Generally, 2% iodine tincture and 1% methyl violet solution are used.
(4) Anesthesia test method: When the source of pain is unknown, such as pulpitis with diffuse pain, this method can be used to help determine the pain site. If the pain is relieved after injection of anesthetic, it can be determined that it is a toothache in the anesthesia area.
(5) transillumination method: the measured teeth are transilluminated with the light source of the optical fiber transilluminator. When in use, the optical fiber rod is placed on the lingual side (palatal side) of the teeth to irradiate the tested teeth, which is helpful for the diagnosis of cracked teeth and early dental caries according to the different light transmittance of the teeth.
(6)X-ray examination: It has important diagnostic value and curative effect judgment for endodontic diseases and periapical diseases.
1) Diagnosis: Identify the existence, location and scope of dental caries; Whether there are abnormal tooth development, such as abnormal central tip and abnormal lingual fossa; The situation of pulp cavity and root canal, such as the size of pulp cavity and root canal, tooth absorption, pulp stone and root canal calcification, etc. Apical and periapical diseases, such as apical granuloma, abscess, cyst and compact osteitis.
2) treatment: before treatment, observe the size of pulp chamber, the number, size, shape and curvature of root and root canal to help determine the treatment plan; The working length of root canal and the broken instrument were measured during the treatment. After the treatment, the results of root canal filling and the long-term efficacy of various treatment methods were judged.