Most dental practices have a standard protocol when seeing patients for the first time in their practices. Whilst there should be a certain standard to expect, it does vary. We have our own protocol for examinations which are aimed in providing patients with the treatment they wish to have, but to also ensure patient safety, make a full diagnosis and construct a treatment plan individualised for the patient. The treatment plan provided is usually printed for the patient with all costs attached and is aimed at fixing dental problems and ensuring long term dental health. The protocol our practice follows is detailed here and we believe it represents a standard of care our patients deserve.
1. Medical History questionnaire
We ask all our new patients to complete a medical questionnaire at the first visit and then verbally check this during the examination. It is important to know all medical details of our patients including all medication taken. Often patients think that some details are irrelevant. However, we often find that those details do have a relevance for dental practice. For instance, someone who has a haitus hernia, may not be able to lie flat in the chair. Or someone with arthritis may not be able to hold a toothbrush well, so will need to have their dental management modified. Common things that modify our treatment are allergies especially to penicillin and medication that is being taken especially those that thin the blood. The medical questionnaire also has questions about social history and dental history – all of which are relevant to dental care.
2. Extra-oral examination
It is common for us to palpate under the chin to feel for lymph nodes as this can be a sign of infections within the mouth. A basic evaluation of the lips and jaw joints are also done. If a more detailed exam of the jaw joints appears necessary then one may be done.
3. Intra oral examination
The first thing we check are your soft tissues (lining of the cheeks, palate, upper and underside of the tongue and lips). This is important and may be the only time your mouth is screened for oral cancer. Early detection greatly improves survival. Every year 300 people in Ireland are diagnosed with oral cancer and about half die from it.
Teeth are checked next and recorded on our computer software, noting missing teeth, existing fillings, any dental decay, broken fillings, worn teeth. A smile evaluation is often done if someone presents for cosmetic treatment. This is often combined with clinical photography. Whilst examining teeth we often take pictures of the teeth using a special ‘intra-oral’ camera and these are useful to explain problems that exist in the mouth.
We also perform a screen of your gum condition. This is known as your BPE (Basic Periodontal Exam) score and gives us a guide on the most appropriate way to treat your gum condition and optimise your gum health.
4. Special tests
To aid in gaining a full diagnosis special tests are usually employed. The most common special test are dental x-rays. Dental x-rays are vital in helping us spot dental problems that are not obvious from a visual inspection alone. We can see tooth decay but also, fractured roots, dislodged fillings, decay under fillings, tooth ‘resorption’, tooth abscesses, the fit of dental crowns, and bone quality around the roots, to name a few. At our practice, we only utalise digital x-rays, so the results are instantaneous and only expose you to small amounts of radiation (about 1/5 of the radiation compared to standard film based radiography). X-rays are only taken if clinically indicated to minimise radiation and results are reported on in our clinical notes.
Other special tests might include testing of nerves in the teeth (‘vitality tests’), tests for cracks in teeth, transillumination of teeth to check for cracks or tooth decay and rarely biopsies.
5. Diagnosis and discussion
It is only after all the information previously discussed has been collated that a sound diagnosis of your oral conditions can be made. It may be that more investigations are required that need to be done on anther day and this will be discussed with you. We believe in explaining all the problems to you in plain English and how best to treat your problems as a two-way discussion so that a customised treatment plan can be arrived at. The skill your dentist should have is choosing what will serve you best in the long term. Doing the treatment, from our point of view, is straightforward. However, choosing the best option for any particular patient is where the real skill lies, as this will determine the long-term success of the treatment. Fundamentally, we will suggest what we feel the best treatment options are, but ultimately, it is the patients right to choose whether they want to proceed with the suggested plan.
6. Treatment plan itemisation
At the end of the examination appointment we will provide you with a printed estimate of the proposed dental treatment so you are fully aware of costs involved.
As you can see, there’s a lot to fit into the new patient examination!