The Complete Dental Examination,

As described in the glossary of the Academy of Prosthodontics, examination is the scrutiny or investigation for the purpose of making a diagnosis or assessment. This says nothing of treatment, but only diagnosing and assessing the concerns of a patient. The word diagnosis is described as the determination of the nature of a disease. Examination is described in many texts and literature articles. However, treatment seems to dominate our actions. How can we act before we know all the facts?

Part 1

Joseph J. Massad, DDS, and

William J. Davis, DDS, MS

As described in the glossary of the Academy of Prosthodontics, examination is the scrutiny or investigation for the purpose of making a diagnosis or assessment. This says nothing of treatment, but only diagnosing and assessing the concerns of a patient. The word diagnosis is described as the determination of the nature of a disease. Examination is described in many texts and literature articles. However, treatment seems to dominate our actions. How can we act before we know all the facts?

One of the most important aspects for the dentist is patient acceptance of needed treatment. Patients generally have the means to obtain what they want. It is our duty to let them know what they need and to encourage them to follow through with treatment. By doing a thorough examination, patients become aware of what their needs are. It is up to us to get them to want necessary treatment.

We will look at the exam in two parts. The first part in this issue will address the evaluation of who patients are, where they are coming from, and where they wants to go. An understanding of the patient`s background, family, hobbies, past experiences, psychological stability, and physical health is imperative before making treatment recommendations. In other words, understanding the patient`s psychological and physical health is paramount to any examination. We need to scrutinize all of these aspects before determining the patient`s specific dental needs. The second part of this series will address the dental problems and needs encountered during the exam.

We know that, once we are able to sit down and get to know more about patients, they will become more comfortable with us. As a result, we have a better chance in the long run of providing treatment for those patients` needs. No one wants a stranger to treat them. You would like to have a friend, someone you can trust, before placing your health in their hands. We learned from Dr. Pankey many years ago that it is necessary to determine five basic things about our patients.

1) What is the problem? Let patients verbalize their concerns. It is necessary to determine if we understand what patients` perceptions of their problems are.

2) What is the answer? Sometimes, we may not be able to respond to their problem. Some cases involve deep-rooted psychological feelings that keep patients from revealing their true pain and needs.

3) Is the time right? Timing is a very critical factor. Patients may not hear you if they have other things on their mind. Many times, patients have stressful financial obligations such as children in college, building on their home, starting a new business, or even going through a divorce.

They believe that they are unable to have all the work they need completed in our time frame. It may be necessary to space out the treatment to gain their trust. It would be suicide to treat patients who are not ready. Most of the time, we will develop problems of some sort with these patients when we begin at a bad time in their lives.

4) Are you the right person to treat this patient? Many times, we have patients who are extremely discriminating in every aspect of their dental needs. If you do not have the psychological strength or stability to treat a patient like this, then you may be precipitating health problems for yourself.

You need to ask: Can we treat this patient? Do we have what it takes to understand this patient`s fears? Let`s also be fair with ourselves. We need to preserve our own health.

5) Is the price right? Will patients be able to follow through to the end? They need to feel the quality, care, and judgment you offer is genuine and the cost is appropriate. Hopefully, by the time treatment is completed, patients will feel they got a bargain. If they do not perceive quality and a fair price, they have not received it.

I believe that these five simple questions can assist us in getting to know patients so that we can establish their needs and treat them successfully.

While reviewing the medical history of the patient, we often pick up clues that reveals underlying psychological problems. Patients, for example, may be taking frequent medications. This leads us to consult with their physicians and determine the patients` overall psychological and physical needs. Once we have reviewed the medical history, we then can ask specific questions of the patient`s dental concerns.

The questions could include, "What do you expect me to do with your teeth?" or, "How do you envision your teeth when we are finished with your work?" Possible answers could be "I want pretty teeth that don`t hurt," or, "I want to eat anything that others around me eat." These types of answers reflect the most common desires of patients today. These answers leave the door wide open for you to do a thorough dental exam with appropriate radiographs, mounted diagnostic models, and photographs.

Once all of the information is assembled, we can form a diagnosis that gives us the information (facts) to present treatment (action) options.

Next month, we will review the thorough dental evaluation, analyzing the patient`s occlusal, periodontal, endodontic, orthodontic, and restorative needs. We will use a systematic approach to keep focused during this process. Knowing our result before we begin will be our ultimate goal.

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