The dental check-up proceeds along methodical lines. The purpose is to determine the health of the mouth and teeth and whether either preventive or remedial work needs to be done, and if so what it is. The list below is based on a first examination at a new dentist. Many of the questions and actions may be unnecessary if you have been going to the dentist for some time, and he or she can refer to a lengthy dental and medical history. Although each dentist will have his or her pet order of doing things, and may place more emphasis on one factor than another, the general pattern of a dental examination is as follows:
– The dentist will need to know your name, address, age, telephone number and possibly NHS number.
– The dentist will need to know about your general health. This includes pregnancy, diabetes, heart trouble, blood pressure problems, infectious hepatitis, rheumatic fever, drug addiction, HIV status, allergies, and medication (including homeopathic or herbal) being taken or just finished. It is important that you answer completely and truthfully. Various precautions may need to be taken.
– The dentist will want to know what, if any, dental problems have brought you to the surgery – pain, sensitivity, bleeding gums or dental accidents.
– The dentist will need to know your dental history: when you last visited the dentist; any problems, such as excessive bleeding after extractions or allergic reactions; whether you prefer local or general anesthetics, and when you last had x-rays.
– The dentist will then examine your mouth and teeth and make a record of which teeth are present or missing, if they are filled or crowned, and if there is bridge work and/or dentures. This is called ‘charting’. This is the record that the police use when they identify mutilated or decomposed bodies by their teeth.
– The dentist will use a focused light source, a mirror and a small, pointed instrument with a right-angled head (a probe). This will be used to check for damage to the outside of the tooth that is not immediately visible to the naked eye (roughening or softening of the outer layer of enamel), and whether there are any small ledges or gaps between existing dental work (fillings, crowns and inlays) and the teeth.
– Each time decay is found the dental assistant enters it on the dentists ‘chart’, indicating the appropriate parts of the tooth. The dentist’s instruction to the nurse may sound like gobbledygook. In fact it is very logical. With a full quota of thirty-two adult teeth, the mouth can be divided into four quarters. In each quarter, each tooth is given a number from 1 to 8, starting in the middle and working to the back. So you can have an ‘upper right 3’ or a ‘lower left 6’, etc. And each of the five surfaces of the tooth has a name.
– If a dentist suspects that a tooth has died, he or she will test it by seeing whether you can feel sensation, generally by applying a very cold substance (ethyl chloride) or a very mild electric pulse to the tooth. If you can feel this tooth is still alive, if not it is dead.
– The dentist will then chart any loose teeth, and measure spaces between the teeth and gums using a blunt-ended, calibrated probe. The deeper the instrument goes the worse is the gum disease and bone loss. This is called ‘pocketing’. The dentist will also check for gum bleeding. This will also be charted.
– The dentist will check for calculus deposits, the presence of plaque, and the general state of mouth and tooth hygiene, and make a survey of the general health of the gums and linings of the mouth (mucosa). The dentist will also look for abscesses, small openings from chronic abscesses (sinuses) and ulcers.
– The dentist will examine the mouth, tongue and cheeks for signs of abnormal lumps or bumps.
– Dentures will be checked for fit, wear, cracks or damage, and bones and gums (ridges) for any suspicious sores, patches, ulcers or bumps.
– The dentist will spend time talking to young children, putting them at their ease, before checking their teeth, especially the permanent teeth if they are present.
– The dentist will note delayed eruption of either milk or second teeth, as well as the alignment of the jaws, crooked teeth or other factors that might need orthodontic treatment at a later date.
– At a first visit the dentist may well take x-rays. This will be for two reasons. Specific x-rays of a tooth or teeth can show what is happening inside the bone at the root end (apex), or determine the precise extent of bone loss around a tooth. Other x-rays, called ‘bite-wings’, show whether there is decay between the teeth, and how widespread is the decay inside teeth. Pan-oral x-rays may also be taken.
– The dentist can now discuss dental problems in the context of a treatment plan, taking into account your preferences and needs. The discussion will also touch on the probable number of visits, costs and the system under which treatment will be given.
– If there is time the dentist may do a minor scaling (removal of calculus).
– The dentist may also discuss oral hygiene, and give treatment for immediate relief of urgent problems.
– The dentist may decide to refer you to a specialist dentist, or perhaps a doctor if he or she feels that there is something in your mouth that needs specialist diagnosis or skills. This will certainly be true of unusual lumps and bumps. – If your teeth and mouth are in good health and have been well looked after, it is possible that you may hear those magic words: ‘No treatment needed.’
While the dentist obviously has responsibilities to you, the patient, it should be a reciprocal arrangement. As the patient you have certain responsibilities towards the dentist. You should always try to have a clean mouth, without food debris. If possible – and we appreciate this may not always be the case – clean your teeth shortly before attending. Stale alcohol does not smell inviting. You should always answer the questions honestly, even if this may cause embarrassment. For most of the time this is for your own protection, but in some instances it is also in the dentist’s and dental staff’s interests. Information received from DentistsHawaii.com