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๐นุตููููููููููุง ุน ูููุจููููุง ู ููุญููู ููุฏ๐น ุฅู ุงูุฐูุฑู ุชููุน ุงูู ุคู ููู @Thirdstagedentistrybot
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ููุณ ุดูุช #ุจุฑูู
ููุฏููุงุช ุนู ุทุฑููุฉ ุนู
ู ุงูุชูุถูู ู ุงุฒุงูุฉ ุงูุชููุณุงุช๐๐๐๐๐
#ุจุฑูู
Cavitron scaler
ุฌูุงุฒ ุงููุงููุชุฑูู
ุงุฏูุงุช + ู
ูุงุฏ ุงูุจุฑูู
ุนูุงุฏุฉ ุงูุจุฑูู :- (ู
ุฑุญูุฉ ูค)
ูก. ุชูุถูู ุงูุงุณูุงู ู ุชูู
ูุนูุง ุ ุชุชุถู
ู :
*ุงุฒุงูุฉ ุงูุชููุณุงุช (ููู ู ุงุณูู ุงููุซุฉ)
*ุงุฒุงูุฉ ุงูุฌูุฑ (ุงูุจูุงู)
*ุชูุถูู ุงูุฌุฐุฑ (ููุฎุงู
ุณุฉ ููุท)
*ุงุฒุงูุฉ ุงูุชุตุจุบุงุช ุงูุณุทุญูุฉ ุงูุฎุงุฑุฌูุฉ
ุงูุงุฏูุงุช :
( ูุงููุชุฑูู/ููุฎุงู
ุณุฉ ููุท ุ ูุงูุฏุจูุณ ุ ุชูุฑุจุงูู ุ ุจุฑุด ู ุฑุจุฑูุจ ูุจูููุดูู ุ ุณูู ุณูููุฑ ุ ูููู
ุงูู ุณูููุฑ ุ ุงูููู/ูุชูุถูู ุงูุฌุฐุฑ ุ ุงูุฏู ุจุฑูุจ ู
ุฏุฑุฌ ุ ู
ูุฑูุฑ ุ ุจูุดูุช/ุฌูุฑ ุชุงูู )
ุงูู
ูุงุฏ :
( ููุณ ุดูุช ุจุฑูู ุ ุจูู
ุณ ุญูุจูุจู ุ ูุทู ุฑูู+ ุนุงุฏู ุ ููููุณ ู
ุฑุทุจ ุ ูุญูู ูุชุนููู
)
ุทุฑููุฉ ุงูุนู
ู :
-ู
ูุฆ ููุณ ุดูุช ุงูุฎุงุต ุจุงูุจุฑูู ู ุญุณุจ ุงูุงูุฏูุณ .
-ุงุฒุงูุฉ ุงูุชููุณุงุช ู ุงูุฌูุฑ ุจุงุณุชุฎุฏุงู
ุงููุงูุชุฑูู ุงู ุงูุณูู ุงุฐุง ูุงู ุงุณูู ูุซุฉ ู ุงููููู
ุงูู ุงุนูู ุงููุซุฉ .
-ุงูุชุฑููุฒ ุนูู ุงูู
ูุงุทู ุจูู ุงูุงุณูุงู ูุงูุงูุฏุฑ ูุช .
-ุงูุชุฑููุฒ ุนูู ุงูุงุณูุงู ุงูุงู
ุงู
ูุฉ ู
ู ุงูุฌูุฉ ุงููุณุงู ูู ุงููู ุงูุณููู / ู ุงูุงุณูุงู ุงูุฎูููุฉ ู
ู ุฌูุฉ ุงูุฎุฏ ูู ุงููู ุงูุนููู(ู ุฐูู ูุงููุง ุงูุซุฑ ู
ูุงุทู ุชุชูุงุฌุฏ ูููุง ุงูุชููุณุงุช ูููููุง ุฑุทุจุฉ ุจุณุจุจ ูุฑุจูุง ู
ู ุบุฏุฏ ุงููุนุงุจ ูุชุชุฌู
ุน ุงูุจูุชุฑูุง ู ุงูู
ููุฑูุจุงุช) .
-ุชุฌููู ุงูุงุณูุงู ุฌูุฏุง ู ุชูููู ุงููุฒู .
-ูุถุน ุงูุจูุณ ุนูู ุงูุงุณูุงู ู
ุจุงุดุฑุชุง ููุณ ุนูู ุงูุจุฑุด(ุงููุฑุดุฉ)โ .
-ูุฑูุจ ุงูุจุฑุด ุจุงููุงูุฏ ุจูุณ ู ููุฑุด ุงูุงุณูุงู ู ูุง ูููู
ุจุงูุถุบุท ู
ุทููุง ุนูููุง (ูุงูู ูุคุฏู ุงูู ู
ุดุงูู ุญุณุงุณูุฉ ู ูุจูุฉ) .
-ูุจุฏู ุงูุจุฑุด ุจุงูุฑุจุฑ ูุจ ู ูู
ุฑุฑู ุนูู ูู ุณู ููุถูู ูู
ุนุงู .
ุชูุถูู ุงูุจูุดูุช ู ุงูุฌูุฑ .
-ุชุนููู
ุงูุงุฏูุงุช ูู ุฌูุงุฒ ุงูุงูุชููููู .
-ูุง ุชูุณู ุชุตููุฑ ุนู
ูู๐ธ .
____________________
#ุจุฑูู
https://t.me/densitysecond99
ุดุฑุญ ููุณ ุดูุช ุจุฑูู ๐ฆท
ex ( PI.I)
GI ููุณ ุทุฑููุฉ ูุฃุณุทุญ ุฃุณูุงู ุงูุชู ูู
criteria ุงูุงุฎุชูุงู ููุท ูู
criteria for PI.I
0- no plaque in gingival area
1- film of plaque adhering ti free gingival margin& adjacent area of the tooth .plaque may be noticed by running a probe across tooth surface
2- moderate accomadation of soft deposit within gingival pocket , on gingival margin and/or adjacent surface which can be seen by naked eye
3- abundance of soft matter within gingival pocket and/or gingival margin and adjacent tooth surface. _______
periodontal pocket depth measurment :
ูุถุน ุฌุฏูู :
ููููุณ ุญูู ูู ุณู ุนู ุทุฑูู
periodontal probe .
_______
ุจุนุฏ ุฐูู ูุณุฌู ุฅู ูุงู ููุงู ุฃู :
_gingival recession
or/and
furcation involvement.
________
ุจุนุฏ ุฐูู ูุฃุชู ุฅูู :
examination of teeth
ูุถุน ุฌุฏูู ูุฐูู ู ุฎูุงู ุงููุญุต ููุงุญุธ ููุง ู
ู :
1- color &stains
2- size
3- form& struture
4- number
5- restoration
6- mobility
7- contact relationship
8- caries
9- fractures
10-attrition,erosion,or abrasion
11- vitality
12- occlusion
13-quality of oral hygiene
ูุทุจุนุง ุฃูู
ุญุงุฌุฉ ููุง ูุฑูุฒ ุนูููุง ุฑูู
6&13
grade of mobility ูุนูู ูุงุฒู
ูุนุฑู .
_______
ุจุนุฏ ุฐูู ููุชุจ :
_ differential diagnosis:
ุชูุชุจ ููุง ู
ุฌู
ูุนุฉ ู
ู ุงูุฃู
ุฑุงุถ ุงูุชู ูุฏ ุชุดู ูููุง ..ุฃู
ุง ุฅุฐุง ููุช ู
ุชุฃูุฏ ู
ู ุชุดุฎูุต ุงูุญุงูุฉ
ููุง ุฏุงุนู ููุง ูููุฑุง ุชูุชุจ:
final diagnosis
____
ูู ุญุงูุฉ ูุฌูุฏ ุดููู ุญูู ุจุนุถ ุงูุฃู
ุฑุงุถ ูุณุชุนูู ุจุจุนุถ ุงููุญูุตุงุช ูุงูุชู ุชูุชุจูููุง ููุง:
special investigation
ุกx-ray ู
ุซูุง ุชุญุชุงุฌ
_______
ุจุนุฏ ุงููุญูุตุงุช ูุงุงูุชุฃูุฏ ู
ู ุชุดุฎูุต ุงูุญุงูุฉ ุชูุชุจ:
final diagnosis
________
ุจุนุฏ ุฐูู ุชุฃุชู ู..
management &treatment plan
ูููุง ุชูุชุจ ุงูุฎุทูุงุช ุงูุฃุณุงุณูุฉ ูููููุฉ ุงูุชุนุงู
ู ูู
ุนุงูุฌุฉ ุงูู
ุฑุถ ..
chronic gingivitis ูู ู
ุนุธู
ุญุงูุงุช
we macke the following:
1- supragingival and subgingival scaling
2- oral hygien instructions( right brushing technique,use soft tooth brush,use dental floss)
3- chlorhexidene ( antiseptic mouth wash) o.2%
4- follow up.
ions ูู
ุง ููุงุญุธ ูุฌูุฏ
openingof mouth and ________
examination of the neck:
ุฃูู
ุดูุก ูุฑูุฒ ุนูู ููุง ู
ู :
_ thyroid gland
Inspect the neck looking for the thyroid gland. Note whether it is visible and symmetrical. A visibly enlarged thyroid gland is called a goiter.
Move to a position behind the patient.
Identify the cricoid cartilage with the fingers of both hands.
Move downward two or three tracheal rings while palpating for the isthmus.
Move laterally from the midline while palpating for the lobes of the thyroid.
Note the size, symmetry, and position of the lobes,
and
examine the
_ jugular vein _________
_ examination of lymph nodes:
ู
ู ุงูู
ูู
ุฌุฏุง ุฃู ูููู
ุจูุญุต ุงูุนูุฏ ุงูููู
ูุงููุฉ ูุฃู ูุญุตูุง ูุฏ ูุณุงุนุฏูุง ูู ุนู
ููุฉ ุงูุชุดุฎูุต
ููู
ุช ุจููู ุจุนุถ ุงูุตูุฑ ูุชูุถูุญ ุฃูุซุฑ :
Lymph nodes of the head and neck
Technique of the examination: use the finger pads with three circular motions of increasing pressure.
Examine size, texture, and tenderness for pathology.
Intra-oral examination:
Oral hygiene status:
ูู ุจุฏุงูุฉ ุงููุญุต ููุงุญุธูุง ููุฐุง ูุนุทููุง ููุฑุฉ ุนูู ู
ุฏู ุงูุชู
ุงู
ุงูู
ุฑูุถ ุจูุธุงูุฉ ูุตุญุฉ ุฃุณูุงูู
______
ู
ูุงุญุธุฉ( ูุฌุจ ุนูููุง ู
ุนุฑูุฉ normal finding ุญุชู ูู
ูู ุชู
ููุฒ ูู
ุนุฑูุฉ abnormal finding
_lips and labial mucosa:
Examination by inspection should include the following:
Color
Size
Morphlogy
Function
Labial frenum
Obvious lesions
Also by palapation :
Bidigital palpation( we use 2 fingers)
______
Buccal mucosa:
Also by inspection and palpation ( bidigital & bimanual ( use 2 hands) can be achievedโฆ.we examine the left and right mucosa( cheek)
________
-palate:
Hard & soft palate
We use mouth mirror for inspection
Also the palate is palpated ( palpation of the soft palate causes gagging and isnot routinely performed unless an abnormality is observed visually )palpation can then be accomplished by using a single finger to quickly sroke laterally from the midline
______
Tongue :
Inspection and palpation ( the tip of the tongue is grasped by a small square piece of the gauze and gently pulled forward and laterally ..and the tongue
should be palpated bidigitally
_______
Floor of the mouth:
Inspection of the floor of the mouth is done by asking the patient to raise the tongue
ูููุง ูุฌุจ ุนูููุง ู
ุนุฑูุฉ ู
ุงูู ุงูุชุฑููุจุงุช ุงูุทุจูุนูุฉ ูุงูู
ูุฌูุฏุฉ ููุง ูุชู
ููุฒูุง ุนู ุงูุชุฑููุจุงุช ุงูู
ุฑุถูุฉ ..
(normal stractures include: lingual frenum , orifices of sublingual and submaxillary salivary gland ,lingual veins,)
Palpation is usually done bimanually to identify any enlargement>
________
Salivary gland:
We examined for any enlargement or other abnormality
ูู ุงูุนุงุฏุฉ ูุช ูุญุตูู
ุง ู
ุน floor of the mouth
_______
Periodontal tissue examination:
Gingiva
_ุทุจุนุง ูุฐุง ุฌุฒุก ู
ูู
ูู case sheet of perio
ูููุง ูููู
ุจูุญุต ูุงู
ู ููุซุฉ ุญูู ูู ุณู ูููุงุญุธ ููุง ู
ู :
_color
_contour
_form
Consistency
_surface texture
ู ุฃูุถุง ูููู
ุจุงุณุชุฎุฏุงู
ุจุนุถ indeces ูู
ุฒูุฏ ู
ู ุงูู
ุณุงุนุฏุฉ ูู ุชุดุฎูุต ุญุงูุฉ ุงููุซุฉ
Gingival index recording:
GI by Loe &Siliness
ููุง ููุญุต ุงููุซุฉ ุญูู ูู ุณู ู
ู ุงูุฌูุงุช ุงูุฃุฑุจุน ..ููู
ูู ูุญุต ูุฐู ุงูุฃุณูุงู ููุท
4
2
6
6
2
4
Mesial โdistal-buccal-and lingual
'ุทุจุนุง ูุง ุฌูุฉ ู
ู ุงูุฌูุงุช ุงูุฃุฑุจุนุฉ scored from 0 to 3
0-ูุนุทู for normal gingiava
1- mild inflammation ,slight edema , no bleeding
2- moderate inflammation ,redness, glazing gingival, whish bleed on probing
3- severe inflammation .marked redness.edema.spontaneous bleeding tendency
ุจุนุฏ ู
ุง ุฃุนุทูุช scoreููู ุฌูุฉ ุชุฌู
ุนู scores of the 4 areas ุจุนุฏ ุฐูู ุชูุณู
ููู
ุนูู 4 ุญุชู ุชุญุตูู ุนูู :
Gingival index for tooth
ุจุนุฏ ุฐูู ..ุชุฌู
ุนู Gingival index for teeth ูุชูุณู
ููู
ุนูู ุนุฏุฏ ุงูุฃุณูุงู ุงูุชู ูุญุตุช ู
ุซุงู :
ุนูุฏ ูุญุต : upper lfet 4
ู
ู ุฌูุฉ mesial : : ุนุทูุช 1
ู
ู ุฌูุฉ distal : ุนุทูุช 1
ู
ู ุฌูุฉ : buaccul :ุนุทูุช 1
ู
ู ุฌูุฉ : lingual : ุนุทูุช 1
ูุฌู
ุนูู
: 1+1+1+1= 4 ููุณู
ูุง ุนูู 4 = 1
ูุนูู GI for upper left 4 =1
ูููุฐุง ู
ุน ุจุงูู ุงูุฃุณูุงู ..
ุซู
ูุฌู
ุน GI ููู ุณู
ูููุณู
ูู
ุนูู ุนุฏุฏ ุงูุฃุณูุงู ุงูุชู ุชู
ูุญุตูุง ูุงูุชู ุชููู ููุง ุนุฏุฏูุง 6 ุญุชู ูุญุตู ุนูู GI for individual
___________
dental plaque Ind
ุงูุงู
ุฑุงุถ ุงูุชู ุชุญุชุงุฌ ุฃู ุงุญุชูุงุทุงุช ุฎุงุตุฉ ุฃู ุงุนุทุงุก ุฃุฏููุฉ ูุจู ุงูุจุฏุก ูู ุงูุนูุงุฌ ู
ู ุจูู ูุฐู ุงูุฃู
ุฑุงุถ ู
ุซูุง :
_ hypertension...diabetesmellitus...leukemia
____
* ุฃูุถุง ูุนุฑู ..
disease that give manifestations in the oral cavity
ุงูุฃู
ุฑุงุถ ุงูุชู ุชููู ููุง ุนูุงู
ุงุช ูู ุงููู
ู
ุซูุง :
lupus erythematosus...anemia...lichen planus
_____
* ูุฐูู :
diseases which may be endenger the dentist and or other patient
ุงูุฃู
ุฑุงุถ ุงูุชู ุชููู ุฎุทุฑุฉ ุนูู ุงูุทุจูุจ ููุณู ูุนูู ุบูุฑู ู
ู ุงูู
ุฑุถู ู
ุซู :
ูAIDS...viral hepatitis...T.B
_____
ุฃูุถุง ูุนุฑู :
drugs which indicate systemic diseases
ุงูุฃุฏููุฉ ุงูุชู ูุฃุฎุฐูุง ุงูู
ุฑูุถ ...ูู
ุซูุง ุจุนุถ ุงูู
ุฑุถู ูุฏ ูุง ูุนูู
ุจุงูุถุจุท ุงูู
ุฑุถ ุงูุฐู ุนูุฏู ..ูุงูุฏูุงุก ูููู ููุง ู
ููุฏ ูู
ุนุฑูุฉ ุงูุญุงูุฉ ุงูุชู ูุนุงูู ู
ููุง ุงูู
ุฑูุถ..
ููุฐุง ุฅุฐุง ูู
ูุนุฑู ุงูู
ุฑูุถ ุงูู
ุฑุถ ุงูุฐู ุนูุฏู ุจุงูุถุจุท ุงุทูุจ ู
ูู ุงุญุถุงุฑ ุงูุฏูุงุก ุงูุฐู ูุณุชุนู
ูู..
ู
ุซูุง ูู ูุงู ูุณุชุนู
ู ..nifedipine.
this drug for hypertentsion
______
ูุฐูู ูู
ุนุฑูุฉ :
* drugs which may produce oral manifestation
ุจุนุถ ุฃููุงุน ุงูุฃุฏููุฉ ุชุณุจุจ ุจุธููุฑ ุจุนุถ ุงูุนูุงู
ุงุช ูู ุงููู
ู
ุซูุง ..
..nifedipine ..ูุณุชุนู
ู ูุนูุงุฌ hypertentsion...ูุณุจุจ
gingival hyperplasia
______
ุฃูุถุง ูุนุฑู :
drugs which need certain adjustment and speacial management before and during dental procedures
ุจุนุถ ุงูุฃุฏููุฉ ุชุญุชุงุฌ ุงูู ุชุนุฏูู ูู ุงูุฌุฑุนุงุช ู
ุซูุง :
steroid therapy
anticoagulant e.g heparin
____
drugs interactions
ุชูุงุนูุงุช ุงูุฃุฏููุฉ ู
ุน ุจุนุถูุง ...ููุฐุง ู
ูู
ู
ุซูุง ูู
ุง ุฃููู
ุจูุตู ุฏูุงุก ูุงูู
ุฑูุถ ูุฃุฎุฐ ูู ุฏูุงุก ุขุฎุฑ ..ูุงุฒู
ูุนุฑู ุชุฃุซูุฑ ุงูุฃุฏููุฉ ุนูู ุจุนุถูู
__
allergic and adverse reactions to drugs
ุทุจุนุง ูุณุฃู ุงูู
ุฑูุถ ูู ุนุงูู ุณุงุจูุง ู
ู ุฃู ุญุณุงุณูุฉ ุถุฏ ุฃู ุฏูุงุก ุฃู ุฃู ุขุซุงุฑ ุฌุงูุจูุฉ ุฃุฎุฑู ( ู
ูู
ุฌุฏุง ูุฃุฎุฐู ุจุงูุชูุตูู )
____
prior surgery and or hospitalization
ูุฎุตูุตุง ููู
ุง ูุชุนูู blood transfusions
____
history of radiotherapy
ุทุจุนุง ูุฏ ูููู ููุฐุง ุงูููุน ู
ู ุงูุนูุงุฌ ู
ุถุงุนูุงุช ุนูู oral and paraoral structures
_____
infections and immunization
ูุง ููุณ ุณุคุงู ุงูู
ุฑูุถ ูู ุชุนุฑุถ ุฃูู ุฃู
ุฑุงุถ ู
ุนุฏูุฉ ูู ุงูุณุงุจู ู
ุซู measles
herpes simplex...ููู ุฃุฎุฐ ุงูุชุทุนูู
ุงุช ุงููุงุฒู
ุฉ ..ูุฎุตูุตุง ูู ูุงูุช ุงูุญุงูุฉ
ุทูู ..
____
ุฃูุถุง ูุง ููุณ ุงูุณุคุงู ุนูู pregnancy in females
_____
ุทุจุนุง ูู
ุง ููุช ุณุงุจูุง ู
ุนุธู
ุงูุฃุทุจุงุก ููุถููู ุฃู ูุคุฎุฐ ูู ุดูู ูุตุฉ
ููู ุงูู
ุฑูุถ ูู
ููู ุนูุฏู ุฃู ู
ุดููุฉ ุตุญูุฉ ููุชุจ ูุงูุขุชู:
there's no any past or present systemic diseases
no history of any previous operations,or irridation,or any allergies
__
ุจุนุฏ ุฐูู ูุนู
ู :
* Review of systems
ููุง ูุณุฃู ุฃุณุฆูุฉ ุฎุงุตุฉ ุจูู ุฌูุงุฒ ูู ุงูุฌุณู
...
-cardio- vascular system
- pulmonary system
-gastrointestina system
_ Immune system
_endocrine system
- hematopoietic system
_ gentinatourinary system
musculoskeletal system
_ skin
_ nervous system
( ู
ุนุธู
ุงูุฃุญูุงู ูุฎูุงู ุงูุงู
ุชุญุงู ูุง ูุทูุจู ุงูุฏูุงุชุฑุฉ ) ..ููู ุชุนุชุจุฑ ูุฐู ุงูุฃุณุฆูุฉ ู
ูู
ุฉ ุฌุฏุง ุจุงููุณุจุฉ ููุฃุทุจุงุก ..ูู
ุงุฐุง ุุ
:these questions explores
* the possibility of presense of unrecognized or undiagnosed diseases
ูุนูู ู
ู ุฎูุงู ูุฐู ุงูุฃุณุฆูุฉ ูุฏ ููุชุดู ุฃู
ุฑุงุถ ุบูุฑ ู
ุดุฎุตุฉ ุฃู ู
ุนุฑููุฉ ุจุงููุณุจุฉ ููู
ุฑูุถ..
* the effectiveness of current treatment for diagnosed illness
ูุฐูู ูู
ูููุง ู
ุนุฑูุฉ ู
ุฏู ูุนุงููุฉ ุงูุนูุงุฌ ููุฃู
ุฑุงุถ ุงูู
ุดุฎุตุฉ ..
ุทุจุนุง ุนูู ุงูุฃูู ูุณุฃู 3 ุฃุณุฆูุฉ ุญูู ูู system ..
- ููู ุญุงูุฉ ูู
ุชูู ููุงู ุฃู ุนูุงู
ุงุช ุงูุฌุงุจูุฉ ุชุฏู ุนูู ู
ุฑุถ ุฃู ุฃู
ุฑ ุบูุฑ ุทุจูุนู ููุชุจ :
NAD...
this means no abnormal detected
or means: Nil abnormal detected
_______
ุจุนุฏ ุฐูู ูุฃุฎุฐ : the family history
here we asked about:
_ hereditary diseases
_ infectious diseases
this important for the dentist becuase he might suspect undiagnosed diseases if several members of the patient's family are affected>
____
Social history :ุงูุชุงุฑูุฎ ุงูุงุฌุชู
ุงุนู
we asked e,g:
abuot marital status ,numer of children,daily activities and hobbies
the social history reflect the patient life and level of education
______,,
Personal habits: ุงูุนุงุฏุงุช ุงูุดุฎุตูุฉ
ููุง ูุณุฃู ุญูู :
* habits related to oral hygiene
ุทุจุนุง ููุง ูุณุฃู ุงูู
ุฑูุถ ุนู ุงูุทุฑููุฉ ุงูุชู ูุณุชุฎุฏู
ูุง ูู ุชูุฑูุด ุฃุณูุงูู ,ุนุฏุฏ ู
ุฑุงุช ุชูุฑูุด ุงูุฃุณูุงู ,ููุน ูุฑุดุงุฉ ุงูุฃุณูุงู ูู
ุนุฌูู ุงูุฃุณูุงู ,ูู ูุณุชุนู
ู ุฎูุท ุงูุฃุณูุงู dental floss ..ุฃู ุฃู ูุณููุฉ ุชูุธูู ุฃุณูุงู ุฃุฎุฑู
_____
also significant: a click heard later in the opening cycle may represent a greater degree of disc displacement.
Clicks may frequently be felt as well as heard, though they are not normally painful.
Crepitus
Crepitus is the continuous noise during movement of the joint, caused by the articulatory surfaces of the joint being worn. This occurs most commonly in patients with degenerative joint disease.
The joint sounds should be listened to with a stethoscope, preferably a stereo one, as the two sides can be more easily compared.
'
Range of motion
This is the only truly measurable parameter, as the others are more subjective. It is just as important to record jaw movement as a means to assess the rate and degree of improvement as it is to determine the severity of symptoms.
Movements to be measured are:
Incisal opening - pain free limit
Incisal opening - maximum (forced)
Lateral mandibular excursions
Mandible deviations on pathway of opening
Incisal opening
The incisal opening is measured from the upper incisal tip to the lower, with the patient first of all opening to the limit of their comfortable, pain free range. This is then compared to the normal range of motion (see right). Their maximum (forced) limit is also recorded. It is important to determine whether a limitation of vertical movement is due to pain or a physical obstruction. If it is pain, then it may be a muscular problem, if an obstruction, then disc displacement is most likely.
Lateral Excursions
The lateral movement should be measured from mid-line to mid-line, the patient moving the mandible to their maximum extent, from one side to the other.
Mandibular deviation
When the jaw is opened, the path it follows should of course be straight and consistent. Deviations from the norm are either lasting or transient, and are all suggestive of internal derangements of different sorts.
Lasting deviations
Lasting deviations are caused by the joint on one side not moving as far as on the other. If the movement is consistent but off centre(i.e. a straight diagonal pathway), this may due to adhesions within the joint. If the movement is normal till just before the maximum range, when a lateral deviation occurs, this may be due to anterior disc displacement without reduction (if the overall range of opening is reduced).
Jaw opened Jaw closed
Transient deviations
Transient deviations occur when the joints are moving as far but at different rates. This is often caused by disc displacement with reduction.
ุทุจุนุง ุนู
ููุฉ ูุญุต ุงูู
ูุตู ุงูููู ู
ูู
ุฉ ุฌุฏุง ูุฎุตูุตุง ููุง ูุฃุทุจุงุก ุฃุณูุงู ููุฐุง ูููุช ููู
ุงูู
ุนููู
ุงุช ุงูู
ูู
ุฉ ุงูุณุงุจูุฉ ู
ู ุงุญุฏ ุงูู
ูุงูุน ูุงูุชู ุชุชุนูู ุจุนู
ูุฉ ุงููุญุต :
Tenderness to palpation
Pain in or in front of the ear is a common reason for a patient to seek treatment. A tenderness to palpation implies inflammation, generally as a result of acute or chronic trauma.
A finger should be placed in the immediate pre-auricular area, gently applying pressure on the lateral pole/head of the condial while the jaw is closed. The level of pain and discomfort on each side should be assessed and compared.
The little finger should also be placed in the external auditory meatus, and pressure gently applied forwards
palpation of lateral aspect
Joint sounds
There are 2 types of joint sound to look out for:
Clicks - single explosive noise
Crepitus - continuos 'grating' noise
Clicks
A joint click probably represents the sudden distraction of 2 wet surfaces, symptomatic of some kind of disc displacement. The diagnosis of a joint click, and therefore treatment, varies on whether the click is left, right or bilateral, painful or painless, consistent or intermittent. The timing of a click is also significant: a click heard later in the opening cycle may represent a greater degree of disc displacement.
Clicks may frequently be felt as well as heard, though they are not normally painful.
Crepitus
Crepitus is the continuous noise during movement of the joint, caused by the articulatory surfaces of the joint being worn. This occurs most commonly in patients with degenerative joint disease.
* habits which have deleterious effect on the oral structures
ู
ุซูุง :cheek and lip biting,clenching,bruxism.mouth breating,thumb sucking,tongue thrusting,smoking,and alcohol use
____
clinical examination:*
1Extra-oral Examination ..
general health examination:*
Physical appearance:
,ูููุง ููุงุญุธ ุงูู
ุฑูุถ ู
ู ุฃูู ุฏุฎูู ุงูู
ุฑูุถ ููุนูุงุฏุฉ
Gait
This means the manner of walking
-stature:
It is the size and relative propotion of the body parts it may be reflect a hormonal imbalance.
- extremities fingers and finger nails:
examination of the extremities may reveal signs of systemic diseases
also nail discoloration may be associated with respiratory and cardiovascular disorders e,g congestive heart failure or may be associated also with :Lichen Planus
also spoon-shaped nails with dull color associated with iron deficiency anemia
_
skin:
the appearance of skin also should be noted because some finding may be assist in differential diagnosis:
vital signs:
body temperature: 36.8----------37.3C
pulse rate 60-- 90/min
blood pressure: systolic 100-140mmHg
diastolic 60-90mmHg
respiratory rate 18-20/min for healthy adult
ูู
ู 16-18 ูููุจุงุฑ ูู ุงูุณู
20-24 ููุฃุทูุงู
ุนุงุฏุฉ ูุง ูุชููุฑ ูุฏููุง ุฃุซูุงุก ุงูุงู
ุชุญุงู ุฌูุงุฒ ููุงุณ ุงูุถุบุท ูุงูุญุฑุงุฑุฉ ูููุชูู ูููุงุณ ุงููุจุถ ูุงูุชููุณ ..
___
- skull
- ููุง ููุงุญุธ size and shape
ู
ุซูุง ููุงู ุญุงูุงุช ูููู ูููุง ุงูุฑุฃุณ ูุจูุฑ ( large head ) ู
ุซู : ูู ุญุงูุฉ Acromegalic
ูุฐูู ุดูู ุงูุฑุฃุณ ููุงุญุธู ู
ุซูุง ููุงู ( boxy head ) ูู ุญุงูุฉ Ricketsโฆุญูุซ ูููู ููุง ู
ู frontal eminencies and posterior areas are
prominent
_____
- face
- ููุง ููุญุต facial form of the patient ุนู ุทุฑูู inspection and palpation
- ูููุงุญุธ ููุง ู
ู ุงูุดูู ูุงูุญุฌู
ูููุงู ู
ุฌู
ูุนุฉ ูุจูุฑุฉ ู
ู face patterns โฆููู ู
ูู
ุฉ ุฌุฏุง ููู ูุซูุฑ ู
ู ุงูู
ุฑุงุช ุชููู ู
ุญู ุณุคุงู ูู ุงููุธุฑู ..ูุณุฃููู
ุจุฐูุฑูุง ููุท ููุง ุณุฑูุนุง :
โข Acromegalic face
โข Moon face
โข Scleroderma face
โข Hyperthyroid face
โข Nephrotic face
โข Congental face
โข Adenoid face
โข Mongoloid face
โข Angry like facial appearance
ููุง ููุณ ูุฐูู ู
ูุงุญุทุฉ facial asymmetry
ูุงูุฐู ูู
ูู ุฃู ูููู ูุงุชุฌ ู
ู ุนุฏุฉ ุฃุณุจุงุจ ู
ุซูุง trauma or due to TMJ ankylosis
_____
-Eye
ููุง ููุญุต ุฌู
ูุน ุฃุฌุฒุงุก ุงูุนูู ููู ุจุนุถ ุงูุฃุญูุงู ุจุนุถ ุงูุญุงูุงุช ุงูุชู ุชุตูุจ ุงูุนูู ูุฏ ุชุฏู ุนูู dental lesion
ู
ุซูุง :
Blue sclera is common in osteogensis and odontogenesis imperfecta
_____
-Nose
ูู ุงูุนุงุฏุฉ ููุง ูููู
ุจูุต ุณุทุญู ููุฃูู ูููุงุญุธ ุฃู ุชุบูุฑ ูู ุงูููู ุฃู ุงูุญุฌู
ุฃู ุงูุดูู ุงูุฐู ูู
ูู ุฃู ูููู ูู ุนูุงูุฉ ุจุฃู
ุฑุงุถ ูู
ููุฉ ู
ุซูุง
Saddele nose( depression of the nasal bridge ) is common in congenital syphilis and sickle cell anemia , infantile myxodema and some trauma
_____
_Ears
ูุง ููุณ ุฃู ุจุนุถ ุญุงูุงุช ุงูุชูุงุจ ุงูุฃุฐู ูุฏ ุชุนุทู ููุณ ุฃุนุฑุงุถ ุจุนุถ ุงูุฅูุชูุงุจุงุช ุงูุณููุฉ ุฃู ู
ุดุงูู ุงูู
ูุตู ุงูููู ููุฐุง ูุชู
ุงูุชุฃูุฏ ู
ู ูุญุต ุงูุฃุฐู
____
_Hair
ูู ุจุนุถ ุงูุญุงูุงุช ูุฏ ูุฏู ุงูุดุนุฑ ุนูู ู
ุฑุถ ู
ุนูู ู
ุซูุง ูู hereditary ectodermal dysplasia ( Streeter's syndrome )
The hair is silky and sparse
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temporomandibular joint:
we examine it for:
Tenderness to palpation
Pain in or in front of the ear is a common reason for a patient to seek treatment. A tenderness to palpation implies inflammation, generally as a result of acute or chronic trauma.
A finger should be placed in the immediate pre-auricular area, gently applying pressure on the lateral pole/head of the condial while the jaw is closed. The level of pain and discomfort on each side should be assessed and compared.
The little finger should also be placed in the external auditory meatus, and pressure gently applied forwards.
Joint sounds
There are 2 types of joint sound to look out for:
Clicks - single explosive noise
Crepitus - continuos 'grating' noise
Clicks
A joint click probably represents the sudden distraction of 2 wet surfaces, symptomatic of some kind of disc displacement. The diagnosis of a joint click, and therefore treatment, varies on whether the click is left, right or bilateral, painful or painless, consistent or intermittent. The timing of a click is
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