The Clinical Exam – what do you need to know?

 Last week we discussed the “puzzle pieces” that are necessary for a complete diagnosis allowing you to understand function, and dysfunction.  This is essential to understanding your patient and the complex factors that they present with.  In a personalized medicine model (occlusal medicine) it is critical that we assemble a comprehensive database of information for each of our patients so that we can determine the ideal therapies based on individual needs.  Too often, dental treatments are not personalized creating less than ideal treatment results, potential iatrogenic consequences and frustration for the entire team as well as the patient.

The clinical examination (non-instrumental) begins with our patient conversation (blog #3).  Once we know the patient’s concerns, past history and future goals we can properly design and present treatment.  Of course, a thorough medical and dental history is essential and we integrate this information into our database.

What information forms the basis of the clinical examination?

• Medical and dental history
• Occlusal index
• Muscle palpation
• Neurologic screening
• Extra and intra-oral examination and charting of the dentition
• Assessment and charting of the periodontium, fremitus, biomechanical wear
• Occlusal assessment including RCP contact, guidance, presence of Protrusive, Laterotrusive and Mediotrusive interferences
• Dental and skeletal relationship
• Range of motion (mandibular) – clinical assessment at the level of the incisors
• TM joint palpation
• Auscultation of the TM joints
• Joint loading
• Occlusogram assessment

 Capturing this information is essential to making a proper diagnosis and ensuring improper treatment decisions are avoided before therapy commences. 

At VieSID Canada we teach each of these steps in detail.  Students of our 15 day mini-residency graduate with a thorough understanding of comprehensive diagnosis.  Once this information is gathered it is entered into a database including selected instrumental analysis appropriate for each patient.  In this way we are able to individualize our  therapies and treat our patients with personalized care.