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Dental exams. What is being done at them? Why are there so many pictures and code words? What are these people actually doing?
If you’re like most of the folks in this country, you’ve been to the dentist at least once in your life. Perhaps you had a toothache, maybe you just wanted your teeth professionally cleaned, or maybe you see your dentist faithfully every six months. Regardless of what brought you in to see your dentist, you had a dental exam. Have you ever wondered exactly what is happening at your dental exam, and why? This article will explain the steps of the dental exam, and the reasons for each step.
THE MEDICAL HISTORY
Every examination at the dental clinic starts with a thorough medical history. Some of the questions on the medical history form may seem irrelevant. Why does the dentist need to know every medication I take? The truth is, the dentist has studied every system in your body. The dentist knows all about your endocrine system, your reproductive system, and so forth. This is because every part of your body is truly connected to every other part of your body. The dentist is going to lay you back in their chair, ask you to open your mouth, possibly give you medications to numb part of your mouth, use tools on your teeth and gums, and possibly even do surgery. You want your dentist to know everything that is going on with your body before they add any stress or drug to the system.
BLOOD PRESSURE/PULSE/OXYGEN SATURATION READINGS
Depending on what procedure you are being seen for, your dentist or dental technician may gather these readings. Oftentimes, people first find out they have high blood pressure from their dentist. The dentist needs to know if your blood pressure is normal because they are probably going to cause stress or give you a shot of a drug, and they don’t want you to faint or have a stroke. In fact, if your blood pressure is too low or too high, the dentist may be unable to treat you at all. If your pulse is racing or non-existent, it matters for the same reasons. Patients who are sedated are at risk of low oxygen levels in their bodies, and an oxygen saturation reading will let your dentist know if you are getting enough oxygen.
IDENTIFICATION OF CHIEF COMPLAINT
Your dental professional will ask you if you are experiencing any dental pain. This will also open a discussion as to what your dental goals are, your reason for seeking this visit with your dental professional. Do you have a toothache? Are you wanting to replace the teeth you’re missing? Do you like your smile, and so on. Your dentist needs to know your goal, so they can help you achieve it!
X-RAYS
Ugh. Those films. They stuff this huge thing in your mouth, and then ask you to bite down? Quite uncomfortable. Well, those films are invaluable to your dentist. When your dentist reads your x-rays, they are looking for abscesses, bruised ligaments, bone support, bone loss, dental decay, fractures, bone quality, missing teeth, un-erupted teeth, tumors, and cysts, just to mention a few things. This is a snapshot of your mouth in time. Your dentist will refer back to these films during every procedure. They can detect trends from one set of films to the next. It is truly amazing the amount of information a full set of dental x-rays gives your doctor. Furthermore, it is actually malpractice for your dentist to offer any treatment on a tooth without a current x-ray. By current, we mean within one year at the most.
GUM MEASUREMENTS
Next unpleasant thing. The doctor or hygienist pokes you in the gums everywhere. What the heck? Well, these measurements are another treasure trove for your dental team. Your toothbrush bristles can reach 3 millimeters under your gum-line. If the top of your gums is 4, 5, or more millimeters above the ligament that is holding your tooth into your jaw, you cannot clean that area at home. Bacteria that dislike oxygen move into these areas and wreak havoc in the form of inflammation, bone loss, and infection. The doctor or hygienist will also measure how far your gums are from where they are supposed to be. Are they receding? Are they puffed up and fire-engine red? Do they bleed when you just barely touch them? These measurements are how the dentist and hygienist detect gum infection. Either you have healthy gums, you have gingivitis, or you have a gum infection. We can handle the first two. We really dislike infections. This is how your dental team knows what type of dental cleaning you need, as well as how often you need them. Loose teeth are noted during this part of the exam, as well.
SOFT TISSUE EXAM/ORAL CANCER SCREENING
Now, if your dentist wasn’t in the room yet, they are now. The dentist by now knows what your medical history says, what your films look like, and about the health of the support system for your teeth. It’s time to look for signs of oral cancer, precursors to oral cancer, and any other tissue abnormalities. Even if you have no teeth, you need this exam every year. The dentist will look at every surface of your tongue. They will look at the inside of both cheeks, the inside of the lips, and feel the glands in your chin and neck. They will look at the floor of your mouth, and down your throat. Yes, you need to say ‘Ah’, so that your throat opens for viewing!
OCCLUSAL ANALYSIS
The dentist will ask you to bite down, and they will look at your bite. This will show them crowding, problems with occlusion, spacing, and eruption issues. Do you need braces? This is where your dentist decides.
TOOTH EXAM
Many people feel like this is really the ‘exam’ of their ‘exam’. This is actually only one small portion of the exam appointment. The dentist will look at each individual tooth. They will look for existing restorations, decay, cracks, fractures, and evidence of tooth grinding/clenching. They will look at areas of missing teeth, and formulate a way to help to restore them. This is the part of the exam where the dental language really gets out of hand. You will probably understand the words like ‘decay’, ‘fracture’, ‘crown’, but not the code words like ‘DO’, ‘MODB’ and so forth. Your dentist isn’t saying those things to sound cool. Since we know you want to know, B is buccal, the side closest to the cheek. F is facial, the side closest to the lip. M is mesial, the side closest to the midline. D is distal, the side furthest from the midline. O is occlusal, the chewing surface of the back teeth. L is lingual, the side closest to the tongue. I is incisal, the chewing surface of the front teeth. There. Now you know our code.
Phew! Now your dental exam is complete. The dentist will go over their findings with you and the two of you can reach a decision as to the proper course of treatment, if any is indicated. The dentist will explain the procedures to be done, the alternative treatments you can choose from, the risks of doing or not doing these treatments, and answer any questions you may have. We’re off and running!
