Description

“Oral Diagnosis” literally means “analysis of the inner mouth”.

A successful oral treatment is only possible if an accurate
diagnosis has been made.  Oral diagnosis in dentistry is the practice of
determining all problems inside and outside of the mouth by using scientific
knowledge to determine the relationship between them, and thereby helping to
make the right decisions regarding treatment based on the findings in
hand.  An effective oral diagnosis can be done through oral inspection,
external inspection, and radiologic inspection. 

An extraoral examination includes inspection of the tissues in
and around the mouth (face, jaws, temporomandibular joint, lips, nose, neck,
chin…).  Additionally, intraoral examination inspects the teeth in a
systematic manner.  Receding gums, plaque, tartar buildup, abscess presence,
mobility, cavities, inharmonious restorations, complications, color, count, and
shape defects should all be assessed.  Following the inspection of each
individual tooth, the patient should also be examined in terms of closing jaws
and their relation with each other.  After evaluating all teeth and
intraoral tissues, the patient should then be informed of any necessary
intervention with teeth that don’t currently cause them any discomfort.

Tooth cavities which are not deep may not cause any discomfort,
but can be a source of pain should they progress.  Also, being well
informed about gum disease in its infancy can prevent receding gums and tooth
loss in the future.

Oral diagnosis is important not only in dentistry, but also in
terms of systematic diseases.  The patient should definitely be inquired
regarding systematic diseases.  For example diabetes mellitus, heart
disease, hypertension, atherosclerosis and hormonal disorders, along with the
medication used by the patient for these, could affect the dental treatment
planning.  With diabetes mellitus, atherosclerosis and hypertension,
extreme care should be taken during surgical and implant procedures as the
medication used for these diseases directly affects the amount of time it takes
for blood to clot.  Furthermore, certain intraoral and extraoral findings
can be a symptom or indication of certain systematic diseases. 

The patient’s general health status, health problems relevant to
general medical sciences, prescribed medications and allergic conditions are
all factors that may change the dentist’s choice of medication and
intervention.   Therefore in the Oral Diagnosis department, an
anamnesis containing detailed information about the patient is taken and
treatment is planned accordingly.  For example if the patient has allergic
reactions, they may need to be tested prior to being given anaesthesia. 
Similarly, the patient may need to consult their dentist and refrain from
taking blood thinner medications such as Coumadin, Plavix or Aspirin a certain
amount of time before beginning the treatment. 

In addition to these, a patient’s expectations from the
treatment should also be assessed.  If for example the reason for applying
to a dentist is to have more aesthetic teeth, the expected result should be
thoroughly expressed.  By doing this, the doctor can better inform the
patient about the applicability of the expectations. 

One of the most important assistive diagnosis techniques in
dentistry is radiologic examination.  Radiographs used in dental radiology
can be divided into two categories: intraoral and extraoral.

Inside of the Mouth (Intraoral) Radiographs

Intraoral radiographs encompass periapical radiographs, which
are routinely used by many dentists.  With periapical radiographs, one or
multiple teeth and their surrounding tissues, as well as the alveolar bone
surrounding the teeth can be observed.  Tooth decay, dental abscess,
periodontal bone loss, secondary cavities and many more disorders/diseases can
be displayed with periapical radiographs.

Panoramic Radiographs

Panoramic radiographs are an extraoral imaging technique capable
of displaying all teeth, buried teeth, surrounding bone tissue, complete
jawbone, physiologic and pathologic gaps in the mouth, and joints at once in a
single frame.  It is especially used for imaging of simple procedures such
as general oral examination, buried tooth extraction, resection, small cysts or
a few implants.  While it images all teeth at once, it exposes the patient
to less radiation than with a serial periapical radiograph and allows the
doctor to make a general evaluation.

Periapical Radiographs

Allowing doctors to image a small number of neighboring teeth
and the bone tissue surrounding them, peripheral radiographs are an intraoral
imaging technique used to get a more detailed picture of suspicious
circumstances detected in panoramic radiographs.  In terms of details, it
is much more detailed than panoramic radiographs. 

Why are panoramic x-rays necessary?

Panoramic x-rays are used in the diagnosis of decays, cysts and
tumors invisible to the human eye. 

They are radiographs that assist in making treatment planning
faster and accurate. 

They are images that must be seen by the doctor prior to
maxillofacial surgery, as they display the area in question in detail and
increase the success rate of the operation.

What are the advantages of panoramic x-rays?

Panoramic
x-rays provide early diagnosis of several cavities as well as cystic and
tumor-related formations.

All teeth can be displayed with one single x-ray.

With an image of all of the teeth, it allows for early diagnosis
and treatment.  By this, it is both time and cost efficient.

Standard panoramic radiographs also provides vital information
regarding right and left biting radiographs, undetectable midface decay,
chronic lesions, buried teeth, problems with the periodontal tissues (bone

grafts),
formations in the jawbone, excessive fillings, and additionally in children;
the location of permanent teeth, the development of roots and resorption of
baby teeth roots. 

In patients that have received a trauma to the teeth, immediate
and periodic periapical radiographs provide information regarding the tooth,
the root, and its surroundings. 

In patients over 40, regardless of complaints, radiographs are
crucial for determining bone pathologies and asymptomatic diseases.

With the radiologic findings, alternative treatment planning can
be done more easily once all problems have been determined.  In short, a
half hour initial diagnosis will lead to a successful and informative

treatment approach.