In this part of the lecture we will talk about INTRAORAL

EXAMINATIONS ( IOE) , these examinations include :

1- THE GENERAL ASSESSMENT >>> which includes :

♦ asessment of speech :
in term of ability to talk and pronounce letters properly
,without marked lisp ,especially cleft pts. Or mentally
retarded, downs syndrome , deaf pts.

♦ Assessment of TMJ :
Range of opening of mouth, deviation ,discomfort or pain.

♦ Assessment of head & neck soft tissues :

muscle tenderness, swellings.

♦ lymph nodes : tenderness , swelling.

♦ Lip posture: competence, everted or normal.

♦ Facial profile:convex, concave, straight .

♦Tongue function & rest position:

the tongue position during rest is at the floor of the mouth
& when we talk it becomes in a labiodental position , some
pts. move their tongue abnormally when they talk so they
will have what's we call lisping & thrusting.
2- GENERAL ASSESSMENT OF INTRAORAL FEATURES
FOR PATHOLOGY :

♦ Lips : we examine the lips in term of >>>

* color ( its normally pink, but we still have some physiological

variation btw different people ) ,

** dryness ( usually bcoz of dehydration , 4-example the pt. come to

the clinic & he forget to drink adequate amount of water , or it may be
due to a disease in the salivary glands such as sjogren syndrome which
affect saliva production & cause xerostomia , also there are some
medication which have an effect on the salivary glands ( they found
that asthmatic pts. who continuously use ventoline inhaler , have
erosions in their teeth & that’s becoz ventoline is one of the
medication which decrease saliva production >>>> so acidic food &
drinks will have bad effect on teeth >>> erosions will occur,
Alyrephen (anti histamine ) is another drug which affect saliva
production , so pts. who receive this medication will feel thirst
together with drowsiness & if they do not drink adequate amount of
water , they will become dehydrated
.
*** laceration **** swelling .

♦ Tongue : in term of * color ** dryness *** ulcers

**** attached frenum ( tongue tie ).

♦ oral mucosa : we examine the palate , cheeks, floor of

the mouth , check for inflammation, swelling, white / red
patches , ulcers .

♦ periodontium : it includes the cementum, bone , PDL &

gingiva ( here in the gingiva we examine >>> * the color ,
which is normally pink , but if there is inflammation then the
gingiva becomes erythmatous & its color becomes red, also
if the gingiva has pale color , then we will think of anemia, if
it is blue ,then we think of cyanosis .
 ** stippling , normally the gingiva has stippled architecture
, but when there is inflammation , gingiva becomes
edematous & loose its normal stippled architecture.

If the pt. has cyanosis then it will be noticed firstly by the dentist ,
becoz cyanosis starts to appear on the oral mucosa ( gingiva , tongue ,
lips ) , after that it appears on the nails , eyes, etc ……

◄ Oral hygiene : it’s a problem here in Jordan , most of

the children have poor oral hygiene which lead to plaque
accumulation & calculus formation, many parents don’t know
that their children teeth should be brushed !! so our duty as a
dentists to construct the parents about their Children oral
hygiene , we have to tell them that if their child is less than 2
yrs old & his lower incisors have been erupted ,they have to
clean them by GOOSE ,
* nowadays there are some types of goose which contain XYLITOL &
this is good for children becoz xylitol have a good taste & at the same
time it can protect their teeth from caries .
* Some types of chewing gums also contain xylitol instead of normal
sugar & this is better , becoz xylitol cant be fermented by bacteria , so
we can protect our teeth against caries …

Xylitol
Xylitol occurs naturally in foods in small quantities. Its use at present is
confined to confectionery and toothpaste. Xylitol like other sugar alcohol, is
caloric, but has been shown to be noncariogenic and to possess the
properties of a marketable sweetener.
Numerous incubation experiments have demonstrated that Xylitol is
fermented to acid very slowly (if at all) in comparison with glucose or even
sorbitol. Plaque pH studies confirm the non-acidogenicity of Xylitol. Some
laboratory findings suggested that Xylitol also may promote
demineralization. At present Xylitol is not available in the United States after
animal studies suggested that Xylitol might be carcinogenic.
 * When the child becomes 4 or 5 yrs old , he can use the
toothbrush & the toothpaste to clean his teeth , but he has to
choose the smallest type of toothbrush with fine bristles ,

♦ recently a new type of toothbrush has been introduced to the

markets which is the electric toothbrush which work with batteries ,
it’s a good one but not necessary , we can depend on the ordinary hand
brush as long as we are using them correctly.

♦ if we use the electric toothbrush , we have to monitor it & move it

correctly .

♦ The electric toothbrush is useful in 2 situations :

1- in physically handicapped persons , becoz they cant move the
ordinary toothbrush properly.
2- in case of children to encourage them to brush their teeth.

♦ About the toothpaste it should be a special type for

children & not to use the adult one.

♦ Some toothpaste companies produce a toothpaste for children from

age 0 to 2 yrs & another type for children from age 2 to 6 yrs , then
from 6 to 12 yrs , and after 12 yrs children can use the adult type
toothpaste >>>>> these types are differ from each other by the
concentration of fluoride & by the flavor ( usually the adult type with
mint flavor but the children type with fruit flavor) .

♦ The quantity of the toothpaste that we use for the child

is very important, when the child is less than 3 yrs we tell
his parent to put the proper amount of the tooth paste
which is ( 2d 7abet el 3adas ), after 3 yrs we can increase
the amount to become ( 2d 7abet el bazeelah ), SO … we
 need a minimum amount of the toothpaste just enough to
cover the bristles of the toothbrush.

♦ Some parents say that they don’t brush their children

teeth becoz they swallow the paste !! we have to tell them
that if their child can spit the paste out its OK … , but if he
cant & he is using the children toothpaste there is no harm
if he swallow it .

♦ It’s the responsibility of the parents to brush their

children teeth when they are less than 4 or 5 yrs , but when
the child becomes more than 5 yrs , he has to brush his
teeth by his own , but under the supervising of his parent ,
when the child becomes 12 yrs , he should start to brush his
teeth alone .

** the way by which the parents can brush their children teeth when
they are less than 4 yrs , is by asking them to turn around & lying down
with their mouth facing their parents , its an easy way by which the
parents can see all the child teeth & brush them correctly …

3- ASSESSMENT OF THE GINGIVA :

Gingival index : is an index by which we can determine the

stage of gingival inflammation .

The mouth is divided into sextants …

( we choose 6 key teeth, 3 in each arch , 2 of them should
be buccally ( the 1st molar -6- & the 1st premolar – 4 - & one
should be labially which is the 1st central incisor -1- , if we
choose the upper right 6 & the upper right 1 & the upper
left 4 , then we should choose the opposite in the lower arch
y3ne … we have to choose the lower left 6 & the lower left
1 & the lower right 4 ,
in the same arch 6& 1 should be on the same side & 4 on the
other side , then we give a grade for each tooth we
examine ,then we add these grades together and divide
them by 6 to find the average, which is the gingival index ).

The grades are :

0 >>> absence of inflammation.

1 >>> mild inflammation ( slight change in color & texture ).
2 >>> moderate inflammation (redness, edema ,bleeding on
probing )
3 >>> sever inflammation ( marked redness , edema ,
ulceration , spontaneous bleeding).

4- ASSESSMENT FOR ORAL HYGIENE :

Debris or oral hygiene index >>> the mouth is divided into

sextants ( 2 buccal & 1 labial segment per arch ), the same as
the gingiva ..
0 >>> No debris or stain .
1 >>> soft debris covering no more than 1 /3 of tooth
surface.
2 >>> soft debris covering more than 1/3 of tooth surface ,
but less than 2/3rds .
3 >>> soft debris covering over 2/3rds of tooth surface.( has
very poor oral hygiene ) .

** in case of deciduous teeth we select E instead of 6 , D

instead of 4 & A instead of 1.

5- ASSESSMENT OF TEETH :

Number >>> count the teeth & compare with age, if their
No. less than normal then the case is hypodontia & if the No.
more than normal then it is supernumerary.
Morphology >>> micro / macrodontia, fusion , gemination.

Color >>> normal , pink ( due to internal resorbtion ), bluish

( due to pulp necrosis or after RCT ) , yellowish ( due to
extrinsic staining ), chalky ( becoz of fluorosis ) , brownish .

Mineralization defects >>> caused by fluorosis , trauma ,

systemic illness .

6- ASSESSMENT FOR DENTAL CARIES :

** Methods are >>>

Visual : inspecting the caries with good mirror & bright

light source after drying the tooth .

Probing : tactile examination of the surface with a sharp

dental explorer , an area is defined carious when the
explorer resist withdrawal after insertion with moderate
pressure , in addition there is softness , opacity ,
discoloration & loss of translucency .
( carious lesion is not always soft , it can be hard ).

** Clinical aids are >>>

1- Bitewing radiographs , especially for interproximal lesions .

2- Transillumination probes .
3- Electronic caries detector ( the conductivity is increased
with demineralization ).
7- ORTHODONTIC ASSESSMENT :

Facial profile : convex , concave , straight .

Teeth / jaw discrepancy : if the teeth are large & the jaw is
small then the case is crowding & if the teeth are small in
relation to the jaw , then the case is spacing .

The remaining slides are not read by the doctor …

‫ا‬

- ‫ ﺗﻤﺖ ﺑﺤﻤﺪ اﷲ‬-

DONE BY :
JAMILEH MOHAMMED HASAN .