DIAGNOSIS
• Phrased to limit the answer to a single sentence
• The process of evaluating the patient's health as
well as the resulting opinions formulated by the
clinicians
• The assessment of findings which specifies what
is happening to a patient and why.
HOW DO WE GATHER OUR DATA?
I. DIAGNOSTIC INTERVIEW
• The verbal exchange between the patient and the
clinician that elicits the patient's knowledge
concerning health information The goal is to
identify all relevant info efficiently
• Clinicians should maintain control of the
interview by determining the relative info and
provide direction to the course of the interview.
SIGNIFICANCE
• Different methods of phrasing the same question
can produce different answers and variable
accuracy depending on the patient's personality
• The way in which a question is asked Is one of
the most useful techniques for maintaining
control of the interview
II. OPEN-ENDED QUESTION
• Prompts the patient into a narrative discussion
• Directs the patient to describe the entire topic
with the expectation that most of the info will be
contributory
• Patient is in control of the discussion
INDICATION AND CONTRAINDICATION
Indications
• Effectively covers a complicated topic
• Perceived as less stressful by most patients
• Effective on patients who are aware of health
issues
• Can calm anxious patients
Contraindications
• In unresponsive patients
• Patients who deviate from the topic
III. CLOSE-ENDED QUESTION
• Demands specific information
or less
• Clinician is in control of the discussion
INDICATION AND CONTRAINDICATION
Indications
• Most specific and efficient method of requesting
an Info
• Effective for unresponsive patients and for
unfamiliar with health issues
• Redirects an unproductive conversation·
Contraindications
• Patient may respond too directly Without
clarifying the info
• Patients tend to interpret the questions literally
which may lead to misrepresentation
• Patient perceives the clinician as 'cold or
'remote'
• Not effective for responsive patients
IV. LEADING QUESTION
• A technique that suggests the answer within the
question
Advantages
• For unresponsive patients
• For winning the confidence of suspicious
individuals
Disadvantages
• Patients might respond affirmatively as
suggested by the clinician
• Patient might lose confidence on the clinician
because of his incorrect assumption
• For patients who are indecisive or vulnerable to
suggestions
V. OPTION QUESTION
• Effective for sensitive topics
• Effective in forgetful patients
• Can manipulate a response from indecisive
patients
 INDICATION AND CONTRAINDICATION I. CASE HISTORY

• States inconsistent info and allows the patient to • Basic demographic information
resolve the contradiction • chief complaint
• history of present illness (hpi)
Indications
• past medical and dental history
• Designed for the patient to face the contradiction • family history
(by making a misleading statement or tell the • social history
truth)
1. BASIC DEMOGRAPHIC INFORMATION
• Effective in obtaining withheld info and when
• conflicting info has been given • Patient's full name
Contraindications • Address and telephone no.
• Age, sex and race
• Not effective for suspicious, anxious patients • Occupation
• Not effective for responsive patients • Marital status
• Party to contactin case of emergency
VI. INDIRECT QUESTION
• Third party involvement (insurance)
• Presents a topic in such a way that the patient • Responsible party
will reveal info beyond what is specifically
requested by the question 2. CHIEF COMPLAINT

Indications • WHAT PROMPTED THE PATIENT TO SEEK

TREATMENT?
• Useful in understanding sensitive or conflicting • Is the patient's expression of a disease
info • Whitten in the patient's own words, not limited
• Useful in exploring the patient's attitude to a word, phrase or sentence.
• If there are two or more chief complaints,
Contraindications
number them on the history sheet
• Unproductive FOUR CATEGORIES OF A CHIEF
• Time consuming COMPLAINT
• May not clarify the info given by the patient 1. COMFORT (pain, swelling, sensitivity)
2. FUNCTION (difficulty in mastication or
speech)
SOURCES OF INFO OTHER THAN THE 3. SOCIAL (bad faste, odor)
PATIENT 4. APPEARANCE (fracture, unattractive
• Parent or guardian must provide the history for a restoration, discoloration)
child (not a competent source of diagnostic info)
CHIEF COMPLAINT
• Patient's medical records, physician
• Note: Even for older adolescents who are 5.
capable of relating the info, the history is SUBJECTIVE SYMPTOMS
considered invalid if legally contested

FIVE ELEMENTS OF A GOOD

DIAGNOSTIC WORK-UP BASED ON PATIENT’S REPORT

1. history
2. Tmj/occlusal evaluation
3. Extra and intraoral examination
4. Diagnostic cast
5. Full mouth radiographs
3. HISTORY OF PRESENT ILLNESS
• Is the chronologic account of the patient's chief
complaint and related symptoms
• Clinician’s interpretation of patient's complaint
• OLDCARTS
o Onset
o Location
o Duration
o Characteristic
o Aggravating factors
o Relieving factor
o Treatment
o Severity
• SHOULD INCLUDE THE
1. Onset (when did it start?)
2. Course (acute, chronic, intermittent)
3. Type
4. Character (localize, diffuse, self-limiting)
5. Duration (how long do you experience pain?)
6. Relation to other activities
4. MEDICAL HISTORY
• Past systemic diseases, injuries and operation
that may be related directly or indirectly to the
dental treatment
• Includes general assessment of the patient before
the complaint, previous history and results of
physical examination, idiosyncrasies to drugs,
allergies, previous operations, injuries,
hospitalizations and results
• Should be accurate and current and includes the
medication the patient is taking as well as all
relevant medical condition
• If necessary, the patient's physician(s) can be
contacted for clarification
• The following conditions may be helpful:
o Conditions affecting the treatment
methodology
o Conditions affecting treatment plan
o Systemic conditions with oral
manifestations
o Possible risk factors
5. PAST DENTAL HISTORY
• Includes frequency of visit to dentists, past
experience to local anesthesia, past experience
during extraction and healing process, other
dental operative treatments
• Patient's history of dental treatment
o Periodontal history
o Restoratve history
o Endodontic history
o Orthodontic histroy
o Removeable prosthodontic history
o Oral surgical history
o Radiographic history
o Tmjd
2 medicines that are avoided by dentists
1. Aspirin – blood thinner
2. Clopidogrel
6. FAMILY HISTORY
• It deals with the information about any health
problems that may run in the family.
7. SOCIAL HISTORY
• Includes informafion about patient's habits and
lifestyle
TMJ AND OCCLUSAL EVALUATION
• Prior to the start of fixed prostho. procedures,
the px's occlusion must be evaluated to
determine if it is healthy enough to allow the
fabrication of such restoration.
• NORMAL = Maintain
• DYSFUNCTIONAL = Improve and Correct
• Palpate the TMJ bilaterally anterior to the
auricular tragi while the patient opens and closes
the mouth.
• Check for asynchronous movement
(anterior disk displacement
• Auricular palpation with light anterior pressure
(posterior disk displacement)
• TENDERNESS OR PAIN =inflammatory
changes
• Inter-incisal movement
EXTRA AND INTRAORAL OCCLUSAL EXAMINATION
EXAMINATION • Special attention is given to tooth
alignment,eccentric contacts and jaw
HEAD AND NECK EXAMINATION
maneuverability and centric relation should be
• Check head and neck for: evaluated
o Size • Any discrepancy between the intercuspal
o Shape position
o Symmetry
GENERAL ALIGNMENT
• Check for facial profile
o Normal • Teeth can be evaluated for crowding, rotation,
o Prognathic overeruption, spacing, malocclusion, and
o Retrognathic vertical/horizontal overlaps
• Check for abnormalities:
LATERAL/PROTRUSIVE CONTACTS
o Skin and hair
o Lymph node enlargement • Presence/absence of tooth contact in eccentric
o Cutaneous ulceration and scars movements
o Pigmentafions
o Muscles of mastication
o TMJ function
INTRAORAL EXAMINATION

• Reveal information concerning the condition of

the soft tissues, teeth and supporting structures
• Tongue, floor of the mouth, vestibule, cheeks,
and hard/soft palates are examined and any
abnormalities are noted
PERIODONTAL EXAMINATION

• Provide information regarding the status of

bacterial accumulation, the response of the host
tissues, and the degree of imeversible damage
• Existing periodontal disease must be comrected
before any prostho. tx is undertaken
GINGIVA

• Healthy gingival is pink, stippled and firmly

bound to the underlying connective tissue
• Gingival margin is knife-edged and sharply
pointed papillae fill the interproximal spaces