ORAL EXAMINATION,

DIAGNOSE AND TREATMENT

PLANNING IN CHILDREN

drg. Prawati Nuraini, MKes, SpKGA(K)

PEDIATRIC DENTISTRY DEPARTMENT
FACULTY OF DENTISTRY
AIRLANGGA UNIVERSITY
 PEMERIKSAAN RONGGA
MULUT, DIAGNOSA DAN
RENCANA PERAWATAN PADA
GIGI
DAN MULUT ANAK

Prawati Nuraini, drg.,MKes.,SpKGA

 REFERENCES
Mc Donald and Avery”s
Dentistry For the Child and Adolescent, 10th
Ed , 2016, p 1-16
Nikhil Marwah
Textbook of Pediatric Dentistry, 3rd ED,
2014, p.45-54
 TIK

• RECORDING THE HISTORY

• CLINICAL EXAMINATION
• PROVISIONAL DIAGNOSIS
• SPECIAL EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Vital Statistics
Vital statistic history
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Chief complaint

 Apa keluhan px datang ke drg

 Menanyakan keluhan pada anak terlebih dahulu
sebelum menanyakan pada orang tua unt menjalin
hubungan dengan anak.
 Diperlukan jawaban dari orang tua
 Keluhan utama ditulis berdasarkan bahasa pasien
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 History of present illness

Hal-2yg berhubungan dengan keluhan utama :

– lamanya, mulai timbulnya, keparahannya,
keadaan yang mengurangi atau memperparah,
gejala penyerta, diurnal variation, postural
variation, obat-2 an /perawatan yg sdg
diterima
Beri penjelasan tentang kemungkinan
penyebab dan keadaan penyakit
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Family (Social) history
Latar belakang sosial anak dan keluarganya,
jumlah anak dalam keluarga
Kehadiran di sekolah, performa dalam kelas
Lingkungan di rumah
Pekerjaan orang tua
Kelainan Genetik oral/umum
Pertanyaan yg diajukan jangan sampai
menyinggung perasaan
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Medical History

Beberapa penyakit/gangguan fungsional dapat

berpengaruh langsung/tdk lgs pada masalah
rongga mulut dan mempengaruhi perawatan
rongga mulut
Informasi ttg kehamilan, kelahiran, neonatal
period, early childhood
Riwayat rawat inap, operasi, penyakit2 yg
diderita, traumatic injury
 Prenatal, Natal and Postnatal
History

Prenatal
Adanya infeksi atau kelainan sistemik selama
kehamilan
Imunisasi selama kehamilan
Wether received Antiserum D Vaccination or
not in case Rh +ve (father) and Rh –ve mother
 Prenatal, Natal and Postnatal
History

Natal
Time of birth- to rule out preterm birth
Type of delivery- normal/forceps/cesarean
Vaccination given at birth
Forceps delivery-predisposed factor for TMJ
disorder
 Prenatal, Natal and Postnatal History

Post natal
Developmental milestones-
crawling,sitting, walking etc
Develomental of speech
Immunization schedule
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Drug History

Obat-2 yg digunakan untuk penyakit sistemik

Alergi obat
Obat yg sdh digunakan pada kondisi saat ini
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Past Dental History
Pengalaman anak thd perawatan gigi
Macam perawatan yg telah diterima
termasuk pain control, tingkah laku anak
terhadap perawatan gigi sebelumnya
Faktor yg mempengaruhi adanya masalah
gigi yang masih ada
Frekuensi menyikat gigi, pasta gigi,
lamanya kebiasaan jelek menghisap
mulut, dietary habit,
 Past Dental History
Lamanya minum ASI, susu botol pada
waktu tidur, frekwensi ngemil diantara 2
jam makan
Dental history dapat menjelaskan
rampan karies, abrasi, atrisi
Dental records dan Ro gigi penting unt
informasi perawatan dan kepentingan
medicolegal
Dapat mengevaluasi sikap orang tua
terhadap perawatan gigi anaknya
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Behavioral History

Pengalaman yg tidak menyenangkan pada

perawatan gigi sebelumnya, diperlukan
behaviour management/shaping
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Growth and Development

Development milesstone
Speech and language development
Motorskills
Socialization
 Recording the History

 Vital Statistics  Past dental history

 Chief complaint  Behavioral history
 History of present  Growth and
illness Development
 Family (social)  Diet history
history
 Medical History
 Drug History
 Diet History

Type of meal (vegetative/mixed) influences

the oral hygiene status
Habits of snacking between meals should be
evaluated as they may be cariogenic
In case of high cariogenic patients, a diet
dietary with number of sugar exposures
should be noted while taking diet history
ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
CLINICAL EXAMINATION
 Clinical Examination

General Examination
Extraoral Examination
Intraoral Examination
 General Examination
TB dan BB berhubungan langsung dg status
perkembangan dan nutrisi
Gate (gaya berjalan), lihat gaya yg tidak
normal,mis : weddling gait (jalan bergoyang
spt bebek) ; limping gait (jalan perlahan dan
kesulitan karena ada injury)
Posture, lihat adanya abnormalitas
Stature and built – indikasi mal nutrisi atau
abnormal yg lain
 General Examination

Vital signs – pulse, heart rate,

respiratory rate
Illness, malaise
 Extraoral Examination

Shape of head
Mesocephalic (average shape of head and arch)
Dolichocephalic (long & narrow head; narrow
dental arches)
Brachycephalic (broad&short head; board dental
arches)
 Shape of head

Mesocephalic Dolichocephalic Brachicephalic

 Extraoral Examination

Facial form
– Mesoprosophic- average facial form
– Euryprosophic-board and short facial form
– Leptoprosopic-long and narrow face
 Facial Form

Mesoprosophic Euryprosophic Leptoprosopic

 Extraoral Examination

Facial Profile
– Straight
– Concave
– Convex
 Facial Profile

STRAIGHT CONCAVE CONVEX

 Extraoral Examination

Facial swelling and asymmetri

1. Bacterial /Viral infection and trauma
2. Pathological facial assymetry karena
cranial nerve paralysis, fibrous dysplasia
dan gangguan perkembangan
 Extraoral Examination

Pemeriksaan mata
– Adanya inflamasi atau pembengkakan
– Inflamasi gigi rahang atas – pembengkakan
eyelid
– Anak dg Upper Respiratory Infection,
sinusitis, alergi pembengkakan mata
 Extraoral Examination

Pemeriksaan hidung
– Perhatikan bentuk, ukuran dan warna
– Adanya nasal discharge mengindikasikan
URI
– Anak dg khronis URI mengakibatkan
kebiasaan jelek bernafas melalui mulut
 Extraoral Examination

Pemeriksaan kulit
– Adanya lesi primer dan sekunder
– Scars, memar, laserasi, pallor/pucat, tanda
lahir
 Extraoral Examination

Pemeriksaan dagu
– Dagu yg menonjol
– Mentalis yg aktif mengindikasikan adanya
kebiasaan dan mal oklusi
 Extraoral Examination

Pemeriksaan bibir
– Adanya cold sores, pembengkakan,warna
abnormal
Competent lip (bibir kontak pada waktu otot-2
relaxed)
Incompetent lip
COMPETENT LIP INCOMPETENT LIP
 Extraoral Examination
Pemeriksaan TMJ
– Pemeriksaaan meliputi palpasi,
auskultasiTMJ
– Clicking sound, crepitus, pain, deviation,
restricted opening
Normal mouth opening 40-45 mm
Pemeriksaan fungsi TMJ diperiksa dengan
palpasi headmandibular condyle
 TMJ Examination

The function of TMJ is

examined by palpating
the head of mandibular
condyle and observing
the patient with mouth
closed,open and during
random movement
 Extraoral Examination
Pemeriksaan kelenjar
– Wajib dilakukan pemeriksaan regio leher
termasuk pemeriksaan kelenjar
– Lymphadenopathy sering ditemukan pada
anak-2 karena infeksi virus
– Periksa kelenjar leher bagian samping dan
bawah
Lymph nodes examination
 Clinical Examination

General Examination
Extraoral Examination
Intraoral Examination
 Intraoral Examination

Menggunakan pendekatan TSD,menjelaskan

pada anak apa yg akan dilakukan (T),
menunjukkan instrumen pemeriksaan (S), yg
dilanjutkan dg pemeriksaan IO (D)
Setelah pemeriksaan IO jelaskan pada orang
tua apa yg ditemukan dlm rongga mulut dan
rencana perawatan yg dilakukan
 Intraoral Examination
Pemeriksaan Jaringan lunak
– Pemeriksaan mukosa RM dan jaringan
periodontal
– Abnormal mukosa RM mengindikasikan
adanya penyakit sistemik atau kekurangan
nutrisi
– Penting untuk memeriksa bibir, palatum dan
oropharynx, lidah, dasar mulut, mukosa
bukal
Examination of lips
Examination of tongue
Examination of floor of mouth
Examination of buccal mucosa
 Intraoral Examination

– Periksa juga saliva flow rate dan kualitas

– Periksa abnormal frenal attachment/tongue
tie karena bisa menyebabkan gangguan
bicara
– Periksa gingiva (adanya kemerahan,
pembengkakan, ulserasi, perdarahan
spontan)
 Intraoral Examination

– Nilai kebersihan rongga mulut, adanya plak

dan calculus
– Adanya inflamasi gingiva tanpa adanya plak
akan menyebabkan gigi tanggal atau gigi
goyang pada gigi permanen menandakan
adanya penyakit sistemik yang serius
 Intraoral Examination

Pemeriksaan jaringan keras

– Periksa semua geligi
– Periksa jumlah, bentuk, warna dan struktur
permukaan
– Periksa dengan cahaya yg terang, isolasi dan
kering
 Intraoral Examination
Pemeriksaan gigi
– Periksa adanya gigiyang hilang/kelebihan
– Adanya karies aktif/arrested
– Restorasi masih intact/tidak
– Periksa adanya trauma gigi besarnya, lokasi,
vitalitas pulpa
– Kegoyangan gigi (Fisiologis/patologis)
– Struktur gigi(lokal/menyeluruh)
mis: fluorosis
Tooth number – missing/extra
teeth
Caries-active/arrested
Restorations-intact/deficient
 Trauma
Note :
Extent, site or sign of
loss vitality
 Tooth mobility
Physichological/Patol
ogical
 Tooth structure
Record any
generalized/localiz
ed defect, eg.
fluorosis
 Intraoral Examination

Pemeriksaan oklusi
– Lihat relasi molar dan caninus
– Analisis relasi incisal, relasi caninus, relasi
molar sulung, garis median, adanya
crowding/spacing,adanya kelaianan skeletal
yg parah.
Evaluation of Occlusion
Incisal Relationship
Canine Relationship
 Primary molar Relationship

Distance st ep Mesial step Flush terminal plane

Normal midline and teeth with
midline shift
Presence of crowding
ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
 Provisional Diagnosis

Diagnosis ditegakkan berdasar history dan

gejala klinik pasien
Diikuti special examination, final dignosis,
treatment planning
ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
 Special Examination
Radiograph
Pulp Sensibility
Pemeriksaan darah
Pemeriksaan mikrobiologi
Photography
Diagnostic casts
Caries Activity Test
Advance Diagnosis
Biopsy
ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
 Final Diagnosis

Diagnosis final setelah mempertimbangkan DD

ORAL EXAMINATION, DIAGNOSE AND
TREATMENT PLANNING IN CHILDREN

• RECORDING THE
HISTORY
• CLINICAL
EXAMINATION
• PROVISIONAL
DIAGNOSIS
• SPECIAL
EXAMINATION
• FINAL DIAGNOSIS
• TREATMENT PLAN
 Treatment Plan
Emergency :
– Px dg abses akut dan sakit perlu dilakukan
open bur
Medical :
– Px dikirim ke dokter spesialis atau
konsultasi dg dokter keluarga/dr sp anak
Preventive
– Risk Assesment dg caries diagnosis, dyes,
diet charts dan preventive lain : fossire
sealant, Fluoride application, ART etc
 Treatment Plan
Preparatory :
– Behaviour management, consultation with
other dental disciplines for
interdisciplinary approach
– Oral prophylaxys
Corrective
– Resorative, endodontic, surgical,
orthodontic, periodontic, prosthodontic
Maintenance :
– Tergantung kondisi px mulai 1 mg /6bln/1 th
Terima Kasih