The Dental Examination

Dentists and dental hygienists are very serious about regular dental examinations. It may be the most important service we provide. Unfortunately, many of our patients do not value dental examinations. Maybe it is because dentists and hygienists do not explain what we are doing or why we do it.

The dental exam begins even before the dental professional puts on their gloves. We ask the patient to alert us to changes in their health. Many illnesses effect oral health. Ailments such as Gastro-Esophageal Reflux Disease (GERD), diabetes, and rheumatoid arthritis will effect oral health. These diseases and others will cause dramatic increases in dental decay and gum disease.

Over 400 medications cause dry mouth or xerostomia. Some medications cause overgrowth of gum tissue, mouth sores, change in taste, and discoloration of teeth.

Sometimes it is the other way around. Gum disease may cause trouble for diabetics and might increase the risk of stroke. People who take bisphosphonate medications such as Boneva and Fosamax are more likely to have serious side effects when the patient has poor oral health. Gum disease will shorten the service life of artificial joints.

Diet can easily affect oral health. The dentist and hygienist will caution against regularly drinking soda. Even sugar free soda is acidic enough to accelerate tooth decay. Sticky sweet foods such as dried fruit and sticky candy are cariogenic (decay causing).

Next, the hygienist and dentist will perform a thorough head and neck exam. We check for problems with the temporo-mandibular joint (the TMJ or jaw joint) and the muscles that make it work. This is the most complicated joint in the body. Pain in the TMJ or in these muscles may feel like a tooth ache or head ache.

Swelling in the neck or cheek might indicate infection or cancer. White or red patches on the inner surface of the lips or cheeks, under the tongue, or on the tongue may be a sign of oral cancer. Oral cancer can be deadly; early diagnosis is very important.

Most adults and many children have gum disease. Dentists and hygienists examine the gums carefully for changes in color and texture. Part of the exam involves measuring the depth of the pocket around each tooth. Pockets that are over 3mm (1/8 of an inch) deep are caused by gum disease. Gums should not bleed when brushing or during this exam. The gum exam should not hurt. Pain and bleeding are signs of gum disease.

Of course, the dental examination includes an examination of the teeth. Dental professionals check for signs of decay - stain, chalky enamel, soft tooth structure. Worn, damaged restorations (fillings, crowns and bridges) can lead to dental decay and tooth loss. Loose dentures can cause mouth sores and quicken the loss of remaining natural teeth.

Dental x-ray images or radiographs help the dentist diagnose the dental diseases tooth decay and gum disease. These same images are the only way to diagnose cysts and infections around the roots of teeth. Sometimes oral cancer will show up as a dark spot on a radiograph. Additionally, dental x-ray images help dentists diagnose systemic illness.

Daily oral hygiene (brushing and flossing) is the most important ingredient in oral health care, but no one is able to clean their teeth perfectly every day. A professional prophylaxis or cleaning once every two to six months can clean the areas that suffer from neglect. Wait too long for that cleaning, and the dental professional will need to recommend a more extensive cleaning, deep scaling or full mouth scaling to remove calculus (tartar) from inside pockets in the gums around the teeth.

While cleaning the teeth, the hygienist or dentist will find the spots the patient misses when brushing and flossing. This is the perfect opportunity to help the patient improve their technique. Expect the dental assistant, dentist, or hygienist to spend some time reviewing the best way to floss, or hold the tooth brush.

Professional applications of fluoride are effective at preventing tooth decay and calming sensitive teeth. Some patients benefit from the use of a more concentrated fluoride at home.

Does the patient have gum disease, tooth decay, or missing teeth? They may need dental treatment. The dentist will list the treatment recommendations, explain them, and pass them on to one of the office staff. The office staff person will print the treatment plan, and submit it to the patient's insurance company when necessary. It is important for the patient to know what the treatment will cost, what their insurance will pay, and what will come out of their pocket. Many dental offices offer a variety of ways to pay for dental treatment. The office staff will explain the options to the patient.

Next time you visit your dental office for an examination and prophylaxis, please be on time. Please appreciate how important this appointment is, and please do not say to your hygienist or dentist that you are in the office for "just a checkup."