Diagnostics precede every therapy of a disease. Only when the cause of the disease has been identified can a targeted therapy be applied. This is also the case in dentistry.
A precise anamnesis is an important prerequisite for dental diagnosis. At the first visit of a new patient, he is generally asked to fill out a questionnaire in which he is asked about known illnesses in the past as well as his current complaints. Afterwards, the nature and extent of the complaints are discussed with the dentist.
The dentist will record the condition of the teeth, gums and oral mucosa and assess the overall dental status. Every single tooth will be evaluated and gaps, bridges, crowns and fillings will be registered and recorded in the tooth status. Then a mirror and probe are used to examine for carious defects.
The mirror can also be used to view areas that are otherwise difficult to examine. The probe is used to detect even caries in its early stages. If it is suspected that periodontal disease is already present and gum pockets are present, the depth of the pockets is measured on the teeth in question using a periodontal probe.
In contrast to the normal probe, the probe is rounded at the tip and has a graduation so that the pocket depth can be read in millimeters. The normal depth is 1 to 2 millimeters. With a pocket depth of up to approx.
5 millimeters, a closed curettage, i.e. removal of all pocket contents causing illness, can still be performed without sight. Pocket depths beyond this require open curettage under visual conditions. Furthermore, the sensitivity to knocking (percussion sensitivity) is examined.
This is done by tapping the tooth with an instrument. The X-ray image shows all findings that cannot be detected by eye contact. For example, it is possible to determine the degree of existing bone resorption or, in the case of dead (devitalized) teeth, the presence of whitening at the root tip, which indicates a suppurative focus that may be asymptomatic but requires treatment.
In the case of root canal treatment, the control is also carried out by means of an X-ray. If a restoration with implants is planned, the X-ray shows whether the bone conditions are sufficient for this. A further development of X-ray technology is digital X-ray.
It has several advantages. An X-ray film is no longer necessary, and therefore no development of the X-ray film is required. The image is immediately available and can also be processed to better recognize details.
There are no poorly exposed images. Orthopantomography is available as a panoramic technique for images of the entire dentition. It provides an overview of the entire dentition in one image.
Detailed information on this diagnostic technique can be found under X-ray. Sometimes it is not quite clear whether a tooth is alive (vital) or dead (devital). In this case, the condition can be determined by means of a vitality test.
In the past, this was done using electricity, which caused quite a lot of pain in living teeth. That is why today we use a cold stimulus, which is produced by a cold spray. If teeth are loosened due to periodontological diseases or bone resorption, the Periotest device can be used to determine the degree of loosening.
Periodontometry thus provides a basis for the necessary therapeutic measures. Staining tablets are available for demonstration in the practice or for home use. The red dye erythrosine makes the plaque visible.
You will be surprised how much of these plaque is still present after brushing your teeth. The staining can then be used to specifically remove the plaque residue. The disadvantage of this method is that the red coloration can also be seen on the tongue and lasts for a while.
In addition to the staining tablets, there are also solutions containing fluorescein, which make the plaque light up green after being illuminated with blue light. The advantage is that without illumination no color impairment can be seen. The disadvantage is the availability of a blue light lamp.
Dental diagnostics is the prerequisite for the necessary therapeutic measures. In addition to the anamnesis and the consultation with the dentist, the dentist has numerous diagnostic tools at his disposal.
