So you have selected your provider and it’s time for the initial exam. Prior to your visit, you should have your previous records (last five years) forwarded the new dentist. This provides some background for the new dentist who can do a comparative analysis with the findings of the new exam.

Let’s review the definition of standard of care:  A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.

The initial exam should include but not be limited to:

1. Review of previous dental and medical records

2. Review and update of current medical history to include:

a. Review of systems to include heart and lungs

b. Hospitalizations in the past five years

c. Current medications.

d. Allergies to medications or latex

3. Review of past dental history

4. Head and Neck exam to include palpation of the swollen lymph nodes. Any external crepitus (crackling, popping, or grating sound) in the TMJ

5. Range of Motion of the TMJ recorded. Any deviations on opening should be noted

6. Oral Cancer exam

7. Complete periodontal exam to include pocket depth measurements (six per tooth) and noted bleeding. Any lack of attached gingival should be recorded.

8. Existing restorations (fillings and crowns) charted.

9. New caries (decay) or cavities recorded

10. Panoramic film taken and reviewed

11. Bitewings radiographs taken and reviewed

Depending on the number of findings, the results of the exam can be discussed or deferred until next appointment, which should be a hygiene or cleaning appointment. I am not a big fan of combining initial exam appointments and hygiene appointments unless appropriate time is allotted.

Next time I will discuss periodontal disease and the basis for many dental malpractice suits.

As always….questions and comments welcomed.


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