Fremitus Of Tooth

Tooth Charting System

Fig. 1-19. A, An appropriate charting system will designate the location, type, and extent of existing restorations and the presence of any disease condition, all of which become part of the permanent pa-

Continued tient record.

Fig. 1-19. A, An appropriate charting system will designate the location, type, and extent of existing restorations and the presence of any disease condition, all of which become part of the permanent pa-

Continued tient record.

movement from the initial contact to the MI position is carefully observed and its direction noted. This is referred to as a slide from CR to MI. The presence, direction, and estimated magnitude of the slide are recorded, and the teeth on which initial contact occurs are identified. Any such discrepancy between CR and MI should be evaluated in the context of other signs and symptoms

Full Mouth Series
c D e

Fig. 1-19, cont'd. B, Radiographic findings obtained from a full-mouth series are correlated with the clinical findings and noted in the record. C to E, Charting is performed to provide a quick reference to conditions in the mouth. The following may be useful:

1. Amalgam restorations (C) are depicted by an outline drawing blocked in solidly to show the size, shape, and location of the restoration.

2. Tooth-colored restorations (D) are depicted by an outline drawing of the size, shape, and location of the restoration.

3. Gold restorations (E) are depicted by an outline drawing inscribed with diagonal lines to show the size, shape, and location of the restoration.

4. Missing teeth are denoted by a large X on the facial, lingual, and occlusal diagrams of each tooth that is not visible clinically or on radiographs.

5. Caries is recorded by circling the tooth number located at the apex of the involved tooth and noting the presence and location of the cavity in the description column corresponding to the tooth number on the right.

6. Defective restorations are recorded by circling the tooth number and noting the defect in the description column.

(Modified slightly from Sturdevant CM et al: The art and science of operative dentistry, ed 3, St Louis, 1994,

Mosby.)

that may be present (e.g., elevated muscle tone previously observed during the extraoral examination, mobility on the teeth where initial contact occurs, wear facets on the teeth involved in the slide).

General Alignment (Fig. 1-20). The teeth are evaluated for crowding, rotation, supra-eruption, spacing, malocclusion, and vertical and horizontal overlap. Teeth adjacent to edentulous spaces often have shifted position slightly. Small amounts of

Teeth Structure Drawing
Fig. 1-20. Alignment of the dentition can be assessed in-traorally, although diagnostic casts allow a more detailed assessment. This patient has caries-free teeth in good alignment.

tooth movement can significantly affect fixed prosthodontic treatment. Tipped teeth will affect tooth preparation design or in severe cases, may result in a need for minor tooth movement before restorative treatment. Supra-erupted teeth are often overlooked clinically but will often complicate fixed partial denture design and fabrication.

The relative relationship of adjacent teeth to teeth requiring fixed prosthodontic treatment is important. A tooth may have drifted into the space previously occupied by the tooth in need of treatment because a large filling was previously lost. Such changes in alignment can seriously complicate or preclude fabrication of a cast restoration for the damaged tooth and may even necessitate its extraction.

Lateral and Protrusive Contacts. Excursive contacts on posterior teeth may be undesirable under certain circumstances (see Chapter 4).

The degree of vertical and horizontal overlap of the teeth is noted. When asked, most patients are capable of making an unguided protrusive movement. During this movement, the degree of posterior disclusion that results from the overlaps of the anterior teeth is observed.

The patient is then guided into lateral excursive movements, and the presence or absence of contacts on the nonworking side and then the working side is noted. Such tooth contact in eccentric movements can be verified with a thin Mylar strip (shim stock). Any posterior cusps that hold the shim stock will be evident (Fig. 1-21). Teeth that are subject to excessive loading may develop varying degrees of mobility. Tooth movement (fremitus) should be identified by palpation (Fig. 1-22). If a heavy contact is suspected, a finger placed against the buccal or

Mylar Shim Stock Check Occlusion
Fig. 1-21. Eccentric tooth contact can be tested with thin Mylar shim stock.
Fremitus Dental Test
Fig. 1-22. Fremitus (movement on palpation) indicates tooth contact during lateral excursions.

labial surface while the patient lightly taps the teeth together will locate fremitus in MI.

Jaw Maneuverability. The ease with which the patient moves the jaw and the way it can be guided through hinge closure and excursive movements should be assessed, since these factors are a good guide to neuromuscular and masticatory function. If the patient has developed a pattern of protective reflexes, manipulating the jaw will be difficult. The patient's restricted maneuverability is recorded.

The Full Mouth Survey
Fig. 1-23. A to C, A full-mouth radiographic survey should enable the dentist to make a detailed assessment of the morphology of each tooth and its bone support.

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