History And General Examination

The patient's medical history should be reviewed and updated at least annually. The patient should be examined using the principles introduced in Chapter 1. Particular attention is paid to the soft tissues, because early signs of oral cancer may be detected at a recall appointment.

ORAL HYGIENE, DIET, AND SALIVA

Patients tend to become somewhat less diligent in their plaque-control efforts when the active phase of their treatment is completed. The dentist should look carefully for any signs of deterioration in oral hygiene and assess the general effectiveness of plaque control at every recall with an objective index (Fig. 32-7). Deficiencies must be identified early, and corrective therapy should be initiated. The dentist should ask about changes in diet, particularly increased sugar consumption or "fad" diets. Excessive weight loss or gain should also be investigated. For instance, a patient who has recently stopped smoking may start ingesting large amounts of candy, with a resulting increase in carious damage.

Saliva plays an important role in dental caries. Patients with xerostomia can rapidly develop extensive carious lesions . 7 Diagnosing the cause of reduced saliva is imperative and is often due to drug side effects.

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