At Elite Dental Associates, we pride ourselves in being as thorough as possible in our dental exams. Dr. Chang, his associates and hygienist follow the guidelines set forth by the American Dental Association (ADA) to provide our new and existing family of patients with the most comprehensive examination possible. This is done through our stringent procedure of examination and radiography.The ADA recommends “comprehensive dental exams” for all patients that are new to a practice and for “established” patients, those who are already in the practice, every three years. ADA defines a comprehensive oral exam as an extensive evaluation and the recording of all extraoral, intraoral and soft tissues.ADA defines a “periodic oral exam” as a dental exam that is done on established patients to determine any changes in dental and health status since a previous comprehensive or periodic evaluation. A comprehensive exam lays the foundation for the “routine (periodic) oral exam” and is much more than just a cleaning.
The mouth is really a window into the body. Medical conditions may be discovered by a comprehensive dental exam before symptoms show up elsewhere in the body. Some examples are:
By doing a comprehensive exam, we can together devise a strategy for long-term health and comfort.
Dental Radiographs are commonly called x-rays. Dentists use radiographs for many reasons: to find hidden dental structures, malignant or benign masses, bone loss, and cavities.
A radiographic image is formed by a controlled burst of X-ray radiation which penetrates oral structures at different levels, depending on varying anatomical densities, before striking the film or sensor. Teeth appear lighter because less radiation penetrates them to reach the film. Dental caries, infections and other changes in the bone density, and the periodontal ligament, appear darker because X-rays readily penetrate these less dense structures. Dental restorations (fillings, crowns) may appear lighter or darker, depending on the density of the material.
The dosage of X-ray radiation received by a dental patient is typically small (around 0.150 mSv for a full mouth series, according to the American Dental Association website), equivalent to a few days’ worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area). Incidental exposure is further reduced by the use of a lead shield, lead apron, sometimes with a lead thyroid collar. Technician exposure is reduced by stepping out of the room, or behind adequate shielding material, when the X-ray source is activated. This exposure is also significantly reduced with digital technology…. Something that is utilized at Elite Dental Associates for the safety of our family of patient and staff itself.
Once digital/photographic film has been exposed to X-ray radiation, it needs to be developed, traditionally using a process where the film is exposed to a series of chemicals in a dark room, as the films are sensitive to normal light. This can be a time-consuming process, and incorrect exposures or mistakes in the development process can necessitate retakes, exposing the patient to additional radiation. Digital x-rays, which replace the film with an electronic sensor, address some of these issues, and are becoming widely used in dentistry as the technology evolves. They may require less radiation and are processed much quicker than conventional radiographic films, often instantly viewable on a computer. However digital sensors are extremely costly and have historically had poor resolution, though this is much improved in modern sensors.
This preoperative photo of tooth, (A), reveals no clinically apparent decay other than a small spot within the central fossa. In fact, decay could not be detected with an explorer. Radiographic evaluation, (B), however, revealed an extensive region of demineralization within the dentin (arrows) of the mesial half of the tooth. When a bur was used to remove the occlusal enamel overlying the decay, (C), a large hollow was found within the crown and it was discovered that a hole in the side of the tooth large enough to allow the tip of the explorer to pass was contiguous with this hollow. After all of the decay had been removed, (D), thepulp chamber had been exposed and most of the mesial half of the crown was either missing or poorly supported.
It is possible for both tooth decay and periodontal disease to be missed during a clinical exam, and radiographic evaluation of the dental and periodontal tissues is a critical segment of the comprehensive oral examination. The photographic montage at right depicts a situation in which extensive decay had been overlooked by a number of dentists prior to radiographic evaluation.