Classification of indices

In general, there are two types of Dental indices.

The first type of index measures the ‘number’ or ‘proportion ‘ of people in a population with or without a specific condition at a specific point in time or interval of time.

The send type of Dental index measures the ‘number of people affected’ and the ‘severity’ of a specific condition at a specific time or interval of time.

1.Based upon the direction in which their scores can fluctuate:

▪️Irreversible index:

An index that measures conditions whose scores will not decrease on subsequent examinations. Eg: DMFT index.

▪️Reversible index:

An index that measures conditions that can increase or decrease on subsequent examinations. Eg: Loe and Silness gingival index.

2.Depending upon the extent to which areas of oral cavity are measured

▪️Full mouth indices:

These indices measure the patient’s entire periodontium or dentition. Eg: Russell’s Periodontal Index

▪️Simplified indices:

These indices measure only a representative sample of the dental apparatus. Eg: Greene and Vermillion’s Oral Hygiene index – Simplified

3.Indices may be classified under certain general categories according to the entity which they measure

▪️Disease index:

The ‘D’ (decay) portion of the DMFT index best exemplifies a disease index.

▪️Symptom index:

The indices measuring gingival/sulcular bleeding are essentially symptom indices.

▪️Treatment index:

The ‘F’ (filled) portion of the DMFT index best exemplifies a treatment index.

4.Dental indices can also be classified under special categories as,

▪️Simple index

An index that measures the presence or absence of a condition. Eg: Silness and Loe Plaque Index

▪️Cumulative index:

Am index that measures all the evidence of a condition, past and present. Eg:DMFT index for dental caries.

References:

Textbook of Public Health Dentistry – Soben Peter 6th edition.

FREY SYNDROME

Also known as Auriculotemporal syndrome or Gustatory sweating, it is an unusual phenomenon which arises as a result of damage to the auriculotemporal nerve and subsequent reinnervation of sweat glands by parasympathetic salivary fibers.

Etiology: This syndrome follows some surgical operation (area involving auriculotemporal nerve) , during which the damaged nerve regenerates, parasympathetic nerve supply develops, interacting sweat glands, which then function after salivary, gustatory, or psychic stimulation.

Clinical features: Patient typically exhibits flushing and sweating of the involved face, mainly temporal region, during eating.

Profused sweating can be evoked by parenteral administration of pilocarpine or eliminated by administration of atropine or a prominent block of auriculotemporal nerve.

The syndrome is a possible complication of parotitis, parotid tumor, ramus resection, mandibular resection for correction of prognathism. It has been reported as a complication in as high as 80% of cases following parotidectomy.

Treatment: Intracranial division of auriculotemporal nerve.

Reference: Shafer’s Textbook of Oral Pathology, 9th edition.

Muscles of facial expression

Muscles of face bring about different types of facial expressions, hence the name muscles of facial expression, the actions of many of them are implied by their names.

CHARACTERISTICS:

  1. Lie in superficial fascia and inserted into the skin.
  2. Morphological, they represent subcutaneous muscle of lower animals, called panniculus carnosus.
  3. Embryologically, develop from mesoderm of 2nd pharyngeal arch, hence supplied by facial nerve
  4. Functionally, perform all important functions of non-verbal communication in addition to closing and opening of orifices.

MUSCLES AROUND THE ORIFICE OF EYE

🔹️Orbicularis oculi

Consists of three parts:

  1. Orbital part: arises from medial palpebral ligament, frontal process of maxilla and adjoining part of frontal bone. Fibres form complete elliptical loops around the eyes.

It closes the eye tightly during intense sunlight and also for winking.

2. Palpebral part: arises from medial palpebral ligament and sweeps laterally over the upper and lower eyelids to be inserted into lateral palpebral ligament.

It closes the eyelids gently as in sleep or in blinking.

3. Lacrimal part: arises from posterior lacrimal crest and lacrimal fascia and passes laterally in front of tarsal plates of both eyelids to be inserted into lateral palpebral range.

It dilates the lacrimal sac , thus helping in the drainage of lacrimal fluid.

🔹️Corrugator supervision

It arises from medial end of superciliary arch, passes laterally and upwards to be inserted into the skin of eyebrow.

It drags the eyebrow medially and downwards producing vertical wrinkles on the the forehead.

🔹️Frontalis

It elevates the eyebrows and produces transverse wrinkles on the forehead.

🔹️Levator palpebra superioris

It elevates the upper eyelid.

MUSCLES AROUND NASAL CAVITY

🔹️Procerus

Arises from nasal bone, passes upwards to be inserted into the skin of lower part of the forehead.

It produces transverse wrinkles across the bridge of the nose.

🔹️Nasalis

Consists of 2 parts:

  1. Compressor naris: arises from maxilla close to nasal notch, passes upwards and medially to form aponeurosis across the bridge of the nose.

It compresses the nasal aperture.

2. Dilator naris: arises from maxilla for the margin of nasal notch and inserted into the lateral part Ala of nose.

Dilates the anterior nasal apertures.

🔹️DEPRESSOR SEPTI

It arises incisive fossa of the maxilla and is inserted into the lower mobile part of the nasal septum.

It fixes the nasal septum to allow dilation of anterior nasal aperture by dilator naris.

MUSCLES AROUND MOUTH

🔹️Orbicularis Oris

It has extrinsic and intrinsic portions. The major extrinsic portion is composed of interlacing fibres of the muscles which converge around the mouth for their insertion into the lips. The fibres of buccinator converge towards modulus and form chiasma.

The intrinsic portion consists of fibres running obliquely between the skin and mucous membranes of lips, incisive slips, which pass laterally into lips and interlace with fibres of peripheral part of orbicularis oris.

🔹️Nine muscles which converge around the mouth

  1. Levator labii superioris alaeque nasii: arises from frontal process of maxilla, inserted into Ala of nose. Elevates upper lip and dilates the nostrils.
  2. Levator labii superioris: arises from maxilla just above infraorbital frames and inserted into upper lip. Elevates upper lip.
  3. Levator anguli oris: arises from maxilla below infraorbital foramen, inserted into angle of mouth. Raises the angle of mouth.
  4. Zygomaticus minor: arises from zygomatic bone, inserted into upper lip. Elevates upper lip.
  5. Zygomaticus major: arises from zygomatic bone, inserted into angle of mouth. Draws angle of mouth upward and laterally.
  6. Depressor labii inferioris: arises from anterior oblique line of mandible, inserted into lower lip. Draws lower lip downward and laterally.
  7. Depressor anguli oris: arises from posterior part of oblique line of mandible, inserted into angle of mouth.
  8. Risorius: arises from parotid fascia, inserted into angle of mouth. Retracts angle of mouth gently.
  9. Buccinator: arises from outer surface of alveolar process of maxilla, pterygomandibular raphe, outer surface of alveolar process of mandible. It flattens the cheek and helps in blowing the cheek.

Muscle of chin: Mentalis

Arises from incisive fossa of mandible, inserted into lower lip.

It puckers the chin and protrudes the lower lip.

REFERENCE:

Vishram Singh: Textbook of Anatomy

CLINICAL EXAMINATION OF DENTIN HYPERSENSITIVITY

  1. Evidence of dentin exposure (gingival recession, loss of enamel)
  2. Sensitivity or pain on tactile examination of suspected teeth
  3. Evaporative stimulus: Suspected tooth is isolated using cotton rolls. If a momentary blast of air from air/water syringe causes sensitivity. It can confirm DH
  4. percussion sensitivity
  5. Pain lingering after the stimulus is removed
  6. Vitality tests to rule out pulpal involvement
  7. Radiographic examination to check for caries, pulpal or periodontal involvement
  8. Signs of fractured, leaky or poor restorative margins.

Reference: Clinical operative dentistry-principles and practice : Ramya Raghu, Raghu Srinivasan

CASE HISTORY 👩‍⚕️🦷

CASE HISTORY

“It is defined as planned professional conversation that enables the patient to communicate his/her symptoms, fears and feelings so as to obtain an insight into the nature of patient’s illness” 🤒

It includes the following sequence;

🔰Personal information: name, age, sex(M/F), occupation, address with contact no., O.P no. are noted.

It is recorded to create a rapport with the patient. To assess their socio-economic status, age-related risk factors.

🔰Chief complaint: It ascertains the principle reason as to why the patient is seeking medical attention.

Complaint is recorded verbatim in patient’s own words: symptoms,onset,duration, previous treatments, history of illness.

🔰Dental history: Helps in reviewing patient’s risk status and past dental experiences. It’ll add info. about patient’s current dental problems.

🔰Medical history: Helps identify conditions that could alter, complicate, or contraindicate proposed dental procedures. Following may be detected:

🔸️Communicable diseases: herpes simplex,chicken pox, mumps, tuberculosis etc. Should be questioned about contact with hepatitis B, HIV.

🔸️Allergies and drug history: Drug allergies ( local anesthetics like novocaine, analgesics, antibiotics)

Also certain medications 💊 can alter the treatment:

Ex:- Antiepileptic drugs – gingival enlargement

🔸️Systemic health: Cardiac abnormalities:- risk of bacterial endocarditis following dental procedures.

In such cases, prophylactic antibiotic cover is given.

Diseases of respiratory system:- may be on bronchodilators, antihistamines or steroid therapy. May interfere with anesthetic management.

Diseases of endocrine, neurological, hematological, infectious, reproductive, gastric, renal, liver, autoimmune, psychiatric should be noted.

🔸️Aging: In geriatric group, medications and illness can alter oral physiology, maintenance of hygiene and treatment plan.

🔰Social review: Helps to identify patient’s attitudes, expectations and motivation for dental treatment.

🔰Family and personal history:

Gives an overview of patient’s lifestyle.

▪️Habits like chewing tobacco, quicklime, areca nut, pan masala, gutka, chronic alcoholism, chronic smoking etc.

▪️A detailed history of immediate family of the patient, with their age, general health, medical ailments, cause and age at the time of death of any deceased member is recorded. A family history of epilepsy, cardiac disorders, diabetes, bleeding disorders and tuberculosis is of particular importance.

Sometimes, dentist is the first person to recognize any disease in a patient 🌻