Hard Tissue Charting

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Hard Tissue Charting

• Dental Hygiene Theory
• Instructor Nickee dela Cruz R.R.D.H.

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Hard Tissue Charting

• Is completed documented at the ASSESSMENT
  appointment
• Is updated at each maintenance appointment
• Should follow a routine so that nothing is missed
  (sequencing)
• Do not use erasers or white out, if you make a
  mistake stroke 1 line through it date initial
  the change

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Charting

• Conditions which exist or are present in the oral
  cavity are recorded in BLUE
• Carious lesions, teeth requiring treatment
  (extractions other pathologic conditions, such
  as abcesses) are recorded in RED
• SUSPECTED carious lesions are charted in GREEN,
  but if they are diagnosed by the DDS as being
  decay, they are changed to RED

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Normal, Atypical, Abnormal Findings to Observe
during Hard Tissue Exams
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The dental hygienist should be able to

• Recognize signs of development anomalies
  acquired tooth damage bring them to the DDSs
  attention
• Be able to properly document in the odontogram
  (hard tissue) in the clients chart

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Anomalies of the Teeth

• Hyperdontia or supernumary teeth, extra teeth
  such as mesiodens which will occur between the
  maxillary anterior teeth
• Hypodontia absence of 1 or 2 teeth or
  anodontia, congenitally missing teeth most common
  are 3rd molars than maxillary lateral incisors,
  than mandibular premolars

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Mesiodens
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Mesiodens (arrow). A, Radiographic appearance. B,
Clinical appearance
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Hypodontia
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 Microdontia (arrow)
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Supernumary Teeth
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Anomalies of the Dental Tissue

• Macrodontia larger than normal teeth, they tend
  to be wider, longer, higher than normal teeth,
  may affect several or all teeth in the dentition

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Anomalies of the Dental Tissue

• Gemination a tooth tries to split or twin

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Gemination
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Gemination (arrow)
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Anomalies of the Dental Tissue

• Dens in dente a tooth within a tooth usually
  the lingual of maxillary incisors

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Dens in dente
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Anomalies of the Dental Tissue

• Dilacerations severe distortion or crown or
  root by trauma during formation

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Dilaceration
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Definition of DYSPLASIA

• medically abnormal development or growth of a
  part of the body, for example, an organ, bone, or
  cell, including the total absence of such a part

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Intrinsic StainingStain or discoloration within
the tooth

• Enamel dysplasia
• HYPOPLASIA (rough, pitted enamel surface,
  ameloblasts disrupted during the matrix formation
  of the tooth)
• Interruption of the enamel developmental process
  results in irregular enamel formation or lack of
  enamel formation. Restorative treatment may be
  required because of susceptibility to decay and
  to improve appearance.

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Enamel Hypoplasia
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Enamel hypoplasia
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• Syphilitic enamel hypoplasia.
• A, Hutchinson's incisors.
• B, Mulberry molars.

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Enamel Dysplasia

• HYPOCALCIFICATION defect in enamel during
  mineralization, spotted surface is generally
  smooth, may be from trauma, nutritional
  deficiencies, excess fluoride intake

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Enamel Hypocalcification
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Enamel Dysplasia

• AMELOGENESIS IMPERFECTA hereditary condition
  where dentin pulp develop normally but enamel
  is easily chipped or worn away
• A spectrum of hereditary defects in the function
  of ameloblasts and the mineralization of enamel
  matrix that results in teeth with multiple
  generalized abnormalities affecting the enamel
  layer only.
• teeth vary in color from white opaque to yellow
  to brown   
• all teeth are affected, smaller and pitted

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Amelogenesis Imperfecta
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Enamel Dysplasia

• Dentinogenesis Imperfecta
• The bluish color and translucent features of this
  dentition are very suggestive of dentinogenesis
  imperfecta.
• Unlike amelogenesis imperfecta, the enamel in
  dentinogenesis imperfecta is normal it is the
  underlying dentin that is structurally deficient.

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Dentinogenesis Imperfecta
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Dentinogenesis Imperfecta
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Here is another example of the clinical features
of dentinogenesis imperfecta.
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Dentin Dysplasia (Rootless Tooth)

• A hereditary defect in dentin formation in which
  the coronal dentin and tooth color is normal the
  root dentin is abnormal with a gnarled pattern
  and associated shortened and tapered roots

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Taurodontism

• A malformed multirooted tooth characterized by an
  altered crown-to-root ratio, the crown being of
  normal length, the roots being abnormally short,
  and the pulp chamber being abnormally large.
• Observed on radiographs shows enlarged pulp
  chamber resulting in thinner dentin

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Taurodontism
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Talon Cusp

• Lingual of maxillary mandibular anterior teeth

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Acquired Anomalies

• Attrition wear from tooth on tooth
• Attrition of the mandibular anterior teeth

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Abrasion

• Mechanical tooth wear caused by a foreign
  substance

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Erosion

• Loss to tooth surface due to a chemical agent
• Erosion from sucking on lemons (arrow) NEXT SLIDE

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Tooth Fracture

• Small to large chips or breaks in the enamel

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Surfaces of the Teeth
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Quadrants Primary vs. Permanent
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Charting Symbols for Oxford Dental Hygiene Clinic

• Chapter 13
• pg 247

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Missing Teeth ? M

• Teeth that are not present because of extraction
  or are congenitally missing
• Charting procedure
• Place a vertical line or X through the facial,
  occlusal lingual surfaces
• Chart in BLUE ink

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Unerupted Teeth ? U

• Teeth that have not yet erupted or are impacted
• Circle facial, occlusal, lingual surfaces of
  tooth
• Chart in RED ink

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Teeth to be extracted ? Ex

• Teeth to be extracted because of pathologic or
  orthodontic reasons
• Draw a RED diagonal line through the tooth, or an
  alternative method is to draw 2 RED parallel
  lines through the tooth

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Amalgam Restorations ? A

• Alloy of silver/mercury silver or dark grey in
  color widely used as a restorative material
• Chart surfaces where the restorations appear
• Outline the shade in BLUE for precise notation
  use Blacks classification

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Tooth Colored Restorations ? R resin CR
Composite resin

• Outline exact size shape of restoration
• Shade with BLUE ink
• Chart surfaces involved
• Use Blacks Classification

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Temporary Restorations ? Temp, T

• Temporary filling cements zinc oxide-eugenol
  cement
• Chart temporary restorations the same as amalgam
  or resins in BLUE ink, but distinguish from
  amalgams with the abbreviation

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Veneer ? Ven

• Veneer or layer of resin that is used to cover
  the unsightly area of tooth
• Outline shade in surface of tooth where veneer
  is found
• Chart in BLUE ink

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Full Gold Crown ? FGC

• Can be onlays or inlays or crowns
• Outline fill in with diagonal lines covering
  all surfaces
• Chart in BLUE ink

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¾ Gold Crown ? ¾ GC

• Covers less than ¾ of tooth surfaces
• Outline fill with diagonal lines places on all
  surfaces or portion of surfaces covered by crown
• Chart in BLUE ink

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Ceramic to Metal Crowns

• GCFP crown, porcelain face
• GCAF gold crown, acrylic face
• Chart similarly to gold crowns
• Abbreviation can be used to distinguish it from
  full gold or ¾ crowns
• Chart in BLUE ink

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Gold Inlay ? GI

• Does not cover the cusps
• Outline the shape of the restoration on the
  surfaces where it appears
• Chart in BLUE ink

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Gold Onlay ? GO

• Restoration which involves the cusp tips
• Outline color the shape of the restoration on
  the surfaces where it appears
• Chart in BLUE ink

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Fixed Bridges

• Each tooth may be labeled with the appropriate
  abbreviations FGC, GCPF, ¾ GC
• Outline abutment pontic teeth in BLUE ink
  fill in with diagonal lines on occlusal, facial,
  lingual surfaces
• Chart the pontic teeth as extracted
• Place 2 horizontal lines between the occlusal
  surfaces of the teeth to represent the splinted
  unit

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Dental Implants ? IMPL

• Make a written comment under the teeth involved

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Dental Caries ? C

• Outline the SUSPECTED carious area(s) in GREEN
• Once diagnosed as caries by DDS, outline in RED
• On completion of the restoration, fill in the RED
  areas with BLUE

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Blacks Classification
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Blacks Classification
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Blacks Classification
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Recurrent Decay ? RD

• Outline the area of recurrent decay in RED
• Recurring caries around the margin of an existing
  restoration

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Appliances Partial or Complete Dentures

• PUD partial upper denture
• PLD partial lower denture
• CUD complete upper denture
• CLD complete lower denture
• Chart the missing teeth with vertical lines or
  Xs through all surfaces
• Join vertical lines or Xs with horizontal line
  at root apex label to indicated upper or lower
  partial or complete denture

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Overhanging Restorations ? OH

• Chart with triangular symbols in the
  interproximal area
• Chart in BLUE ink

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Dental Sealants ? S

• Encircle place abbreviation inside the circle
• Chart on occlusal surface in GREEN

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Root Tip ? RT

• Chart tooth as missing place abbreviation
  symbol near root apex
• Chart in BLUE ink

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Root Canal ? RC

• Place vertical line through pulpal area of root
• Label with abbreviation
• Chart in BLUE ink

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Decalcification or Hypocalcification ? Decal

• Outline the area label with abbreviation
• Chart in BLUE ink

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Erosion ? Ero

• Shade area in BLUE place symbol

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Hypoplasia ? Hypoplas

• Chart using wavy lines to denote the irregularity
  of enamel with symbol
• Indicate with abbreviation

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Attrition ? Att

• Place a horizontal line over the affected
  surfaces
• Chart in BLUE ink

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Abrasion ? Abr

• Chart 2 horizontal lines in BLUE ink
• Caused by mechanical wear caused by improper
  toothbrushing or other habits such as chewing on
  pencils, pipe smoking

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Supernumary Teeth ? Su

• Draw additional tooth in location found
• Chart in BLUE ink
• Label with abbreviation

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Other Dental Anomalies

• Other anatomic variations such as dens in dente,
  should be clearly indicated in the record section
  of the dental chart

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TMJ Evaluation

• Detecting or noting any noises while bilaterally
  palpating the TMJ
• Noises include
• CREPITUS (cracking/grinding of the bones rubbing
  together)
• POPPING or CLICKING
• Tenderness pain/muscle tension should also be
  noted

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Percussion

• Is done on each tooth to check for sensitivity,
  by gently tapping the dental mirror handle tip on
  each tooth recording the findings noted as
• Normal WNL
• Sensitive P
• Very Sensitive P
• Extremely Sensitive P

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Open Bite
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Crossbite
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Overbite
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Occlusal relationship of primary molars
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Reviewing Radiographic Findings Relevant to the
Clinical Assessment

• Found on the back of the Hard Tissue

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Radiographic Findings

• Review normal or pathological findings
• Is part of the ASSESSMENT phase can be used in
  the IMPLEMENTATION phase
• Radiographs are also required for documentation
  record keeping of clients dentition ( ie.
  Forensic dentistry often uses radiographs)

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Periodontal Conditions Observed in Radiographs

1. Normal anatomy the tooth crown to root ratio
2. Confirmation of clinical findings topography of
   root surfaces
3. Status of the lamina dura
4. Changes in the PDL
5. Remaining bone height
6. Local irritants such as calculus overhanging
   restorations
7. Patterns or extent of disease
8. Possible furcation areas
9. Disease progression or remission by serial
   radiography