The intraoral examination consists of an inspection of the soft tissues (including the gingiva), the teeth, the occlusion, and the temporomandibular joint. Full-mouth roentgenograms should be taken. In addition, study models and Kodachrome photographs of the dentition may be helpful. It may be necessary to test the vitality of the teeth. The date of the examination should be noted. All data should be carefully charted because they become a part of the patient's record.
A proper dental examination pays attention to the soft tissues as well as the teeth. The condition of the following should be observed: tongue, buccal mucosa, floor of the mouth, palate, frena, throat, and oral mucosa. Do the amount and consistency of saliva appear normal? Are there variations in the color, contour, or firmness of the gingiva? Is the form of the gingiva physiologic? Is the gingiva firm or is it retractable and does it bleed easily? Is the vestibule shallow or deep? Is the zone of gingiva narrow or broad? Does the patient have pain? Are there areas of food impaction? Are any other possible local causes evident? Does the patient relate a history of trench mouth or pyorrhea, recurrent cold sores, cankers or mouth blisters, dental abscesses, sinus trouble, swellings or pain? Is there evidence of these in the mouth?
In examining the gingiva, the clinician must keep the picture of the "normal" gingiva in mind: With this as a guide, he/she can more readily observe the extent and state of inflammation and the distribution of the lesions. The size of the teeth should be noted, and the degree of caries susceptibility should be gauged by the number of restorations and cavities. The type and quality of restorations should be evaluated. In addition, erosions should be noted. The biting surfaces should be examined for excessive occlusal wear. When this is evident, the patient should be questioned as to whether he/she grinds the teeth or chews on one side only.
Does he/she chew tobacco? Is he/she unhappy with the appearance of the mouth? Diastemata should be noted, and proximal contacts tested with dental Hoss. Conditions such as toothbrush abrasion, tooth mobility, tooth malpositions, hypoplastic enamel, supernumerary teeth, nonvital teeth, and tooth sensitivity should be recorded. For tooth sensitivity, questions may be asked conceming the effects of temperature extremes and sweets. The teeth may be percussed.
The general status of oral hygiene should be ascertained. Note the presence of plaque, stain, and calculus. A disclosing solution may be used to show the patient the presence of plaque. In addition, the patient may be questioned concerning the date of the last prophylaxis, the method and frequency of toothbrushing, and cleaning aids used in an attempts to gauge the rate of calculus deposition. At this time some practitioners take a plaque survey. The score indicates the status of the patient's oral hygiene as shown by the stained plaque. During treatment complete indices can be taken and compared with earlier indices to note improvement or lack of improvement in plaque control.
Disclosing solutions and tablets may be used to make plaque visible. Disclosing solutions impart a bright red color to the plaque, stains, and calcified deposits. Two-toned disclosing solutions may be applied to distinguish between old and new plaque. The solutions also stain the imperfect margins of plastic fillings and the mucosa of the lips, cheeks, tongue, and floor of the mouth. Because these stains tend to last on mucosal surfaces for several hours, some patients object to the regular use of disclosing solutions. The stain of disclosing tablets, on the other hand, does not last as long nor is it as intense.
When disclosing tablets are used, the patient is instructed to chew the wafer thoroughly, working it into the saliva, and then to swish the fluid vigorously about the mouth for a minute. Care must be taken that the solution reaches all parts of the mouth. If it does not, surfaces of some teeth may not be stained, even when plaque is present. Proper staining can be attained by a vigorous pumping action of the cheeks to force the solution between the teeth. After about a minute the mouth may be emptied and rinsed gently with water. Examination should be made immediately. The patient should observe the procedure with a mirror.
Obviously the use of stains such as basic fuchsin, Bismark brown, or erythrosin can facilitate the patient's efforts at plaque removal. Stains facilitate the patient's objective: the complete removal of plaque from the tooth surfaces. They provide an effective means of determining whether this objective has been reach ed by the absence of a stain on exposed tooth surfaces.