The Comprehensive Oral Health Evaluation

 Over the past few weeks I have been discussing the process of a comprehensive oral health evaluation.  So far I’ve explained the importance of the temporomandibular joints (TMJ), the muscles that allow the joints to function and a person’s occlusion (bite).  Today I would like to discuss other essential elements of the examination.

A soft tissue examination should always be part of a comprehensive evaluation.  This involves a thorough screening for oral cancer.  Approximately 9,000 to 10,000 people die of oral cancer each year and this doesn’t have to be the case.  If caught in its early stages, oral cancer can most often be eliminated.  But, unfortunately the disease has often progressed to a point where aggressive treatment is necessary.  Oral cancer has one of the lowest five-year survival rates of all cancers because most people don’t know they have it until it is in the advanced stages.  Your dentist will do a screening at your initial examination as well as at every periodic oral hygiene examination. 

Next, your dentist will evaluate the health of the periodontium (gums).  Your dentist will look for a variety of conditions that signal gum disease.  He/she will measure “pockets” around every tooth to diagnose stages of the disease.  Signs such as mobile teeth, bleeding or receding gums also indicate the gums are not healthy.  I like to describe gum disease as the “high blood pressure” of the mouth.  Just like blood pressure, you don’t know you have a problem with gum disease unless it is checked.  Many people are under the impression that gum disease hurts.  I actually wish it was uncomfortable in the early stages because people would have something done to stop the disease process.  Unfortunately, it doesn’t hurt until in the advanced stages when a tooth typically requires removal or heroic surgical procedures to save it.

The next stage of the comprehensive examination involves an evaluation of the teeth.  Of course the dentist screens for decay, but a lot more is involved than just looking for cavities.  Your dentist will look for signs of wear on the teeth which indicate abnormal forces that have been placed on a tooth.  They will look for concerns such as craze (crack) lines in the teeth, root exposure from receding gums, mobility, abfractions (notches at the gum line caused by excessive force from function or abrasion), staining and deteriorating restorations that are in need of replacement.  Unless each tooth is thoroughly examined, long-term health is potentially compromised.

An esthetic evaluation is apt to be included as well.  If a patient has expressed concern about the way their teeth look, they will have the opportunity to “tour” the mouth together with their dentist, discussing each point of concern and treatment alternatives they have.  Today, the world of dentistry offers any one who chooses the opportunity for an incredibly beautiful, natural smile.

As you can see, a comprehensive oral health evaluation involves a lot more than the typical cursory “check up”, but every bit of information is critical to helping a patient maintain optimal health for a lifetime.  Next week I will discuss some of the tools and “records” that assist us in evaluating a patient’s mouth for proper diagnosis and treatment planning.