xii ACKNOWLEDGEMENT

edly one of the most challenging clinical specialties able to find many, if not most, of the answers they
at all levels. We certainly cannot claim to have all seek.
the answers, but we hope that students, practition-
ers, and researchers who are willing to commit the Stephen F. Rosenstiel, Columbus, Ohio
significant amount of time and discipline necessary Martin F. Land, Alton, Illinois
to achieve mastery of Fixed Prosthodontics will be Junhei Fujimoto, Tokyo, Japan
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1
HISTORY TAKING
AND CLINICAL
EXAMINATION

tion involving all the teeth in an entire arch or the

KEY TERMS entire dentition.
chief complaint palpation To achieve predictable success in this technically
click percussion exacting and demanding field, there must be metic-
communication periodontal examination ulous attention to every detail: from the initial
dental history slide patient interview and diagnosis, through the active
fixed prosthodontics systemic conditions treatment phases, and to a planned schedule of
fremitus temporomandibular joint follow-up care. Otherwise, the result is likely to be
medical history (TMJ) dysfunction unsatisfactory and frustrating for both dentist and
patient, resulting in disappointment and loss of con-
fidence in each other.
Problems encountered during or after treatment
can often be traced to errors and omissions during
ixed prosthodontic treatment involves the re- history taking and initial examination. An inexperi-

F placement and restoration of teeth by artificial

substitutes that are not readily removable from
the mouth. Its focus is to restore function, esthetics,
enced clinician may plunge into the treatment phase
before collecting sufficient diagnostic information
that helps predict likely pitfalls.
and comfort. Fixed prosthodontics can offer excep- Making the correct diagnosis is prerequisite for
tional satisfaction for both patient and dentist. It formulating an appropriate treatment plan. This
can transform an unhealthy, unattractive dentition requires that all pertinent information be obtained.
with poor function into a comfortable, healthy occlu- A complete history includes a comprehensive assess-
sion capable of years of further service and greatly ment of the patient’s general and dental health,
enhance esthetics (Fig. 1-1A and B). Treatment can individual needs, preferences, and personal circum-
range from the fairly straightforward restoration of stances. This chapter reviews fundamentals of
a single tooth with a cast crown (Fig. 1-1C) or history taking and clinical examination, with special
replacement of one or more missing teeth with emphasis on obtaining the necessary information to
a fixed dental prosthesis (Fig. 1-1D) or implant- make appropriate fixed prosthodontic treatment
supported restoration to a highly complex restora- decisions.

3
4 PART I PLANNING AND PREPARATION

A B

C D

Fig. 1-1
A severely damaged maxillary dentition (A) restored with metal-ceramic fixed prostheses (B). C, Complete cast crown restores
mandibular molar. D, Three-unit fixed dental prosthesis replacing missing mandibular premolar. (C, Courtesy of Dr. X Lepe. D, Courtesy of
Dr. J. Nelson.)

HISTORY chief complaint as the major problem. Therefore,

when a comprehensive treatment plan is proposed,
A patient’s history should include all pertinent in- special attention must be given to how the chief com-
formation concerning the reasons for seeking plaint can be resolved. The inexperienced clinician
treatment, along with any personal information, trying to prescribe an “ideal” treatment plan can lose
including relevant previous medical and dental sight of the patient’s wishes. The patient may then
experiences. The chief complaint should be become frustrated because the dentist apparently
recorded, preferably in the patient’s own words. A does not understand or does not want to understand
screening questionnaire (Fig. 1-2) is useful for the patient’s point of view.
history taking; it should be reviewed in the patient’s Chief complaints usually belong to one of the
presence to correct any mistakes and to clarify incon- following four categories:
clusive entries. If the patient is mentally impaired • Comfort (pain, sensitivity, swelling)
or a minor, the guardian or responsible parent must • Function (difficulty in mastication or speech)
be present. • Social (bad taste or odor)
• Appearance (fractured or unattractive teeth or
restorations, discoloration)
Chief Complaint
The accuracy and significance of the patient’s Comfort
primary reason or reasons for seeking treatment If pain is present, its location, character, severity, and
should be analyzed first. These may be just the frequency should be noted, as well as the first time
obvious features, and careful examination often it occurred, what factors precipitate it (e.g., hot, cold,
reveals problems and disease of which the patient or sweet things), and any changes in its character.
is unaware; nevertheless, the patient perceives the Is it localized or more diffuse in nature? It is often
Chapter 1 HISTORY TAKING AND CLINICAL EXAMINATION 5

HEALTH QUESTIONNAIRE

REG. NO.
Name Date Age
Write Yes or No.
1. Have you been hospitalized or under the care of a physician with the last 2 years?
2. Has there been a change in your general health within the past 2 years?
3. Are you allergic to penicillin or any other drugs?
4. Indicate Yes or No to any of the conditions below for which you are being treated or you have had:
Y / N Heart attack Y / N Hives, skin rash Y / N Substance abuse
Y / N Heart trouble Y / N Cancer treatment Y / N AIDS
Y / N Heart surgery Y / N Radiation therapy Y / N HIV infection
Y / N Angina (chest pain) Y / N Ulcers Y / N Diabetes
Y / N High blood pressure Y / N Gastritis Y / N Hepatitis
Y / N Prolapsed mitral valve Y / N Hiatus hernia Y / N Kidney trouble
Y / N Heart murmur Y / N Easy bruising Y / N Psychiatric treatment
Y / N Artificial heart valves Y / N Excessive bleeding Y / N Fainting spells
Y / N Congenital heart lesions Y / N Artificial joint Y / N Seizures
Y / N Cardiac pacemaker Y / N Arthritis Y / N Epilepsy
Y / N Rheumatic fever Y / N Asthma Y / N Anemia
Y / N Stroke Y / N Persistent cough
Y / N Allergies Y / N Emphysema
Women only
Do you use tobacco? Y / N Type How much? Y / N Currently pregnant
Y / N Nursing
Do you drink alcohol? Y / N Type How much? Y / N Female problems
5. Have you had any serious illness, disease, or condition not listed above?
If so, explain

6. Indicate date of your last physical examination

7. Name and address of your personal physician

8. List any medications you are currently taking

9. Have you had any problems or anxiety associated with previous dental care?
If so, explain

DENTAL QUESTIONNAIRE
Indicate Yes or No to the following:
Y / N 10. Does it hurt when you chew?
Y / N 11. Is a tooth sensitive or tender?
Y / N 12. Do you have frequent toothaches or gum pain?
Y / N 13. Do your gums bleed a lot when you brush your teeth?
Y / N 14. Do you have occasional dryness or burning in your mouth?
Y / N 15. Do you have occasional pain in the jaws, neck, or temples?
Y / N 16. Does it hurt when you open wide or take a big bite?
Y / N 17. Does your jaw make "clicking or popping" sounds when you chew or move your jaw?
Y / N 18. Do you suffer from headaches?
Y / N 19. Do you have occasional ear pain or pain in front of the ears?
Y / N 20. Does your jaw "feel tired" after a meal?
Y / N 21. Do you ever have to search for a place to close your teeth?
Y / N 22. Does a tooth ever get in the way?
23. Is there anything you wish to tell us that has not been asked?
24. Were there any items you did not understand?
I will inform the Clinic of any changes in the above
Person completing form sign here:
self parent guardian
Circle relationship
If minor: parent or legal guardian signature
Date signed:

Fig. 1-2
Screening questionnaire.