Well-defined systems within our offices, such as scheduling, financial arrangements and specialist referrals promote predictable flow and consistency.  However, what about the systems within the systems? These are essentially our mini-systems.

Probably the most important mini-system in our office is the flow of the comprehensive exam. Do we chart existing restorations first? Recession? Periodontal probings? How about maximum opening or decayed, missing, or broken teeth? It's a long list.

 

So, where do we start and how do we make sure we have looked at everything? What is the best order and why? It might help to break the exam into eight categories:
  1. Pre-clinical Interview

  2. Radiographic Exam

  3. Muscle Evaluation

  4. Joint Evaluation

  5. Soft Tissue Evaluation

  6. Existing Dentition and Conditions

  7. Occlusal Evaluation

  8. Periodontal Evaluation


If our goal is to have all eight sections of the exam completed efficiently and accurately but at the same time make sure our patients feel engaged and cared for, an “outside-in” approach might be the most appropriate.

Evaluation of the Muscles and Joints
During the preclinical interview, regardless of the patient’s chief complaint (which we will certainly acknowledge and discuss), we can always find a reason to begin the clinical exam with an evaluation of the muscles and joints. By beginning this way we are demonstrating from the outset that we are focused on the entire system in an effort to guide our patients to health. More importantly, we are allowing our patients to feel our touch in a gentle and non-invasive manner (outside of the mouth), almost like a deep massage of the head and neck. While we do this we can relate to the patient that any positive findings could be related to what we might find in the mouth or to the chief complaint.

Moreover, a systematic approach to the muscle exam (a “micro-mini system,” beginning with the temporalis, down the neck to the suboccipital muscles, para-cervicals and trapezius, then back up the SCM, to the digastrics, and masseters) immediately demonstrates competence and confidence to the patient.

Combining our muscle exam with a thorough palpation of the cervical and submandibular lymph nodes and the thyroid area not only reinforces our focus on overall health, it also serves as the beginning of our soft tissue and oral cancer screening (which will soon serve as our transition into the oral cavity), not to mention another competence and confidence-building component of the “outside-in” examination.

Non-Invasive Manner
Next, a comprehensive evaluation of the joints, coupled with range of motion, pain upon movement, first point of contact in the fully-seated condylar position (FSCP), and direction/magnitude of slide will certainly engage the patient in a similar non-invasive manner and begin to create energy and anticipation of what we might find when we begin our intra-oral examination.

The smooth and gradual transition from outside to inside is facilitated by the soft tissue evaluation and oral cancer screening, beginning with the lips, buccal mucosa, cheeks, hard and soft palate, floor of the mouth, and lateral border of the tongue. Not only does this continue to support our comprehensive approach, but it is also the perfect segue to evaluate recession and attachment levels, our first interaction with the teeth, or at least something that touches the teeth.

At this point we have demonstrated that this is only the beginning of our comprehensive approach to facilitating health. We have also demonstrated our gentle and intentional touch. Equally, if not more important, we have eased into our clinical relationship with the patient, intentionally creating safety by working outside-in. This is a systematic approach to examination that simultaneously provides a predictable and comprehensive exam for the dentist, assistant and patient.


The concept of Facially Generated Treatment Planning can greatly simplify treatment planning for patients. You can find more information about treatment planning, esthetics and occlusion within the Spear Digital Suite. Download the free resource:
The 8 Steps Checklist-Facially Generated Treatment Planning.