EXAMS IN DENTISTRY

Diagnosis is the key to success in any area of medicine, including dentistry. Proper diagnosis leads to success in treatment. In dentistry, there are different exams used at different times of a patient’s “career” at the dentist. I would like to clarify some of these in this column.

The Comprehensive Oral Evaluation is the term used to describe the initial exam with a new dentist. For insurance purposes, it is usually paid once in the lifetime of a patient with a single dentist. If a patient does not see the dentist on a regular basis it may be paid for once every 5 years. This evaluation usually is a more detailed exam performed by the dentist. It includes charting of the patient’s teeth (including present/missing teeth and existing restorations), a periodontal exam (to determine the health of the gums and bone that support the teeth), a visual oral cancer screening (a detailed exam of the soft tissues to check for any abnormalities), a review of the patient’s health history (including familial history, medications, etc.), and a general occlusal exam (an evaluation of how the teeth, muscles and TMJ joints are working together). This exam is used as the baseline for where a patient starts in an individual dental practice.

The Periodic Oral Evaluation is the exam that is done in conjunction with visits to the hygienist. For insurance purposes, this exam is usually covered every 6 months. It is separate from the “cleaning” of the teeth. This exam generally looks at the same areas as the previous exam described, but in less detail. The results of this exam are compared to the baseline exam that has been previously completed. Although the exam must be overseen by a dentist, many of the parts of the exam may be performed by the hygienist and reviewed by the dentist.

The Limited Oral Evaluation is the term used to describe an unscheduled visit to the dentist, usually for when a patient presents with a problem. For example, if a patient presents with the chief complaint of a toothache, this exam covers the reading of any necessary dental x-rays and diagnosis of the problem. It may result in the scheduling of the patient for treatment, or referral to a specialist. Different insurance companies have various guidelines for how often they will pay for these visits.

Then there is the underutilized Occlusal Analysis. The reason it is underutilized is because insurance companies generally do not cover it. This is unfortunate, because it serves a very distinct and important role in the diagnosis of many issues that patients encounter. Temporomandibular joint (TMJ) issues, muscular problems, tooth wear/fracture and pre-prosthetic evaluation are all things that could benefit from the occlusal analysis. It is generally a combination of a clinical exam and an evaluation of models of a patient’s teeth, which are mounted on an instrument which simulates the patient’s jaw movements. There are many important things that can be learned from completing this detailed study of the bite relationship, which can lead to much greater success in treating certain patients.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.