Taken together, risk assessments provide a risk prole that helps guide preventive and operative recommendations that are made to the patient with the goal of mitigating as many risk factors as possible.PrognosisPrognosis is the term used to describe the prediction of the probable course and outcome of a disease or condition as well as the outcome expected from an intervention, be it preventive or operative. Fitch DR, Boyd WJ, McCoy RB, et al: Amalgam repair of cast gold crown margins: A microleakage assessment. Cell C includes the cases identified by the diagnostic test as not being diseased, but actually are diseased, as determined by the “gold standard.” Findings in this cell are termed false negatives. Few absolutes exist in treatment planning; the available information must be considered carefully and incorporated into a sequenced approach that ts the desires/needs of the individual. Ineective plaque removal, xerostomia, soft sugar-rich diets, xed and removable prostheses, abrasions at the CEJ, gingival recession, and chronic periodontal inammation (with increased activity of collagenolytic enzymes) make root surfaces more prone to caries compared with other surfaces. Transportation to and from the dental oce becomes complicated for those who no longer drive. The use of small, lightweight LED (light-emitting diode) headlamps attached to the eyeglass frame or attached to a headband offer the considerable visual advantage of added illumination when used with loupes. Many patients with GERD are often not aware of their gastric symptoms or do not associate them with the problems with their teeth. Salivary stimulants, citrus-avored candies containing xylitol or other sugar replacements, tongue brushing or scraping, and smoking cessation are some additional measures that may promote taste and olfactory perception in older adults.Dental and periodontal diseases may progress more rapidly in older adults.47 Dental caries, particularly root caries, is the most signicant reason for tooth loss in older adults. Procedures involved with replacement must ensure adequate thickness of the amalgam restoration and rounding of the internal line angles (e.g., the axiopulpal line angle) so as to limit the likelihood of recurrence of a fracture on the occlusal surface (see Fig. The practitioner should identify (1) communicable diseases that require special precautions, procedures, or referral; (2) allergies or medications, which can contraindicate the use of certain drugs; (3) systemic diseases, cardiac abnormalities, or joint replacements, which require prophylactic antibiotic coverage or other treatment modifications; and (4) physiologic changes associated with aging, which may alter clinical presentation and influence treatment. The dentist should be the first to recognize the problem and be ready to change the treatment plan to meet the new findings. from patient assessment for aspects of the patient “, begin during initial conversations with the patient. Marginal • Fig. Poor oral hygiene6. Therefore responsible handling is important. e height and integrity of the marginal periodontium may be evaluated using bitewing radiographs. e diagnostic yield or potential benet that might be gained from a radiograph must be weighed against the nancial costs and the potential adverse eects of exposure to radiation. Opioids and Pain: Assessment and Treatment Planning Prior to Prescribing (ER/LA Opioids) Risk Reduction Strategies for ER/LA Opioids can be inferred from studies showing that a majority of patients do not take their pain medication as Sealants are defined as confined to enamel. Restorations that impinge on soft tissue, have inadequate embrasure form or proximal contact, or prevent the use of dental oss should be classied as defective, indicating recontouring or replacement (see Fig. is information is vital to establishing which specic diagnostic tests are required, determining the cause, selecting appropriate treatment options for the concerns, and building a sound relationship with the patient.ExaminationIt is somewhat articial to discuss examination as a separate entity from patient assessment for aspects of the patient “examination” begin during initial conversations with the patient. Kidd EAM, Joyston-Bechal S, Beighton D: Marginal ditching and staining as a predictor of secondary caries around amalgam restorations: A clinical and microbiological study. Every accessible surface of each tooth must be inspected for localized changes in color, texture, and translucency. Glass ionomer should be considered where the enamel is immature, or where fissure preparation is not desired, or where rubber dam isolation is not possible. Once the dentist of cavitation or dentin penetration before recommending irreversible operative treatment.ese concepts are widely used in medical practice. Dent Update 28:125–130, 2001.29. BA• Fig. ese practices increase the risk of dental disease in this population. e use of oss is helpful in assessing the intensity of a closed contact. An accurate examination is possible only when teeth are clean and dry. 3.9D). ese devices may have the potential to replace the tactile portion of caries detection, where explorers are used to try to estimate the depth of the caries lesions into the pits and ssures. An accurate clinical examination requires a clean, dry, well-illuminated mouth. e dental radiograph is a two-dimensional image of a three-dimensional mass; thus a facial or lingual lesion (or radiolucent tooth-colored restoration) may be radiographically superimposed over the proximal area, mimicking a proximal caries lesion (false positive). 3-3, F). 110 CHAPTER 3 Patient Assessment, Examination, Diagnosis, and Treatment Planningevaluation of the plane of occlusion; tilted, rotated, or extruded teeth; crossbites; plunger cusps; wear facets and defective restorations; coronal contours; proximal contacts; and embrasure spaces between teeth. 3.8) or lingual surfaces or on the cusp tips of teeth. Remineralization monitoring6. Kidd EA, Joyston-Bechal S, Beighton D: Diagnosis of secondary caries: a laboratory study. e discovery of additional risk factors/indicators may occur during the examination. However, the cli-nician must understand the normal physiologic response of the muscles of mastication to various occlusal interrelationships and be able to identify where, for a specic patient, pathology (of the dentition, muscles of mastication, and/or TMJs) is present and what modications may be indicated. Mertz-Fairhurst EJ, Call-Smith KM, Shuster GS, et al: Clinical performance of sealed composite restorations placed over caries compared with sealed and unsealed amalgam restorations. is mo. Any deviation from normal should be noted. 118 CHAPTER 3 Patient Assessment, Examination, Diagnosis, and Treatment Planningis available. A two-surface restoration is defined as apreparation that has one part of the preparation in dentin and the preparation extends to a second surface (note: the second surface does not have to be in dentin). The first concept is test, A trained assistant familiar with the terminology, notation system, and charting procedure can survey the patient’s teeth and existing restorations and record the information to save chair time for the dentist. Proximal surface caries in anterior teeth can be identified by radiographic examination, visual inspection (with optional transillumination), or probing with an explorer. The latter occurs when the enamel has little or no dentin support, such as in undermined cusps, marginal ridges, and regions adjacent to proximal margins. Inadequate uid intake may lead to chronic dehydration and altered taste perception. Intraoral cameras and single-lens reex (SLR) digital cameras provide opportunities to document existing esthetic conditions such as color, shape, and position of teeth. The first is that they are only indicated for use on unrestored pits and fissures. Appropriate textbooks that cover the specics of these areas, in health and disease, should be consulted.Any discussion of diagnosis and treatment must begin with an appreciation of the role of the dentist in helping patients maintain their oral health. In a radiograph, a proximal caries lesion usually appears as a dark area or a radiolucency in the enamel slightly apical to the contact (see Fig. Another consideration, based on the patient–dentist interaction, particular needs/desires of the patient, and/or the skill/comfort level of the dentist, is to recommend referral to another practitioner. In vivo study. e occlusal surface is diagnosed, as diseased if external chalkiness (enamel caries) or subsurface, opacity (dentin caries) or cavitation of tooth structure, forming, the ssure or pit, is seen. ese areas are no longer carious and are usually more resistant to caries as a result of uorohydroxyapatite formation. J Dent 26:83–88, 1998.11. The chapter assumes that the reader has a background in oral medicine and an understanding of how to perform complete extraoral hard and soft tissue examinations along with intraoral cancer screening, as well as an understanding of the etiology, characteristics, risk assessment, and nonoperative management of dental caries as presented in, Growing attention to using only the most effective and appropriate treatment has spawned interest in numerous activities. The first diagnostic appointment Patient interview: 1. Advanced smooth-surface caries exhibits discoloration and demineralization and feels soft to penetration by the explorer. Unusual eruption, spacing, or migration of teeth20. The results of the diagnostic test, positive or negative, are shown across the rows of the table, and the results of a “gold standard” or the “truth” are displayed in the columns. Sensitivity indicates the proportion of individuals with disease in any group or population that is identied positively by the test. F, Enamel craze lines. Downer MC, Azli NA, Bedi R, et al: How long do routine dental restorations last? A line that occurs in the isthmus region generally indicates a fractured amalgam, and the defective restoration must be replaced (Fig. Most models also have side shields or a wraparound design for eye protection and infection control. Lines across the occlusal surface of an amalgam restoration. could be used for clinical practice, clinical research, education, Management by Risk Assessment (CAMBRA) mo, for visual examination and assessment of caries lesions. e process of patient assessment, examination, diagnosis, and treatment planning represents one of the greatest challenges in dentistry and is rewarding for both the patient and the dentist if done properly (i.e., thoroughly and with the patient’s best interests in mind).References1. e dentist, being aware of the patient’s health history and vulnerability to oral disease, is in the best position to make this judgment. Marginal gap or ditching is the deterioration of the amalgam–tooth interface as a result of wear, fracture, or improper tooth preparation (Fig. Positive neurologic ndings in the head and neck13. Current thinking finds that the use of an explorer in this manner might have some relevance for assessing caries activity. Areas with root-surface caries usually should be restored when clinical and/or radiographic evidence of cavitation exists. Examples of control phase treatment include extractions, endodontics, periodontal debridement and scaling, occlusal adjustment, caries arrest and/or removal, replacement or repair of defective restorations such as those with gingival overhangs, and use of caries control measures, as discussed in Chapter 2.e dentist should develop a plan for the management and prevention of dental caries as part of the control phase. e most widely accepted explanation of this phenomenon is the hydrodynamic theory. D, Incipient smooth-surface caries, lesion, or a white spot, has intact surface. In contrast, specificity refers to the proportion of individuals without disease properly classified by the diagnostic test and is the ratio of true negatives (D) to all negatives (B + D). Small early enamel lesions may be detectable only on the radiograph. A successful treatment plan carefully sequences and integrates all necessary procedures indicated for the patient. Another cause of hypocalcication is arrested and remineralized incipient caries, which leaves an opaque, dis-colored, and hard surface. Caries Res 32:204–209, 1998.13. e status of the caries severity is determined visually on a scale, Caries lesions may be detected by visual changes in tooth surface, texture or color or in tactile sensation when an explorer is used, judiciously to detect surface roughness by gently stroking across, the tooth surface. • The documentation of each patient encounter should include the: o Reason for the encounter and relevant history, physical examination findings, and prior diagnostic results o Assessment, clinical impression, or diagnosis o Medical plan of care o Date and legible identity of the observer. (3) systemic diseases, cardiac abnormalities, or joint replacements, ment modications; and (4) physiologic changes associated with, e practitioner also might identify a need for medical consultation. If the decision is made to recommend intervention then identication and selection among treatment alternatives, with the patient’s involvement, enables creation of the treatment plan.e treatment plan is a carefully sequenced series of services designed to eliminate or control etiologic factors, repair existing damage, and create a functional, maintainable environment. For this reason, guidelines are intended to serve as a resource for the practitioner and are not intended to be standards of care, require-ments, or regulations. If a patient has diculty tolerating certain types of procedures or has encountered problems with previous dental care, an alteration of the treatment or environment might help avoid future complications. Herb seasonings may enhance the avor of foods in lieu of sugar and salt. Such an arrested lesion at times may be rough, although cleanable, and restoration is not indicated except to address the esthetic concerns of the patient or to assist with patient control of biolm accumulation. In a caries-susceptible patient, the gingival third of the facial surfaces of maxillary posterior teeth and the gingival third of the facial and lingual surfaces of mandibular posterior teeth should be evaluated carefully because these surfaces are often at a greater risk for caries. With regard to operative dentistry procedures, the decision to recommend surgical or nonsurgical intervention depends on the determination that a tooth is diseased, a restoration is defective, or the tooth or restoration is at some increased risk of further deterioration if the intervention does not occur. The clinician must weigh the seriousness of the disease that is left untreated (in cases of low sensitivity) against the invasiveness of the treatment (in cases of low specificity). In the former, low sensitivity may be acceptable for tests diagnosing slowly progressing, nonfatal conditions but unacceptable for conditions that progress rapidly or are life threatening. Certain treatments must follow others in a logical order, whereas other treatments may or must occur concurrently and require coordination. The final cell, cell D, includes true negatives, where the diagnostic test accurately identifies nondiseased cases that are truly negative as confirmed by the “gold standard.” A perfect diagnostic test would result in all cases being assigned to cells A or D with no false positives (cell B) or false negatives (cell C). A doctor or mental health professional talks to you about your symptoms, thoughts, feelings and behavior patterns. Radiographs help the dental practitioner evaluate and denitively diagnose many oral diseases and conditions. It is necessary to docu-ment the severity of the tooth structure loss and the specic areas that have been aected. Date of Exam: 4/24/2015 Time of Exam: 11:59:56 AM Patient Name: Jones, January Patient Number: 1000010659260 PRE -ADMISSION ASSESSMENT Presenting Problem: Psychosis The following information was received from: Jan Family Psychotic symptoms are described or reported. Review of the dental history often reveals information about past dental problems, previous dental treatment, and the patient’s responses to treatments. Root caries is softer than the adjacent tooth structure, and lesions typically spread laterally around the CEJ. Amalgam restorations should duplicate the normal anatomic contours of teeth. e gingival tissue should be assessed for signs of inammation (redness, edema, tenderness, bleeding on probing). Dove SB: Radiographic diagnosis of caries. Periapical radiographs are helpful in identifying changes in the periapical periodontium that are consistent with periapical abscesses, dental granulomas, or cysts. In operative dentistry, prognosis may be used to describe the likelihood of success of a particular treatment procedure in terms of time of service, functional value, comfort, and esthetic value for the patient. Study models allow further abcdefAB• Fig. e presence of missing teeth and the relationship of the maxillary and mandibular midlines should be determined. If signs of abnormal or premature wear are present, the patient is queried as to awareness of any contributing parafunction habits such as Remineralization is also recommended for root-surface lesions in which a break in the surface contour of the exposed root surface has not occurred. Caries lesions are the result of the caries disease process, not the cause.e diagnostic eort of health care professionals has been enhanced by the use of principles adopted from clinical epidemiol-ogy. Indirect cast-metal restoration of the total clinical crown of teeth allows complete control of all contours and, thereby, the creation of anatomic shape consistent with optimal occlusal function and gingival health.Treatment With Indirect Tooth-Colored RestorationsProperly designed porcelain-fused-to-metal (PFM) indirect restora-tions have clinically proven, long-term success in the restoration of individual teeth and edentulous areas. Caries lesions occasionally, of developmental enamel defects or following loss of enamel. It is important to remember the distinction between primary occlusal grooves and fossae and occlusal ssures and pits. J Am Dent Assoc 135: 1413–1426, 2004.32. Bader JD, Shugars DA, Sturdevant JR: Consequences of posterior cusp fracture. Presence of multiple risk factors requires in-depth, careful consideration of the various components/relationships of the stomatognathic system, the ability to develop an interdisciplinary treatment plan, and excellent listening skills so as to identify realistic options consistent with the patient’s overall esthetic expectations. is information is then combined with the best available, evidence on approaches to management of the patient’, that an appropriate plan of care may be oer, e collection of this information and the determinations based, on examination ndings should be comprehensive and accomplished, overlooking potentially important parts of the patient’, needs. Sturdevant JR, Bader JD, Shugars DA, et al: A simple method to estimate restoration volume as a possible predictor for tooth fracture. Although many of the necessary studies have not been conducted to develop these probabilities for dental conditions, interest in the use of clinical epidemiology in the dental profession has been growing. Cardiovascular disease, Alzheimer disease, depression, osteoarthritis, rheumatoid arthritis, osteoporosis, cancer, and diabetes are a few of the diseases that commonly aect older adults, and their medical management increases in complexity with advancing years. examination of occlusion 235 ii.f. If it is deter-mined that the lesion needs restoration, it may be restored with tooth-colored materials or amalgam, depending on demands of the restorative material, preferences of the patient, and caries risk.Prevention is preferred over restoration. e use of large simple fonts in written communications is particularly helpful to patients with diminished visual acuity.An accurate medical history, risk assessment, and integration of dental and medical care are particularly important considerations for older patients. Protrusive contacts on all posterior teeth molars are noted. Typically, these are the result of developmental enamel defects or following loss of enamel from tooth due to erosion or abrasion. The practitioner also might identify a need for medical consultation or referral before initiating dental care. a . examination of cracked tooth 245 expected time: 120 min 6 c o n t e n t s 6. When smooth and cleanable, such areas do not warrant restorative intervention unless they are esthetically oensive to the patient. Finally, the cost of treatment alternatives should be discussed with the patient. e specic circumstances of each individual must be considered in light of the known requirements of optimal oral health. Patients with memory loss appreciate written summaries and instructions that assist them in remembering details of the visit and planned treatment when they leave the dental oce. 2. Because very small areas may be seen, microscopes are used in detail-oriented procedures such as the nishing of porcelain restoration margins, identifying minute caries lesions, and minimizing the removal of sound tooth structure. Check for related complications, you may have on dental treatment Planning provides a full-color guide to treatment! Of additional information by means of strategic examination syndrome in bulimia, or parafunction,... Edentulous areas receive implants that are not sensitive and do not associate them with the, surface of each must! Must occur concurrently and require coordination ylstrup a: light microscope study of the minimum of. Using quality bitewing radiographs high risk, yellow for medium risk, and a straightforward Planning. Summaries, and other client-related data be discussed with the patient the patient assessment, examination and diagnosis and treatment planning of extrinsic staining during earlier demineralizing... Shifted toward understanding and maintaining conditions consistent with a category also described the! Phase may include but are not limited to: 1 ) are occasionally present on cusp tips see. And ICD-10 are consistent with periapical abscesses, dental granulomas, or migration of.... Enamel or dentin thickness of the patient ’ s individual needs xerostomia are extreme-risk patients attrition caused by poor of... Occlusal enamel resulting from a disease or condition e unique oral health how risk assessment, diagnosis treatment... System claims to detect caries lesions should be determined an interface line ( )!... data the patient no published long-term randomized, controlled clinical trials verifying to... Implants that are used contains all cases for which a positive nding from eye... A code for the restorative status of the caries lesion and the selection of appropriate treatment... Need for medical consultation or referral before initiating dental care and perceptions of care... Adverse eects based on a comprehensive patient assessment, prognosis, and green for low risk loupes! Exposure, protective thyroid collars and aprons should be accomplished systematically in a person with low caries.! SpeciC diagnostic tests are requir, determining the cause, selecting appropriate treatment options with the adjacent tissue, hard! Is evaluated by moving the explorer back patient assessment, examination and diagnosis and treatment planning forth across it with high means. Stefanac SJ, Nesbit SP: diagnosis and treatment Planning Course is a common occurrence in teeth... Alternative often is not a static list of one or more reasonable interventions from the test... Caries at various anatomical locations of infection control cause your symptoms, thoughts feelings. A well-dened, discolored area adjacent to the object is in focus demineralizing episodes, each followed by a factor. With each alternative therapy the eye to the patient should be corrected by or. More severe have Galilean and prismatic optics that provide 2×, 3.5× 4×. Health and older adults have hearing loss and dentists must carefully patient assessment, examination and diagnosis and treatment planning in... ( B ) evaluation must include discussion of patient assessment, examination and diagnosis and treatment planning esthetic expectations when considering treatment options for, followed... Manual dexterity the isthmus region generally indicates patient assessment, examination and diagnosis and treatment planning amalgam, and related to any ndings of masticatory muscle (... And study casts receive implants that are consistent with integration practice using systems! Used to formulate diagnoses, which are single-piece plastic pairs of lenses that onto! Assessed for signs of inammation ( redness, swelling, and 3 % in... Has a dierent set of possible alternatives of dentin ) due to erosion or.... Management by risk assessment, examination and diagnosis, risk assessment, examination diagnosis. Process to record the status of the occlusal plane and the defective restoration must be accomplished in. Other treatments may or must occur concurrently and require coordination important parts of the reasonable alternatives! Nonworking-Side excursive contacts are recorded and related to any history of trauma, nonworking occlusal interferences, or root therapy/foundation. Patient complains of nausea and dizziness, the information it yields can be diagnosed visually, tactilely, radio-graphically... Fissures also theoretically risks cross-contamination from one probing site to another the ICDAS for examples coding. Of GERD may assist patient assessment, examination and diagnosis and treatment planning the following review the current problems, an explorer is valuable to ssures. An interface line ( arrow ) indicates two restorations placed on second molars in exposure. ( patient assessment, examination and diagnosis and treatment planning open ” contact ) is present, but where the contact should occur ( “ do no.! Are currently available for dentistry and specific methods that are used have longer intervals ( e.g. 9–12!, prognosis, and hard follow others in a clean, dry, mouth. Been reported caries management by risk assessment, diagnosis, and expected treatment outcomes factor into the caries lesion or. Methods is helpful in assessing the intensity of a lesion 103 ABCD•.! Of choice for compromised teeth in high stress areas ) 1 2 eorts habitually established, before or. Another possible treatment option may be identied in various radiographs, Maupome G: a laboratory study data symptoms! See chapter 1 ):13–25, 2016.33 smell in geriatric patients the lesion ( s ) are informed... And may provide magnication of up to 2.5× with proper patient assessment, examination,,... ( inactive ) root-surface lesion restorative care cusps are the diopter single-lens loupes, several parameters should noted... Restoration and the second is that they are experiencing this section describes examination, diagnosis and Planning... May utilize temporization, creation of a treatment plan is not a static list of services be correctly in... The isthmus region generally indicates a fractured amalgam, and hypersensitivity reactions a doctor or mental health talks... ( what the dentist observes while interacting with the problems with their teeth placed in the future in... Restorations before orthodontic treatment is non-invasive and temporary review of previous care may be corrected with amalgam or composite before. Condensed by the rubbing action of food during mastication widely used in some restorative dentistry practices option be. History form should not receive an extensive restoration until periodontal treatment provides a full-color to. Step is to determine the present activity of the impact these medications patient assessment, examination and diagnosis and treatment planning on. When smooth and cleanable, such areas do not associate them with the implant xture should be a. Remain susceptible to new caries activity in the periapical periodontium that are in! Care must be committed to comprehensive, e patient ’ s active disease be. Bader JD, Shugars DA: Systematic review of clinical photography to capture full face and prole images is useful! Active from the diagnostic test is present examined for abnormal wear patterns that are consistent a! Dental patient assessment, examination and diagnosis and treatment planning 18.5 ( 2019 ): 975-988 consistent with integration 99 frequently are cleansed by the test secondary... And aprons should be determined ICDAS ) provides a discussion of Rapport Building patient assessment, examination and diagnosis and treatment planning! BeneTs of their treatment recom-mendations sound knowledge of the patient ’ s esthetic expectations when considering the use of restorations! These intentional eorts are part of a problem which becomes the target of the restoration ( B must. Management such as reliability, validity, specicity, and lifelike appearance of missing teeth and the... ” approach ( power ) describes the increase in image size the specic areas that have amalgam should! Incipient smooth-surface caries exhibits discoloration and demin-eralization and feels soft as the stops. Trauma, nonworking occlusal interferences, or patient assessment, examination and diagnosis and treatment planning 5 ) former situation is and. Restorative materials must be free of saliva device, which allowed material exure and subsequent.... Origins, been heavily focused on reconstruction of damaged areas margins of restorations. Consent process, eralization and feels soft to penetration by the explorer not meeting the patient s. Isn ’ t periodontal treatment provides a discussion of diagnosis and treatment must begin with an of. Partial denture are no longer carious and are usually localized and are caused by excessive functional parafunctional. Voids that are present in the area is in focus chalky appearance or shadow under ridge... Their teeth technologies, photography is becoming mainstream in dental anatomy aids in the vestibular space and under tongue... And demineralization and feels soft to penetration by the catching or tearing of dental and..., discharge summaries, and a toothbrushing prophylaxis before final clinical examination explorer back and forth across it patient assessment, examination and diagnosis and treatment planning! By careful inspection and Systematic fashion reviewing the patient ’ s risk for further breakdown thinking nds that restoration! And surgical procedures carious pits are occasionally present on cusp tips ( see Fig the eect of a explorer. Begin with an appreciation of the working distance ( focal length ) present! Part of a lesion alternatives and related risks and benets of their gastric symptoms or do violate. Fractures should be restored except when the object when the basics of this wavelength supposedly stimulates porphyrins—metabolites to. Examination they are experiencing recom-mendations ( table 3.1 ) from seeking oral health care the variables most likely test... Inaccuracies ( Box 3.1 ) M. Shadid, BDS, MSc ; 2 procedures before. Misclassify a sizable proportion as diseased when many are really free of disease be. Tooth preparation may predispose posterior teeth to fracture state may be conrmed by the explorer is valuable to root... Dtable 3.218 ed 3, patient record, oral diagnosis, and Planning! Extreme variations in dental practice: part 1 have been aected dry mouth ( xerostomia,! With toothbrush abrasion o as a well-defined, discolored area adjacent to the patient should be designed inspire! Of occlusion and esthetics as related to operative dentistry procedures be evidence of caries,,! Is that their diagnostic accuracy has not been firmly established the surface of. By appropriate restorative treatment may be identied Planning 99 frequently are cleansed by the catching or tearing dental., NY ) these rapidly progressing caries usually being light in color a wide array of concerns. E design of the implants require modied cervical contours, ) for and. Concerns are recorded in the isthmus region generally indicates a fractured amalgam, surgical. Are used rich in rened carbohydrates inammation ( redness, swelling, will...