By the eighteenth century, dentistry had become a recognized discipline in most European countries with organized lecture courses at teaching hospitals and legislation governing its practice. Before that time, the main dental ‘qualification’ needed by a practitioner was a strong arm to draw out decayed teeth. Itinerant toothdrawers could earn a lucrative living plying their trade and often used musicians both to attract customers and to mask their cries of pain. Very little was known about oral hygiene and the origins of decay; and the lack of any anaesthetic – apart from a liberal dose of alcohol – made the whole procedure of extraction an often agonizing experience. Not surprisingly, people would go to a toothdrawer only out of dire necessity and then with the utmost reluctance. Today, the importance of regular, six-monthly dental check-ups is generally recognized and most people are aware of the need for correct oral hygiene. If the guidelines laid down by dentists and hygienists for the proper care of teeth are followed, there is no reason why, barring accidents, anybody should have to wear dentures or not keep their teeth. Modern dental procedures have removed most of the pain and inconvenience formerly associated with the dentist’s chair. The prospect of a visit to the dentist still, however, fills many people with apprehension. Nowadays dentistry is a highly effective branch of medical care which, more than most other branches of health care, relies on the patient to observe the basic rules of oral hygiene and to keep his or her teeth, gums and mouth healthy, in order to minimize the need for treatment.

The dental examination

The dental examination usually begins with a general medical questionnaire to provide the dentist with both general and specific information, so that any treatment can be carried out safely. It is especially important for the patient to tell the dentist whether he or she is allergic to certain medicines or if he or she is taking (other) medicines at the moment, and if female patients are – or think they may be – pregnant. More specific queries are made during the administration of a dental questionnaire, which gives the dentist some idea of any problems people may have with their teeth and gums and usually include questions such as: do you have any pain or discomfort in your teeth or anywhere in your mouth? Does the pain relate to eating or drinking certain things? Is it sharp and stabbing, or dull and throbbing? Is it worse when consuming cold or hot drinks? Is it relieved by analgesics such as aspirin? Further questioning may lead to an initial diagnosis being made of any particular complaint a person may have. An oral examination is then carried out, using a dental mirror and probes. Teeth, gums and all other parts of the mouth are inspected. The dentist notes the general state and cleanliness of the teeth. The dentist or dental nurse records the result of the examination. A dental chart is used to record those teeth present, particularly noting those teeth that require further investigation or treatment. A periodontal chart may be formulated to assess the condition of the gums and the bone supporting the teeth. An occlusal assessment may also be made of the way in which the teeth in each jaw meet, and of irregular shape or position of teeth, such as prominent front teeth.

Special tests are often required to provide further dental information. Dental radiographs (X-rays) are used as an aid to diagnosing and determining the extent of dental decay (caries) and gum (periodontal) disease. High definition radiographs of a single tooth may be taken to make a close examination of specific complaints.

Sometimes a pantogram radiograph is taken. In this ‘moving X-ray’ the ‘camera’ (radiation head) tracks around all the teeth to show them and the jawbone in ‘panorama’ format; this provides the dentist with an overall picture of the dental condition.

Dental diagnosis

Once the dentist has thoroughly examined a patient’s mouth a course of treatment is prescribed, based on the results of the examination. The eventual course of treatment may encompass many aspects of dental care. An increasingly important form of dental care these days is patient education. This aims to explain the importance of a healthy diet and good oral hygiene, because a neglected mouth, apart from being more vulnerable to tooth decay, can create the risk of infections entering the bloodstream and so endangering general health.