Insight: The dental checkup

In this session, we wanted to explore more about a regular dental checkup. And we thought the best way to do that would be to film a dental checkup with the patient, the dental nurse, and the dentist, and then to play it back with the dentist being able to talk to us about what the thought process is, equipment, and paperwork they were doing while they were going through it and give us some more detail. I’m pleased to introduce Dr. Adrian Jowett, who is our dentist, and we also have - in the film behind me - Mr. White, our patient, and Sarah, the dental nurse. So hello, Adrian. Can you take us through why you would do regular dental checkups?

In a routine checkup like this, your wanting to check the patient’s general oral and dental health and check for any problems. OK, so let’s play the tape and start the process. So you’re introducing yourself to the patient. What are you covering here? It’s very important to introduce yourself by name and also to check that you really have got the right patient, Mr. White, and to check his date of birth and things to try and ascertain that it is the patient you’re used to seeing. OK. So we’ll be watching this on the screen. You can see that we’ve got a variety of angles, including from your perspective.

We put ourselves in your boots with a head-cam so we’ll able to see exactly what you see as we go through this video. So you’re getting up now and you’re going over and what are you going to be doing? Oh, you’re putting on some magnification glasses? Yes. More and more dentists in England are wearing these now to magnify the teeth, the soft tissues. So you can see what’s going on as the cavities and filling and things are becoming smaller over the years. And these are called loupes? Yes. Jewellers used to use them as well. That’s where the term comes from. Ah, right. OK. All right and you’ve also put on a mask and some gloves, by the looks of it.

Yes, this is just the personal protective equipment for stopping cross infection between the patient and the operator. And you’re also washing your hands. Yes. So just using an alcohol disinfectant rub here. My hands were clean when I went into the surgery and it’s quicker and less damaging to your skin to use these between every patient. OK. All right, we come back and we can see the partnership, really, with your dental nurse, Sarah, here because everything is sort of sliding into place because you are now ready for the procedure. And we get a good look at the surgery as well. So everybody is getting into position. So what’s the first thing that you’re going to be doing?

Oh, it’s moving the dental chair. Shall we talk a little about that? Why does it need to move? The whole aim of the dental chair, really, is to try and get the patient in as good position as possible for the ease of the operator, the dentist, so that you can see everything you need to and work comfortably, possibly for quite a long time. And also it’s comfortable for the patient so that they can sit comfortably and participate in treatment for up to several hours sometimes. OK, let’s pause it here because the other thing that you’ve also brought into shot is the dental light, the quite famous dental light that everybody seems to know about it.

So is that really just so you can see better? There’s no other - No. Just so you can see nice and clearly and make sure that everything is visible. Great. OK, so let’s carry on and see what happens. So the first thing is rather than going into the mouth, you’re looking around the mouth with your hands. Yes, here what we’re looking for are the lymph nodes, which you are just trying to palpate for. These are what sometimes people call the glands beneath the board of the mandible and also in the neck. And these can be an indicator of serious disease. They can swell with things like cancer and things. They can swell sometimes if you’ve got a cold as well.

So it’s always worth to know what the patient’s history is. OK. So this is an indication that a dental checkup is much more than just counting some teeth and checking everybody - Yes, definitely. The patient’s oral health in the broadest sense is the key remit. Right. OK. Let’s carry on and have a look at what you’re doing. So you’re checking, as well, that the jaw is in good shape and it can open and close comfortably and everything else? Yes, in most patients there’s not a lot to see but it can be an indicator of major arthritis or sometimes fractures the jaw. OK. Right, you’ve gone into your instrument kit and you’ve grabbed the mirror. Is that right?

And I think we’ve got one here. Yes, there are three parts to the key examination kit. We do have a dental mirror which you can use for looking at surfaces which aren’t directly visible. And also, importantly, for pulling the soft tissues to one side to maximise what you can see. So the more you can see, the more you can see what’s going on. OK. So there we go. We get a good view from your view here of exactly what’s going on. And now you’ve gone for another instrument. What’s this one? Yes, this is a probe for undertaking the basic periodontal examination. This is really to give you an overview of the health of the patient’s gums.

There’s some stripes on here? Yes. The three bands are used really to give a gradation of how healthy the patient’s gums are. This is a depth gauge, is it? It’s a depth gauge, yes. It’s very much that. If you can stay within the first silver band you’d score a zero and that would really show that the patient’s gums are well attached to the teeth and there wasn’t a lot going on. You can sometimes score a one if the gums bleed when you probe them.

And then there was an increasing score of two which would be a little bit of tartar, or dental calculus. And three and four progressively say that the gums are separating from the teeth and you do have a condition of disease. OK. So you’ve got different scaled numbers. And Sarah, on the patient’s notes, is making a record around here. You’ve also gone and grabbed another thing while we’ve been talking. It seems to be a squirty device. Yes, as you said, this is one the famous things as well. It’s known as a three-in-one syringe. The three things are air, water, and spray if you pressed both together.

And the water and the spray can be used for cleaning the surface of the teeth and potentially the gums and things. And the air can be used for drying the teeth to make sure you’ve got a nice dry surface which isn’t shining back at you. This means that you can look for very small defects either in the teeth or in fillings really very clearly. Right. Excellent. I like that. OK, so let’s carry on then and have a look. And we see Sarah now is following what you’re calling out from what you’ve been telling us. She’s filling in the dental chart. And I think we’ve got one of the sheets that Sarah is using here. Here we go.

So can you explain a little about the process, what you’re calling out and how it’s recorded onto this chart? Yes. Each of these squares represents one tooth in the patient’s mouth. Really this is just a map of the patient’s teeth. And you cross out the teeth which are absent and then you can fill in the boxes on the chart for where there are fillings or areas of decay inside the teeth. Sarah appeared to be writing backwards. She’s going that way. Is there a particular way around that you do the charting? Different dentists work in different ways but I will start in the upper left and work our way around in a circle.

And different dental nurses get used to that pattern of working. So you are just finishing the checkup now. So it doesn’t seem to take very long. You’re going through and you have a good of view of the teeth, you’re drying them, you’re viewing them, you’re making the notations. So if our Mr. White is quiet orally healthy, this is quite a quick process? Yes, indeed. The less there is to look at, in a way, the quicker the process goes. Mr. White’s got good oral health and very few fillings and things so there’s actually not an awful lot to write down. And here you are, you’re finishing. So the dental nurse is moving anything out the way for you.

It’s quite a slick operation. The chair comes up and he’s finished. But you’re going to talk to him now. So what will you be saying to the patient at the conclusion of the checkup? Well really you need to summarise what you’ve seen and what other treatment might be required. At the very least, you need to inform the patient that everything’s looking healthy and that you’ve not found any problems that they need to deal with. You might need to explain you have found issues that will need further treatment, or maybe be booked in with a hygienist, or possibly a longer course of treatment which will require quite a lot of explanation. Thank you very much.

I think that was a very good insight into what happens during a dental checkup and we’ll be exploring some of the issues raised in this film in a little bit more detail throughout the course.