The first exam appointment is usually made via a phone call from the patient. Although these days, contact can often be made by e-mail, too. Any initial queries that you have can be answered and you can let the dentist know of any problems you have experienced in the past. You should find out in advance how long the appointment is likely to take and how much it will cost you.
Things that may happen during an initial appointment:
Completing a medical history questionnaire
You don’t want to be too early for your appointment as you might have to sit around and wait and that can add to any nervous feelings you might have. Arriving 10-15 minutes before the actual appointment time is good as your dentist will probably want you to look through a medical history questionnaire, and fill out any details. It’s quite important then to have to hand the details of any medications that you are currently taking and any major illnesses or operations that you have had in the past. This may feel insignificant to you, but it may have an important bearing on any medication that the dentist might want to prescribe for you. Also remember to bring your medical card if you are registering as an NHS patient in the UK (rare these days) and any documentation regarding entitlement to free treatment.
Meeting your dentist
The dentist or nurse should collect you from the waiting room and escort you to the surgery. These days it is less likely that your dentist should hide behind you or behind a mask. Normally they will talk to you face to face and ask why you have come to see them, or explain what they would like to do during the appointment. This is your opportunity to discuss your fears and give your input, for example, if you would prefer that at your first appointment the dentist should not poke at your teeth, or if you can’t handle the thought of sitting in the chair, then make that known before you start.
Remember that it is your mouth that is being examined here and you have the right to stop the examination at any time, or request that particular procedures, for example x-rays, be kept to a later appointment when you feel more confident. But also remember that without all the information such as x-rays etc., the dentist may not be able to give you a complete report of your mouth. Above all, communicate with your dentist, tell him what you feel (un)comfortable with and he/she may be able to suggest ways to help.
The dentist may be able to do a visual check using a small mirror, and you may not have to sit in the dental chair at all, if the thought of that bothers you. Maybe sit in the dentist’s chair to get a change of perspective on things, but do ask permission first!
Your mouth is like a wee cave, and to peer into it’s furthest recesses, it is necessary for the dentist to shine a light. It is rare these days for the dentist to shine this right into your eyes, they know that this is uncomfortable. Modern lights can be turned down a bit, or your dentist may have a light attached to his head so you don’t have to feel like your chin is getting a suntan. A suntanned chin carries the same social stigma as having strap marks showing when you’re wearing that little black number if you’re just back from your holidays. This is worse if your name is Dave.
The dentist will also visually check your gums as well as your teeth. This is to check for any gum disease and any other potential problems that you should know about which are important for your health.
The dentist may also ask you to wear glasses when they lie you back in the dental chair, especially if you’re having your teeth cleaned as part of the check-up. These are to protect your eyes in case there is any water splashing about. It is not a fashion faux-pas to wear these glasses – your dentist will not tell your friends that you have been wearing them!
Dentists have the memory span of your typical goldfish! Because of this, they like to write everything down as they go. This is why, during a check-up appointment, the dentist will count around your teeth and make a note of any fillings that are present, any teeth that are missing and any wee holes in your teeth or areas that they want to keep an eye on. The dentist will start at one side of your mouth, say top right, at the back, and count around until they reach top left at the back. Then they will move to lower left at the back and count around until they reach lower right, at the back. This means that they don’t miss any teeth.
In reality it doesn’t matter if they start at top right, top left or wherever, the thing is that there is a system there that the dentist will follow every time they see you. If a dentist is presented with a system that is contrary to his own he will become confused, like a dog that has had his bowl moved, and he may start to weep. So they always do it the same way. This ‘charting’ as it is called is recorded on either paper notes or on a computer screen if the dentist has a nurse who knows about these things. There’s no point asking the dentist about computers, he will just begin to stare into space. If this occurs, just mention teeth briefly and he’ll soon be back to normal.
Why does the dentist want to poke at my teeth? The dental ‘probe’ or ‘explorer’ can be used by your dentist to gently feel the bumps and valleys on the surface of the tooth. If the dentist notices any ‘tackiness’ on the surface of the tooth, it might be a soft area which would indicate decay is present.
Unfortunately these areas of early decay may not show up on an x-ray. So although it is perfectly reasonable for you as a patient to request that the dentist should not ‘poke at your teeth’, the dentist may feel that a full check-up has not been completed until he/she can. Maybe you can reach a compromise and ask that the dentist be as gentle as possible when touching your teeth with the explorer.
A lot of people are scared of the probe because for years, the ‘gold standard’ for checking for decay was to stick the probe in and give it a good shove! We now recognise that using too much force can compromise the tooth structure of an early lesion that has the potential to remineralise. While the explorer may still have to be used to figure out if decay is present, it is used much more gently nowadays.
Some dentists have a device called diagnodent. This is a gentle laser device that rests on the tooth, and shines a light so that the dentist knows if there is any decay in the tooth. This means that the dentist may not have to poke at your teeth at all. However, they may need cleaned first to remove any debris and allow the device to work properly.
The dentist may also have a small handheld camera with which he can take close-up pictures of your teeth and then display them on a screen. These pictures can be used to explain things more thoroughly so you can see what is actually happening in your mouth. If you can’t stand the thought of looking at your teeth, please let your dentist know!
X-rays are still an important part of any dental examination to help diagnose any problems under the surface or around the foundations of the teeth.
These are usually taken by having you bite on a small tab which steadies the x-ray film in your mouth while the dentist positions the x-ray beam so that they can take the picture (bitewing x-rays). The x-ray beam looks exactly like a telescope. It’s usually on the end of a mechanical arm so it can be adjusted to get it close to the x-ray film for the best picture. It’s because the x-rays travel in a straight line that often there’s no need to wear heavy lead aprons any more. The x-ray films that you hold in your mouth aren’t terribly mouth shaped and some patients find them uncomfortable, but they’re usually over fairly quickly. These films are made of soft plastic and are about 3cm x 4cm in size, although smaller ones are available. The smaller x-ray films do not show as many teeth however and your dentist might have to take more pictures then. To hold the film in your mouth the dentist will ask you to gently close your teeth together on to a small paper tab or plastic holder whilst the film is in your mouth. If you feel something soft, like a sausage, between your teeth it might be the dentist’s finger! Please resist the urge to bite too hard…
Newer digital x-rays are possible and will come up on a computer screen much more quickly than the normal x-ray developer. The film placed in your mouth tends to be slightly bulkier, however the radiation dose is much smaller than routine dental x-rays (even though the dose of radiation of normal x-rays is low too).
Some dentists have an x-ray machine that can take a picture of all your teeth at once (panoramic or panoral x-rays). This involves sitting or standing still whilst the machine slowly rotates around your head. It will not touch you at any point. The picture it provides is a useful overview of your teeth and bones but is no substitute really for the smaller close-up films.
In the U.S., some dental offices take a full-mouth series (FMX) of x-rays, consisting of 4 bitewing films and 14 periapical films (showing the tips of the roots and supporting bone). This is usually not done in the U.K.
As part of a routine check of your mouth, the dentist will also want to have a look at the foundations of your teeth, or in technical speak ‘your gums’! You may notice from time to time when you are brushing your teeth that there is a little bit of blood when you spit out. This bleeding may indicate the presence of gingivitis or gum disease. The dentist has a small probe with a special tiny ball on the end of it, imaginatively called ‘the ball-ended probe’. This is used to gently run around the necks of your teeth where they meet the gums. The first signs of gum disease always start here and your dentist will not want to press hard at all on the gums. By doing this check, the dentist can identify any areas where gum disease is present. Oftentimes just telling you where you may have been missing the gum during brushing will solve this problem.
On some areas of your mouth you may have a build up of calcium deposits on the teeth. This is called calculus or tartar. If left in place the gum can become inflamed under the calculus area, so the dentist will make a note of this and may wish to provide some cleaning for you as part of your dental treatment.
A visual check of the gums will usually tell the dentist if there is gingivitis or gum disease. If you do not like the idea of your dentist “poking around”, realistically, a visual examination would suffice and if gum disease is suspected, any measurements taken at a later date when rapport, trust and confidence have been built.
Other areas of your mouth
Your dentist will want to have a general look around the skin of your mouth (technically, ‘the mucosa’). This does not involve probing, and should be a purely visual check to make sure everything is healthy.
Having most of the information that the dentist needs now, he can give you a run-through of his findings, and answer any questions that you may have. The dentist should be able to give you a rough idea of how many appointments you will require and estimate a cost for your treatment.
© John Urquhart BDS 2006