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Hard Tissue Charting. Dental Hygiene Theory Instructor: Nickee dela Cruz R.R.D.H. Hard Tissue Charting. Is completed & documented at the ASSESSMENT appointment Is updated at each maintenance appointment Should follow a routine so that nothing is missed (sequencing)

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hard tissue charting

Hard Tissue Charting

Dental Hygiene Theory

Instructor: Nickee dela Cruz R.R.D.H.

hard tissue charting2
Hard Tissue Charting
  • Is completed & documented at the ASSESSMENT appointment
  • Is updated at each maintenance appointment
  • Should follow a routine so that nothing is missed (sequencing)
  • Do not use erasers or white out, if you make a mistake stroke 1 line through it & date & initial the change
  • Conditions which exist or are present in the oral cavity are recorded in BLUE
  • Carious lesions, teeth requiring treatment (extractions & other pathologic conditions, such as abcesses) are recorded in RED
  • SUSPECTEDcarious lesions are charted in GREEN, but if they are diagnosed by the DDS as being decay, they are changed to RED
the dental hygienist should be able to
The dental hygienist should be able to …
  • Recognize signs of development anomalies & acquired tooth damage & bring them to the DDS’s attention
  • Be able to properly document in the odontogram (hard tissue) in the client’s chart
anomalies of the teeth
Anomalies of the Teeth
  • Hyperdontia – or supernumary teeth, extra teeth such as mesiodens which will occur between the maxillary anterior teeth
  • Hypodontia– absence of 1 or 2 teeth or anodontia, congenitally missing teeth most common are 3rd molars than maxillary lateral incisors, than mandibular premolars
anomalies of the dental tissue
Anomalies of the Dental Tissue
  • Macrodontia – larger than normal teeth, they tend to be wider, longer, & higher than normal teeth, may affect several or all teeth in the dentition
anomalies of the dental tissue16
Anomalies of the Dental Tissue
  • Gemination – a tooth tries to split or twin
anomalies of the dental tissue19
Anomalies of the Dental Tissue
  • Dens in dente – a tooth within a tooth usually the lingual of maxillary incisors
anomalies of the dental tissue21
Anomalies of the Dental Tissue
  • Dilacerations – severe distortion or crown or root by trauma during formation
definition of dysplasia
Definition of DYSPLASIA
  • medically abnormal development or growth of a part of the body, for example, an organ, bone, or cell, including the total absence of such a part
intrinsic staining stain or discoloration within the tooth
Intrinsic StainingStain or discoloration within the tooth

Enamel dysplasia

HYPOPLASIA – (rough, pitted enamel surface, ameloblasts disrupted during the matrix formation of the tooth)

  • Interruption of the enamel developmental process results in irregular enamel formation or lack of enamel formation. Restorative treatment may be required because of susceptibility to decay and to improve appearance.
Syphilitic enamel hypoplasia.
  • A, Hutchinson's incisors.
  • B, Mulberry molars.
enamel dysplasia
Enamel Dysplasia

HYPOCALCIFICATION – defect in enamel during mineralization, spotted surface is generally smooth, may be from trauma, nutritional deficiencies, excess fluoride intake

enamel dysplasia30
Enamel Dysplasia

AMELOGENESIS IMPERFECTA – hereditary condition where dentin & pulp develop normally but enamel is easily chipped or worn away

  • A spectrum of hereditary defects in the function of ameloblasts and the mineralization of enamel matrix that results in teeth with multiple generalized abnormalities affecting the enamel layer only.
  • teeth vary in color from white opaque to yellow to brown   
  • all teeth are affected, smaller and pitted
enamel dysplasia32
Enamel Dysplasia

Dentinogenesis Imperfecta

  • The bluish color and translucent features of this dentition are very suggestive of dentinogenesis imperfecta.
  • Unlike amelogenesis imperfecta, the enamel in dentinogenesis imperfecta is normal; it is the underlying dentin that is structurally deficient.
dentin dysplasia rootless tooth
Dentin Dysplasia (Rootless Tooth)
  • A hereditary defect in dentin formation in which the coronal dentin and tooth color is normal; the root dentin is abnormal with a gnarled pattern and associated shortened and tapered roots
  • A malformed multirooted tooth characterized by an altered crown-to-root ratio, the crown being of normal length, the roots being abnormally short, and the pulp chamber being abnormally large.
  • Observed on radiographs – shows enlarged pulp chamber resulting in thinner dentin
talon cusp
Talon Cusp
  • Lingual of maxillary & mandibular anterior teeth
acquired anomalies
Acquired Anomalies
  • Attrition – wear from tooth on tooth

Attrition of the mandibular anterior teeth

  • Mechanical tooth wear caused by a foreign substance
  • Loss to tooth surface due to a chemical agent
  • Erosion from sucking on lemons (arrow) NEXT SLIDE
tooth fracture
Tooth Fracture
  • Small to large chips or breaks in the enamel
missing teeth m
Missing Teeth  M
  • Teeth that are not present because of extraction or are congenitally missing
  • Charting procedure

Place a vertical line or X through the facial, occlusal & lingual surfaces

  • Chart in BLUE ink
unerupted teeth u
Unerupted Teeth  U
  • Teeth that have not yet erupted or are impacted

Circle facial, occlusal, & lingual surfaces of tooth

Chart in RED ink

teeth to be extracted ex
Teeth to be extracted  Ex
  • Teeth to be extracted because of pathologic or orthodontic reasons
  • Draw a RED diagonal line through the tooth, or an alternative method is to draw 2 RED parallel lines through the tooth
amalgam restorations a
Amalgam Restorations  A
  • Alloy of silver/mercury; silver or dark grey in color; widely used as a restorative material
  • Chart surfaces where the restorations appear
  • Outline the shade in BLUE for precise notation use Black’s classification
tooth colored restorations r resin cr composite resin
Tooth Colored Restorations  R = resin CR = Composite resin
  • Outline exact size & shape of restoration
  • Shade with BLUE ink
  • Chart surfaces involved
  • Use Black’s Classification
temporary restorations temp t
Temporary Restorations  Temp, T
  • Temporary filling cements; zinc oxide-eugenol cement
  • Chart temporary restorations the same as amalgam or resins in BLUE ink, but distinguish from amalgams with the abbreviation
veneer ven
Veneer  Ven
  • Veneer or layer of resin that is used to cover the unsightly area of tooth
  • Outline & shade in surface of tooth where veneer is found
  • Chart in BLUE ink
full gold crown fgc
Full Gold Crown  FGC
  • Can be onlays or inlays or crowns
  • Outline & fill in with diagonal lines covering all surfaces
  • Chart in BLUE ink
gold crown gc
¾ Gold Crown  ¾ GC
  • Covers less than ¾ of tooth surfaces
  • Outline & fill with diagonal lines places on all surfaces or portion of surfaces covered by crown
  • Chart in BLUE ink
ceramic to metal crowns
Ceramic to Metal Crowns
  • GCFP = crown, porcelain face
  • GCAF = gold crown, acrylic face

Chart similarly to gold crowns

Abbreviation can be used to distinguish it from full gold or ¾ crowns

Chart in BLUE ink

gold inlay gi
Gold Inlay  GI
  • Does not cover the cusps
  • Outline the shape of the restoration on the surfaces where it appears
  • Chart in BLUE ink
gold onlay go
Gold Onlay  GO
  • Restoration which involves the cusp tips
  • Outline & color the shape of the restoration on the surfaces where it appears
  • Chart in BLUE ink
fixed bridges
Fixed Bridges
  • Each tooth may be labeled with the appropriate abbreviations FGC, GCPF, ¾ GC
  • Outline abutment & pontic teeth in BLUE ink & fill in with diagonal lines on occlusal, facial, & lingual surfaces
  • Chart the pontic teeth as extracted
  • Place 2 horizontal lines between the occlusal surfaces of the teeth to represent the splinted unit
dental implants impl
Dental Implants  IMPL
  • Make a written comment under the teeth involved
dental caries c
Dental Caries  C
  • Outline the SUSPECTED carious area(s) in GREEN
  • Once diagnosed as caries by DDS, outline in RED
  • On completion of the restoration, fill in the RED areas with BLUE
recurrent decay rd
Recurrent Decay  RD
  • Outline the area of recurrent decay in RED
  • Recurring caries around the margin of an existing restoration
appliances partial or complete dentures
Appliances – Partial or Complete Dentures
  • PUD = partial upper denture
  • PLD = partial lower denture
  • CUD = complete upper denture
  • CLD = complete lower denture

Chart the missing teeth with vertical lines or X’s through all surfaces

Join vertical lines or X’s with horizontal line at root apex & label to indicated upper or lower & partial or complete denture

overhanging restorations oh
Overhanging Restorations  OH
  • Chart with triangular symbols in the interproximal area
  • Chart in BLUE ink
dental sealants s
Dental Sealants  S
  • Encircle & place abbreviation inside the circle
  • Chart on occlusal surface in GREEN
root tip rt
Root Tip  RT
  • Chart tooth as missing & place abbreviation symbol near root apex
  • Chart in BLUE ink
root canal rc
Root Canal  RC
  • Place vertical line through pulpal area of root
  • Label with abbreviation
  • Chart in BLUE ink
decalcification or hypocalcification decal
Decalcification or Hypocalcification  Decal
  • Outline the area & label with abbreviation
  • Chart in BLUE ink
erosion ero
Erosion  Ero
  • Shade area in BLUE & place symbol
hypoplasia hypoplas
Hypoplasia  Hypoplas
  • Chart using wavy lines to denote the irregularity of enamel with symbol
  • Indicate with abbreviation
attrition att
Attrition  Att
  • Place a horizontal line over the affected surfaces
  • Chart in BLUE ink
abrasion abr
Abrasion  Abr
  • Chart 2 horizontal lines in BLUE ink
  • Caused by mechanical wear caused by improper toothbrushing or other habits such as chewing on pencils, pipe smoking
supernumary teeth su
Supernumary Teeth  Su
  • Draw additional tooth in location found
  • Chart in BLUE ink
  • Label with abbreviation
other dental anomalies
Other Dental Anomalies
  • Other anatomic variations such as dens in dente, should be clearly indicated in the record section of the dental chart
tmj evaluation
TMJ Evaluation
  • Detecting or noting any noises while bilaterally palpating the TMJ
  • Noises include
  • CREPITUS (cracking/grinding of the bones rubbing together)

Tenderness & pain/muscle tension should also be noted


Is done on each tooth to check for sensitivity, by gently tapping the dental mirror handle tip on each tooth & recording the finding’s noted as:

  • Normal = WNL
  • Sensitive = +P
  • Very Sensitive = ++P
  • Extremely Sensitive = +++P
reviewing radiographic findings relevant to the clinical assessment

Reviewing Radiographic Findings Relevant to the Clinical Assessment

Found on the back of the Hard Tissue

radiographic findings
Radiographic Findings
  • Review normal or pathological findings
  • Is part of the ASSESSMENT phase & can be used in the IMPLEMENTATION phase
  • Radiographs are also required for documentation & record keeping of client’s dentition ( ie. Forensic dentistry often uses radiographs)
periodontal conditions observed in radiographs
Periodontal Conditions Observed in Radiographs
  • Normal anatomy & the tooth crown to root ratio
  • Confirmation of clinical findings & topography of root surfaces
  • Status of the lamina dura
  • Changes in the PDL
  • Remaining bone height
  • Local irritants such as calculus & overhanging restorations
  • Patterns or extent of disease
  • Possible furcation areas
  • Disease progression or remission by serial radiography