Diagnosis, Treatment Planning and Dental Radiology
Diagnosis and treatment planning
Know the diagnostic process: history (chief complaint, HPI, medical, dental, social, family), examination (extraoral, intraoral, periodontal, occlusal), special tests (vitality, percussion, palpation, transillumination, selective anaesthesia), and imaging. Know problem list construction and the hierarchy of treatment - emergency, disease control, definitive care, maintenance. Know informed consent, risk assessment, and the role of the medical history in modifying dental treatment (anticoagulants, bisphosphonates, cardiac conditions, diabetes, pregnancy, immunosuppression). Know the ASA classification and its implications. Know treatment planning traps: treating the tooth rather than the patient; ignoring occlusal or periodontal factors; failing to plan the end point.
Dental radiology
Know the physics: X-ray production, tube voltage (kVp) controls contrast and penetrability, tube current (mA) and exposure time control quantity; the inverse square law; ALARA and ALADA principles. Know image receptors (film, PSP, CMOS) and processing errors (cone cut, elongation, foreshortening, overlapping, double exposure, film bending, chemical stains). Know intraoral (periapical paralleling vs bisecting, bitewing) and extraoral views (panoramic, lateral cephalometric, CBCT, occlusal, TMJ views) and their indications and limitations. Know radiographic interpretation: caries, periapical pathology, periodontal bone loss, cysts, tumours, impacted teeth, and the ghost image and superimposition artefacts in panoramic imaging. Know radiation protection: collimation, lead apron, thyroid shield, justification, optimisation, dose limits, and the pregnant patient.
Traps
- kVp controls contrast; mA controls quantity (density).
- Elongation results from insufficient vertical angulation; foreshortening from excessive angulation.
- Panoramic images are not diagnostic for caries or fine bone detail.
- CBCT is justified only when 2D imaging is insufficient.
Rule of thumb
Every radiograph must be justified by a clinical question and optimised to answer it with the lowest achievable dose.