Examination Tools

Part of Dentistry

The basic dental instrument set for examination and diagnosis — what each tool does, how to improvise it, and how to use it correctly.

Why This Matters

Dentistry begins with examination. Without proper assessment tools, dental problems are missed, misdiagnosed, or treated incorrectly. A cavity identified in early stages requires a simple filling; the same cavity found at the abscess stage requires extraction. The difference between these outcomes is the systematic examination — and the tools that make it possible.

A complete dental examination toolkit is actually small and achievable. Five basic instruments cover the vast majority of diagnostic needs. All can be improvised from available materials with metalworking capability, and all can be sterilized by boiling or dry heat between uses.

The Basic Examination Set

1. Dental Mirror (Mouth Mirror)

Function: Reflects light into areas not directly visible; retracts cheek and tongue to improve visibility; used to view lingual (tongue-side) surfaces of teeth directly.

Design: Small circular mirror (20–25 mm diameter), mounted on a handle. The mirror surface is angled 15–20 degrees from the handle axis.

Improvisation:

• Salvage small convex or flat mirror glass; mount on handle
• Polish a small piece of stainless steel or other mirror-finish metal to high reflectivity
• Small polished spoon with handle bent to appropriate angle
• A piece of flat polished iron can work in good lighting, though less effective than glass

Use:

• Hold like a pencil, lightly
• Warm mirror over candle or in warm water to prevent fogging from breath
• Do not press hard against cheek — retract gently
• Use indirect vision (looking at reflection) for lingual surfaces

2. Dental Explorer (Probe)

Function: Tactile detection of decay, calculus, root surfaces, cavity margins; checking pit and fissure stickiness; exploring pocket depths (with calibrated probe).

Design: Sharp-tipped instrument, usually with a right-angle bend in the working tip (shepherd’s hook) or a straight tip with curve. Handle is cylindrical and thin for tactile feedback.

Improvisation:

• Any stiff wire with a sharp tip, bent at the working end: straightened fishhook, sharpened bicycle spoke, thin wire with tip hardened and sharpened
• The tip must be hard and sharp — a blunt explorer misses early decay
• A very fine finishing nail with the head cut off, tip filed to fine point, bent at 45 degrees near the tip

Use:

• Light pressure only — the explorer tip catches in soft decay; heavy pressure masks the difference between soft and hard
• If the tip catches in a fissure and does not release when pulled back gently, decay is present
• Explore all surfaces systematically: occlusal pits and fissures, all smooth surfaces at gumline, root surfaces

3. Periodontal Probe

Function: Measures depth of gum pockets around each tooth; assesses bone loss; identifies bleeding points.

Design: Blunt-tipped instrument (not sharp — intended to enter pocket without piercing tissue) with millimeter markings etched into the blade.

Improvisation:

• Straighten a thin piece of wire; flatten and smooth the tip to be blunt (not sharp)
• Mark with file notches at 3, 6, 9, and 12 mm from tip (file notches visible to touch)
• A graduated wire probe made from straightened fishhook wire

Use:

• Insert gently into space between gum and tooth at 6 points around each tooth
• Walk probe slowly around the circumference at each point
• Record depth at each point — anything over 3 mm is abnormal; over 5 mm indicates significant periodontal disease
• Note bleeding: probe gently; sites that bleed promptly after probing have active inflammation

4. Cotton Pliers (Dental Tweezers)

Function: Placing and removing small items (cotton rolls, small dressings, medication), handling small instruments, transferring materials.

Design: Locking or non-locking tweezers with serrated tips, roughly 15 cm long.

Improvisation:

• Watchmaker’s tweezers or fine dissection forceps work well
• Any fine-tipped tweezers with sufficient grip
• Must be sterilizable (metal construction essential)

5. Excavator (Spoon Excavator)

Function: Removing soft decay; scooping material from cavities; testing consistency of dentin.

Design: Spoon-shaped working end; blade is sharp-edged and curved. Available in multiple sizes.

Improvisation:

• A small, sharp-edged spoon shape in steel; can be made by flattening and bending wire to form cup shape, then grinding edges sharp
• Curved tip of a dental probe can substitute for small-scale work

Examination Procedure

With these five instruments, perform a complete examination:

Extraoral (Outside the Mouth)

1. Inspect face for asymmetry, swelling, fistula (skin opening from abscess)
2. Palpate lymph nodes under jaw and along neck — enlarged, tender nodes indicate infection
3. Note jaw opening and any clicking or deviation of the jaw

Intraoral Soft Tissue

1. Inspect lips, cheeks, tongue, palate, floor of mouth for ulcers, swellings, unusual patches
2. White patches on tissue that cannot be wiped off (leukoplakia) — investigate; can be precancerous
3. Red, flat patches similarly warrant close monitoring

Gingival (Gum) Assessment

1. Color: healthy gum is pale pink; inflamed gum is red, swollen, may bleed easily
2. Form: healthy gum has pointed papillae between teeth; inflamed gum is rounded and puffy
3. Note any recession (gum pulling away from tooth, exposing root)

Tooth Examination

Systematically examine every tooth:

1. Mirror: Check all surfaces, note visible cavities, fractures, wear
2. Explorer: Probe all pits and fissures, gumline areas
3. Percussion: Tap each tooth gently with handle of instrument — dull thud indicates healthy tooth; sharp pain to tapping indicates periapical (root tip) infection
4. Mobility: Push each tooth gently; movement of more than 1 mm in any direction indicates significant bone loss

Periodontal Probing

Probe all 6 points around every tooth; record pocket depths; note bleeding. This takes time but reveals the true periodontal status that visual examination alone cannot show.

Record Keeping

Draw a simple tooth chart — a diagram of all 32 teeth. Mark findings:

• Cavities and existing restorations
• Pocket depths at each tooth
• Missing teeth
• Mobility scores
• Areas of concern

Update this chart at each examination visit. Comparing charts over time reveals disease progression or treatment success — the most valuable information for guiding ongoing care.