A quick look and a cleaning can tell you whether you have a cavity today. A comprehensive exam is meant to answer a bigger question: why things are happening in your mouth, and what’s likely to happen next. Here’s what ours actually includes, step by step.
Key points
- The exam is part of your first visit, which runs 60 to 90 minutes. It starts with a conversation, not an X-ray.
- We take a full set of records: digital X-rays, photos and a 3D scan.
- We look at the whole mouth: teeth, gums, old dental work, the bite, the jaw joints and muscles, wear, and how you breathe and swallow.
- Then we go through it with you, photo by photo: what’s fine, and what’s worth talking about.
- Depending on what we find, we may suggest more: a 3D CBCT scan, a saliva flow test or a test of the bacteria in your saliva.
It starts with a conversation
Before anyone takes a picture, you sit down with the doctor and tell us why you came in: what bothers you, what you’d like to change, and anything about past dental visits that made them hard. We also ask you to fill out a short questionnaire about your concerns and goals, including the one we like best: if you could change anything about your teeth, what would it be?
We ask about your health history and medications, and about habits that matter to your mouth, like vaping, nicotine pouches, smoking and marijuana. Not to judge. They change what we look for. What vaping and Zyn do to your mouth.
Records: a baseline for years from now
Next we take a full set of records: digital X-rays, photos of your teeth and a 3D scan. The scan takes a few minutes and replaces the old trays of putty. Together they’re a baseline we can measure against years from now, so small changes get noticed while they’re still small. The technology we use, and why.
What we check
| Area | What we look at | Why it matters |
|---|---|---|
| Teeth | Decay, including decay starting under old fillings, cracks, and the condition of every filling and crown | Small problems found early stay small |
| Gums and bone | Measurements around every tooth, bleeding, and bone on the X-rays, staged with the current 2017 classification | Gum disease rarely hurts, even while it takes the bone that holds teeth in |
| Jaw joints | We feel both joints, listen for sounds, and measure how wide and how straight you open | Joint problems often show up first as worn or broken teeth |
| Muscles | We press on the jaw, temple, neck and shoulder muscles and you rate each one | Sore muscles can make a healthy tooth hurt, or a bite feel wrong |
| Bite | Where your teeth first touch when you close, whether your jaw slides from there, and a load test of the joints | A bite that doesn’t match the joints wears and breaks teeth |
| Wear | The pattern of wear across your teeth | Grinding, clenching and acid each leave a different pattern |
| Tongue and breathing | Where the tongue rests, whether it can reach the roof of the mouth, how you swallow, and whether you breathe through your nose | A low tongue and mouth breathing push teeth and dry the mouth |
How the load test works
The idea is to load the jaw joints without the teeth in the way. We do it with a leaf gauge, a small stack of thin plastic strips you bite on with your front teeth, or by gently guiding your jaw with both hands. It tells us whether your teeth are protecting the joints or not.
If a disc in the joint is out of place, loading it can occasionally cause pain, but not always. If a tooth still touches while the leaf gauge holds your jaw open 2 to 3 millimeters, that can also mean a disc is displaced. Now that we can image the joints, a scan tells us much more than the load test alone.
Finding a joint problem isn’t necessarily about fixing it. It’s about not creating new problems. A displaced disc can sometimes start to click after dental work, so it’s something we want to know about before work begins. Jaw pain: is it your muscles or your joint?
If the tongue and breathing screen suggests a problem, Dr. Jeannie Lee-Mirzayan, our certified myofunctional therapist, does a fuller evaluation. More on myofunctional therapy.
Then we go through it with you
We put the photos and scans on the screen and go through them together, area by area. Each one is either fine, or worth talking about. You see the same pictures we do, and you’ll know why before anything is recommended.
When something does need attention, we sort it into what needs to happen first, what can come next, and what to watch over the long term. For a lot of people the answer is simply to keep up with regular cleanings. When a simple fix will hold, that’s what we recommend. Why a plan beats fixing one tooth at a time.
When we suggest more tests
Not everyone needs more than the exam. Based on what we find, we may suggest:
- A 3D CBCT scan, when there’s a specific question it can answer: planning an implant, working out what’s happening at the jaw joint, or checking for a problem inside a tooth that a regular X-ray doesn’t settle. Every one we take is also read by oral and maxillofacial radiologists.
- Saliva flow testing, when decay keeps coming back or your mouth is dry. Saliva is your teeth’s main defense. Why a dry mouth leads to cavities.
- Testing the bacteria in your saliva, when decay or gum disease is more active than your home care would explain.
We suggest these when the answer would change the plan, not as a routine add-on.
What to bring
- A photo ID
- A list of your medications and any health conditions
- Records or X-rays from a previous dentist, if you have them
- Your dental insurance information, if you have it
- Your questions, and whatever is bothering you most
Haven’t been to a dentist in a while? That’s exactly what this exam is for. Start here. What your first visit looks like.
Call 702-734-0776 or tell us what’s going on.
General education, and not a substitute for an exam.