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Comprehensive Oral Exam

Who is this Exam for?

Everyone! A comprehensive oral exam (COE) is an extensive evaluation and recording of all extra oral, intra oral, soft and hard tissues.

 A recare exam (check up) is an exam that is done on established patients to determine any changes in dental and health status since a previous comprehensive or periodic evaluation.  This exam is usually done 1-2 times a year by the dentist.

 The comprehensive exam lays the foundation for the “routine oral exam” (check up).

 The mouth is really a window into the body. Medical conditions may be discovered by a comprehensive dental exam before symptoms show up elsewhere in the body. Diabetes (especially poorly controlled or undiagnosed), systemic disorders such as leukemia; blood pressure, cardiovascular problems, oral cancer, immune abnormalities and sinus problems are just a few examples.

 All new patients in our office will go through a COE, as well as all existing patients every 5 years after the age of 18.  Existing patients who have been absent from our practice for more than 3 years or who have had a significant change in their medical history also require a COE.

By doing a comprehensive exam, we can together devise a strategy for long-term oral and general health.

What is involved?

 First, we will collect an extensive medical and dental history. It is important to note any current medications, natural remedies or vitamins being taken. Any medical conditions being treated, previous surgeries or hospitalizations, and allergies are also important to note. It is important to keep record of any previous experience, adverse reactions, or family member reactions to anesthesia. Also notify us of any smoking and/or alcohol habits.

 A series of x-rays, depending on your needs, will be taken. The most common x-rays taken during a comprehensive exam are the panoramic (full mouth x-ray that shows all the teeth and their supporting structures, the temporomandibular joint (TMJ), the sinuses and jaw) and bitewing x-rays (used to diagnose cavities and look at bone levels between the teeth). These x-rays allow the dentist to diagnose problems that cannot be seen intra- or extra-orally and use minimal radiation (you get more radiation on an airplane!).

A visual and manual oral cancer screening of the lymph nodes in front of and behind the ears, beneath the chin, and neck area, will be carried out. We will look for pain, tenderness and flexibility of the nodes.  

This exam is particularly important with the increase in oral cancers especially HPV-oropharyngeal cancers, which increased 225% from 1988-2004.  Trends show that these cancers will surpass the number of cervical cancers by the year 2020.

 Also, there will be screening of the lips (inside and out), inside the mouth including hard and soft palate, behind the molars, floor of the mouth, lips, borders, frenums and surfaces of the cheeks.

 In addition, we will check your temporomandibular joint (TMJ) for any chewing problems, pain in joints and jaw area, and mouth opening abilities.

 A periodontal and gingival assessment, which involves probing six measurements of pocket depths on every tooth, will be completed. In this exam mobility of teeth are checked and bone loss is measured, which will then indicate any signs of gum disease. Calculus build-up, bleeding, swelling and recession will be recorded.

Your bite will be assessed, which may include charting of teeth that are crooked, crowded or spaced too far apart, an overbite, open bite or cross bite.

We will chart, in a detailed tooth chart, conditions of the teeth by checking each tooth individually. Also, any work done, decay, leakage, treatments needing to be done, positions of teeth, impactions, wear of teeth, and a cavity check will be noted.

 Intra-oral photos may be taken, which will allow you to see the teeth we feel may have cavities, micro-cracks, defects in tooth structure, faulty fillings and crowns, as well as tissue health.  We also take extra-oral photos of your smile and bite.

 Lastly, we will discuss any important findings with you, and together work out a treatment plan, which will incorporate your immediate, intermediate and long-term dental needs.  Any large treatment plans are discussed between the Treatment coordinator and Dr. Dickinson before making any final decisions on the best treatment options.  The options are then presented to you.

Gum disease and overall health: There is a link!

 Although it is not commonly considered, our mouths are connected to the rest of our body. Research studies have linked gum infections to other diseases of the body such as heart disease and stroke, diabetes, Alzheimer’s and cancer. Your mouth is the gateway to the rest of your body!


 Gum disease is one of the most common human diseases. It is an inflammatory and infectious condition resulting from a build-up of bacteria called biofilm. Without effective home care, oral biofilm and calculus (tartar) may cause gingivitis (inflammation of the gums) at and below the gum line. The inflammation and the formation of both plaque and calculus may spread to underlying bone causing bone destruction and periodontal disease.


If left untreated, chronic inflammation may eventually lead to infection and abscesses, pain and tooth loss.   The harmful bacteria causing both caries (cavities) and gum disease (periodontal disease) can be transferred from one person to another via saliva.  Host response, environmental stressors and genetics play a role in the progression of cavities and periodontal disease.



Frequently Asked Questions:

How often should I have a COE?

 A Comprehensive Oral Examination (COE) should be done every 5 years for EACH patient whether or not you have periodontal disease.

 If you have periodontal disease and are classified as a periodontal patient it is important to ALSO have an Annual Periodontal Assessment (APA), which is a branch of the comprehensive oral examination and consists of the cancer screening, as well as gingival and periodontal assessment. It is used to monitor the disease and its condition once a year.

What are the costs?

Most insurance companies cover a portion of the COE every 3-5 years, which they also classify as a New Patient Exam.  However, if you do not have dental benefits the cost of the exam (plus the cost of x-rays), which varies with each individual is significantly lower than paying for future emergency dentistry!

Any further questions regarding this exam are welcomed and can be put forth to any one of our dental team members!

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