What are the steps for conducting a comprehensive Dental Health Assessment (DHA) dental exam on a patient?

Comprehensive Dental Health Assessment (DHA) Examination

A comprehensive dental health assessment requires a systematic approach beginning with medical history documentation, followed by extraoral and intraoral clinical examination, and appropriate radiographic imaging based on clinical findings and risk assessment. 1

Medical History and Risk Assessment

Document the following critical information:

• Current and past medical conditions, including cardiovascular disease, diabetes, immunocompromised status, bleeding disorders, and medications that may affect dental treatment 1
• History of tuberculosis and symptoms indicative of TB (cough, fever, night sweats) 1
• Radiation therapy history to the head and neck region, as this dramatically increases risk of dental caries and osteoradionecrosis 1
• Smoking status and counsel all current smokers to quit 1
• Dental history including past dental treatment, oral hygiene practices, and patient motivation/compliance 1

Extraoral Examination

Systematically evaluate the following structures:

• Facial symmetry and palpation of the facial skeleton for signs of fractures or masses 1, 2
• Temporomandibular joint function and range of motion 2
• Lymph nodes for enlargement or tenderness indicating infection or malignancy 2
• Soft tissues of the face and neck for lesions, swelling, or abnormalities 1, 2

Intraoral Examination

Complete a thorough assessment including:

• Soft tissue examination of lips, buccal mucosa, tongue, floor of mouth, palate, and oropharynx for lesions, ulcerations, or abnormalities 1
• Periodontal assessment including probing depths, bleeding on probing, recession, and mobility of all teeth 1
• Dental examination evaluating each tooth for caries, fractures, wear patterns, restorations, and structural integrity 1
• Occlusion assessment to identify malocclusion, premature contacts, or bite disturbances 1
• Oral hygiene status including plaque and calculus accumulation 1

Radiographic Examination

Select imaging based on clinical findings and patient risk:

• Panoramic radiograph as the initial screening examination when pain, swelling, or paresthesia is present, or for comprehensive assessment 1, 3
• Bitewing radiographs for caries detection in all patients, particularly those at high caries risk 1
• Periapical radiographs when pulpal or periapical pathology is suspected, or to evaluate specific teeth in detail 1, 3
• Complete radiographic series including radiographs of all teeth for comprehensive pre-radiation therapy evaluation 1
• CBCT imaging should be reserved for cases where conventional radiography provides inadequate information, not as a first-line examination 1

Risk Stratification

Assess caries and periodontal disease risk based on:

• Existing periodontal and dental conditions including active disease, previous disease history 1
• Radiographic evidence of periapical pathology 1
• Xerostomia or salivary dysfunction, particularly in patients with history of head and neck radiation 1
• Patient compliance with oral hygiene and preventive protocols 1

Special Considerations for High-Risk Patients

For patients undergoing head and neck radiation therapy:

• Dental assessment must occur as early as possible prior to initiation of radiation therapy 1
• Identify and remove teeth with poor prognosis including moderate-severe periodontal disease, periapical disease, and caries within the radiation field 1
• Allow minimum 2-week healing period between extractions and radiation start, only when this does not delay oncologic treatment 1
• Provide comprehensive patient education about lifelong risk of osteoradionecrosis and need for preventive protocols 1

Documentation Requirements

Record all findings systematically:

• Formal characterization of any pathology detected, using standardized classification systems when applicable 1
• Treatment plan based on examination findings, risk assessment, and patient factors 1
• Recall interval based on risk level—at least every 6 months, or more frequently for high-risk patients with xerostomia or active caries 1

Common Pitfalls to Avoid

• Do not rely solely on new diagnostic technology without performing a comprehensive clinical examination first, as this can lead to misdiagnosis 4
• Do not defer dental evaluation in cancer patients, as this increases risk of complications during and after radiation therapy 1
• Do not perform CBCT as initial imaging for routine dental assessment—reserve for complex cases after conventional radiography 1