Chapter 13 Flashcards
What is the essential goal of an extraoral examination?
A. To asses periodontal health
B. Identification of abnormalities and pathologies, especially oral cancer
C. To measure tooth mobility
D. To diagnose diseases
B. Identification of abnormalities and pathologies, especially oral cancer
The essential goal of the IOE and EOE is to
Detect possible early signs of cancer
What are the components of an Examination?
Total patient being treated
Exam is all-inclusive
Assesses risks for cancer
Exam is done at new patient exam, comp exam and every continuing care appt
What are the 10 risks during an examination?
History of previous cancer
Family history of SCC
Tobacco use
Alcohol use
Cultural and genetic susceptibility
Sun expose w/o sunscreen
Diet
Surgeries like organ transplant and bone marrow transplant as well as long term use of immunosuppressants
HPV vaccination status
Contraction of HPV from orogenital contact
What are the five types of exams?
Comp
Screening
Limited
Follow-up
Continuing care/ re-eval
What are the six methods of examination for IO and EO?
Visual, palation, instrumentation, percussion, electricity test, auscultation
Examination using direct observation in a systematic sequence; also includes radiographic examination and transillumination
Visual examination— one method of examination
Examination using the sense of touch thru tissue manipulation or pressure on an area with the gloved fingers of one or both hands.
Palpation- one method of examination
The four types of palpation
Digital, Bidigital, Bimanual, BIlateral
Palpation by use of a single finger
Digital
Palpation by use of the finger and the thumb
Bidigital
Palpation by use of finger or fingers and thumb from each hand applied simultaneously in coordination
Bimanual
Two hands are used at the same time to examine corresponding structures on opposite sides of the body
Bilateral
Examination using a perio probe or explorer
Instrumentation—one method of examination
Examination using the act of tapping a surface or tooth with an instrument and assessing sound or response of patient
Percussion—one method of examination
Examination using an electrical pulp vitality tester
Electrical test- one method of examination
Examination by use of sound.
Auscultation— one method of examination
Difference between signs and symptoms
Signs: objective; The abnormality is able to be observed as data by the clinician
Symptoms: subjective. The deviation from normal is felt by the patient or an subjective abnormality is observed.
Three steps to preparing for IO and EO
- Review healthy history and any existing medical record and existing dental record (like radiographs, dental caries) as well ask periodontal and cancer risk factors
- Examine Radiographs
- Explain procedure to patient
What are the three groups of oral mucosa?
Masticatory, Lining and Specialized
Keratinized stratified squamous epithelium firmly attached to underlying structures; this mucosa covers the gingiva (except free margin) and the hard palate
Masticatory mucosa
Nonkeratinized stratified squamous epithelium not firmly attached to underlying tissues; this mucosa is found covering the buccal, labial, part of alveolar region, soft palate, floor of mouth and ventral of tongue
Lining epithelium
This type of mucosa covers the dorsum of the tongue and is composed at the papillae of the tongue
Specialized mucosa
What are the four types of papillae?
Fungiform
Filiforme
Circumvallate
Foliate
Which papillae contain taste buds?
All of them except the filiform which is just for texture
What are the four reasons why having a sequence of examination is important?
Minimize exclusion, efficient, improves patient confidence, and promotes professionalism
What is the sequence of the EOE?
General appraise of head and neck
Cervical Lymph Nodes
Salivary and Thyroid Glands
TMJ
What abnormalities are to be assessed during the general appraisal of the heck and neck portion of EOE?
Injuries
Hair loss
Jaw movements during speech
Asymmetry of the face
Twitching or paralysis
Signs of abuse
Acne and other skin lesions
Color changes of the skin
Swelling
Masses in the neck
What abnormalities are to be assessed during the cervical lymph nodes of EOE?
Lymphadenopathy from either infection will have arose suddenly which will affect lymph nodes on both side of body and make them enlarged, tender, grape like and movable or malignancy which will have developed gradually and painlessly and affect lymph nodes on only one side of body and make them hard, fixed to underlying structures, nonmovable, not tender and clumped together
What abnormalities are to be assessed during the salivary glands and thyroid gland portion of EOE?
Enlarged, swollen, tender, and hard/firm salivary glands
Palpable, Asymmetrical, off the midline, enlarged, fixed to underlying structures thyroid gland; may also have nodules
What are some abnormalities when examining the TMJ during EOE?
Popping or clicking
Grating sensation when opening and closing jaw
Asymmetrical movements
Limited range of movement
Tenderness or pain reported by patient
What is the systematic sequence for the IOE?
- Lips and vermillion border
2.Oral cavity and mucosal surfaces
3.Underlying structures of the lips and cheeks
4.Floor of the mouth
5.Salivary gland function - The tongue
- Palate, tonsils and oropharynx
The abnormalities to notice during the lips and vermillion border portion of IOE would be?
Changes in color/pigment or texture
Chapped
All lesions especially herpetic lesions
Trauma or injury
Swelling
Lip biting
Changes in shape
Irregular vermillion border
Lips that do not meet at rest
Cheiolosis at the commissures
Lip pits
Asymmetry of mouth
What are the abnormalities noticed during the oral cavity and mucosal surfaces portion of the IOE?
Lesions
Línea alba
Cheek biting
Trauma
Injury
Change in color or texture
Swelling
Leukoplakia
Lichen planus
Halitosis
Dry mucosa
What are the abnormalities noticed during the underlying structures of the lips and cheeks portion of the IOE?
Swelling
Nodules
Changes in texture
Tenderness
Minor salivary glands feels like beads
What abnormalities are to be noted during the floor of the mouth portion of the IOE?
Changes in color or texture
Lesions or other surfaces abnormalities
Swelling: Mucocele/ ranula (trauma of the salivary gland duct); salivary caniculi or stones
Leukoplakia
Soft tissues have hard area and discomfort when palpated
What are some abnormalities to be noted during the salivary gland function portion of the IOE?
Xerostomia
Swelling in floor of mouth from blocked or traumatized saliva glands or ducts
What abnormalities should be noted during the tongue portion of the IOE?
Ulceration
Lesions
Swelling
Nodules detected when palpated
Variation in size, color and texture
Inflammation and odor from food accumulation
Assymetrical shape
Dry mouth
Papillae absent
Fissured or pebbly dorsal surface
Geographic tongue
Macroglossia
Ankyloglossia
Black hairy tongue (use of antibiotics)
What are some abnormalities to be noted in the palate, tonsils and oropharynx portion of the IOE?
Palate:
• Swelling
• Lesions
• Tumors
• Cleft palate
• Changes in color (red, white, gray)
• Changes in texture are common in smokers, such as cobblestone appearance.
• Snuff dipper’s or tobacco chewer’s patch
• Petechia (discrete red spots on palate due to trauma)
• Ulcerations
• Trauma
Paralysis will cause the soft palate to sag on the affected side of the face and the uvula to pull to the unaffected side.
Tonsils:
• Inflamed tonsils
• Enlarged tonsils
• Areas of exudates (pus) evident
Oropharynx:
• Markedly reddened and inflamed
• Sore throat
• Discomfort when swallowing or eating
Uvula:
• Deviates from midline
How can we prepare a patient of EOE?
Have them sit upright
Explain the procedure to them
Ask them to remove glasses, objects in mouth and clothing obstructing the view of the neck
How can we the clinician prepare for an EOE after/during general assessment?
Wash hands
Don exam gloves
Stand posterior to patient to see back of head, ears and neck. Look for abnormalities
Eight types of cervical lymph nodes to be palpated
Cervical
Preauricular
Post-auricular
Submental
Submandibular
Subclavicular
Anterior cervical
Posterior cervical
Eight types of cervical lymph nodes to be palpated
Cervical
Preauricular
Post-auricular
Submental
Submandibular
Subclavicular
Anterior cervical
Posterior cervical
