Clinical Examination Flashcards
In an extra oral examination what are the names of the lymphnodes that you will be palpating and where are they located?
Submental - under chin
Submaxillary - under 5/6 mandibular teeth
Cervial - down the neck
Supraclavicular - on shoulder bones
Occipital - back of the head
Posterior auricular - behind the ear
What are the muscles involved in mastication? and where are they located?
4 main types
Temporalis - closes mouth
Masseter - closes mouth and aids chewing
Lateral Pterygoid superior/inferior - Opens mouth and pushes lower jaw out and moves lower jaw side to side
Medial pterygoid superficial/deep - Closes mouth and pushes lower jaw out, moves lower jaw side to side
What is the nerve the innervates the muscles of mastication?
The mandibular nerve which is V3 of trigeminal nerve
What are the two types of occlusal schemes and explain them?
Canine guidance - upper and lower canines on the working side remain in contact
Group function - two or more teeth on the working side are in contact during lateral excurtion
What are the two distinct joint cavities in the TMJ separated by?
Fibrocartilaginous articular disc
Whar are the three TMJ ligamint joints?
- Lateral ligament (temporomandibular ligament)
- Sphenomandibular ligament
Stylomandibular liganent
What are the two types of jaw relfexes?
Mytactic - maintains resting position of the mandible
Nociceptive - relaxes the muscles of mastication
When doing a basic occlusal examination what do you look for?
Has the patient mentioned any TMJ problems
Any clicks, crepitus and deviations
Describe the ICP - is it stable, unstable, can a restoration be placed
What is crepitus? and why is it importaant medico legally
Grating and deviations of the jaw as it opens - this is important as patients that come in for a lot of treatment will notice these things a lot more and can say it is due to the restorations that have been put in
What are signs and symptoms of clenching and grinding of TMJ?
Deviations on opening
clicks
crepitus
degree of opening
palpate mucles during opening and closing of the mouth
Where does the condyle seat?
Glenoid fossa
What is ICP?
Intercuspal position
What is the BULL and PUBL rule?
Lateral forces on the working side effect the Bucaal cusp Upper and Lingual cusp lower
Lateral forces on the non working side will affect Palatal Upper and Buccal Lower
When doing an extra oral examination what do you check for?
General appearance (breathing, eyes):
Facial abnormalities (colour, texture, symmetry, swellings)
Lips (competent, lesions, swelling):
TMJ (tenderness, click, crepitus):
Jaw movement range (trismus, deviation): mm
Muscles of mastication (masseter, temporalis, lateral pterygoids):
Halitosis:
Lymph nodes (lymphadenopathy):
Occlusion (dynamic static)
When doing an intra oral examination what do you look for?
Oral mucosa (vestibule, fraenum, parotid ducts):
Tongue (dorsum, lateral borders):
Floor of mouth (ventrum, submandibular ducts):
Hard/ soft palate (tonsils, uvula, palatoglossal and palatopharyngeal arches):
Gingivae (colour, contour, recession, bleeding):
Plaque (location):
Calculus (location):
Teeth (restorations, cavities, tooth surface loss, staining, mobility, furcation, occlusion):
Removable appliances (hygiene):
Plaque control- good/ adequate/ poor
What are the measurements on a BPE probe?
- 5mm ball end
- 5mm - bottom of black band
- 5mm - top of black band
- 5mm
- 5mm
What are the BPE codes and how are they recorded?
Code 0 - No disease
Code 1 - Bleeding on Probing -BPE should be recorded annually
Code 2 - Supragingival or subgingival calculus (overhanging margins) - No pockets >3mm - BPE should be recorded annually
Code 3 -Pocket 4-5mm - Full probing depth of affected site
Code 4 - Pocket 6mm+ - full probing depth of entire dentition
Code * - Furcation or Recession plus probing depth of 7mm_+
If a patient has a probind depth is 4mm or greater what do you do?
Use a williams probe/PCP 10 probe to do pocket charting
Once BPE scores are recorded what does each code indicate for what treatment should take place?
0 - No need for perio treatment
1 - OHI
2 - Removal of plaque retention factor (supra/sub gingival calculus) & OHI
3 - RSD & OHI
4 - RSD, OHI & refer to specialist
* - RSD, OHI & refer to specialist
Write the process of doing a plaque free score
Apply vasaline to patients lips
Ask patient to chew disclosing tablet
Swish around mouth 30 seconds
Spit
Rinse gently once
Pink – new plaque, purple older plaque
1= Plaque present. 0 – plaque isn’t present
What does pink and purple represent on a plaque free score?
Pink - new plaque
Purple - Old plaque
How do you record plaque free score on SALUD?
1 - Plaque present
0 - Plaque isn’t present
