Clinical Methods -- Oral Physical Exam

Question 1

Body parts included in the extraoral examination (6)

Answer 1

• Temporo-mandibular joints (TMJ) and facial symmetry
• Neck
  
  • Lymph nodes
  • Thyroid
• Lips

Question 2

7 physical parts included in the intraoral examination

Answer 2

• Lips
• Cheeks (buccal mucosa)
• Floor of mouth
• Tongue
• Palate
• Teeth and periodontium

Question 3

5 general rules in dentistry

Answer 3

1. Inspection/observation
2. Palpation
3. Hear (auscultation)
4. Percussion
5. Smell (olfcation)

Question 4

7 things to observe when inspecting the TMJs

Answer 4

Evaluation of the degree and movement and sounds:

• Open
• Close
• Lateral movements
• Protrusion
• Measurement in mm
• Crepitus (grating sound)
• Click

Question 5

What is occurring in this photo?

Answer 5

• Palpation with fingers on the B/L TMJs
• Auscultation (if necessary)

Question 6

4 normal movements and range of motion of the TMJs and facial symmetry

Answer 6

• Rotation - translation
• Opening to 3 fingers in length
• Closing
• Laterality

Question 7

Abnormalities (symptoms) seen in TMJs and facial symmetry

Answer 7

• Painful clicking vs. asymptomatic clicking
• Crepitus
• Asymmetry/condylar fracture

Question 8

4 levels of the cervical lymph nodes

Answer 8

• Superficial
• Deep
• Anterior digastric
• Posterior digastric

Question 9

2 ways to examine the cervical lymph nodes

Answer 9

• Visual inspection
• Palpation of digastric region

Question 10

3 parts of the digastric region

Answer 10

• Submandibular
• Submental
• Cervical

Question 11

4 landmarks of the digastric region

Answer 11

• SCM (sternocleido muscle)
• Inferior border of mandible
• Digital
• Bimanual

Question 12

Label the parts of this anatomical diagram

Answer 12

Question 13

Steps for palpation of the neck

Answer 13

1. Patient’s head turned to opposite side
2. Follow the SCM
3. Tilt the chin down
4. Displace tissue along inferior border of mandible

Question 14

Normal lymph nodes and thyroid

Answer 14

• Palpable or non-palpable
• Movable, non-enlarged, non-painful

Question 15

Abnormalities that can be found when examining the lymph nodes and thyroid

Answer 15

• ENlarged lymph nodes or thyroid –> refer for further investigation

Question 16

Normal appearance of lips

Answer 16

Reddish-pink color

Vermillion border

Question 17

Abnormalities that can be found when examining the lips

Answer 17

Actinic cheilitis (precursor to squamous cell carcinoma)

Herpes labialis

Question 18

5 normal findings of the buccal mucosa (inner cheek)

Answer 18

• Linea alba
• Forcyde granules
• Desquamation due to parafunctional habit
• Stenson’s duct orifice
• Saliva (clear, watery)

Question 19

3 abnormal findings upon examination of the oral mucosa

Answer 19

• Chemical burn
• Ulceration
• Oral lichen planus

Question 20

Normal findings of the labial mucosa (inner surface of lips) upon examination

Answer 20

Minor salivary gland, color

Question 21

Abnormal findings of the labial mucosa upon examination

Answer 21

• Mucositis
• Mucocele
• Ulcer-aphthous ulcer

Question 22

2 examination steps for the palate

Answer 22

• Visual inspection
• Palpation

Question 23

Normal findings upong examining the palate

Answer 23

• Hard/soft palate
• Torus (bump in middle)

Question 24

5 abnormalities of the palate upon examination

Answer 24

• Chemical burn
• Nevus
• Herpes
• Micotinic stomatitis
• Plemorphic adenoma

Question 25

Steps to inspect the oropharynx

Answer 25

* Depress the tongue with a tongue depressor or mirror * Ask the patient to say "ahh"

Question 26

3 spaces in the mouth

Answer 26

Question 27

Parts of the oropharynx

Answer 27

Question 28

What is this

Answer 28

Bifid uvula

Question 29

What is this

Answer 29

Pharyngeal tonsils

Question 30

What is this

Answer 30

Lymphoepithelial cysts

Question 31

Normal findings at the floor of the mouth

Answer 31

Wharton's duct Saliva flow

Question 32

Abnormal findings of the floor of the mouth

Answer 32

* Varicosities * Sialolith/obstruction * Ranula

Question 33

How to palpate the floor of the mouth

Answer 33

* Lingual aspect of the alveolar ridge (digital) * Floor of the mouth (bimanual) * Right index in the floor of the mouth * Fingers of left hand under the chin * NOTE: GENTLE COMPRESSION

Question 34

How to inspect and palpate the tongue

Answer 34

Use the latero-posterior method: * Ask the patient to stick out the tongue * Hold the tongue by wrapping the tip with 2x2 gauze * Assess for induration or tenderness

Question 35

Normal findings on the tongue upon examination

Answer 35

All types of papillae Lingual tonsils

Question 36

Abnormal findings of the tongue (6)

Answer 36

* Papilloma/condyloma * Ankyloglossia * Hair tongue * Fissured tongue * Benign migratory glossitis * OSCCa (oral squamous cell carcinoma)

Question 37

What to inspect for the salivary glands

Answer 37

Openings of the ducts: * Stenson's duct * Warthon's duct

Question 38

How to palpate the salivary glands

Answer 38

* Stimulate (milk) the production of saliva * Observe the color and texture of the saliva

Question 39

How to palpate the buccla mucosa

Answer 39

Palpate the cheeks and lips with this method: * Index in mouth/thumb on cheek (skin)

Question 40

Abnormalities of the teeth and periodontium

Answer 40

* Caries * Tooth fracture * Pulpal polyp * Calculus * Biofilm/plaque

Question 41

6 types of abnormalities of occlusion

Answer 41

* Classe I * Classe II * Classe III * Diastema * Anterior open bite * Cross bite

Question 42

Demonstrate Classe I occlusion

Answer 42

Question 43

Differentiate between classes I, II, and III of occlusion

Answer 43

The degree by which the anterior maxillary teeth angle forward