Extra- oral examinations

Question 1

List 5 aspects of a patient a Dental clinician needs to be aware of when performing a limited overall physical examination

Answer 1

1. Patient posture and gait
2. Exposed skin surfaces
3. Vital signs
4. Cognition and mental acuity
5. Speech and ability to communicate

Question 2

List and describe the ideal procedure for an “Overall appraisal” of the Head and Neck

Answer 2

Go in a consistent sequence, inspect and palpate well, and carefully document everything.

The best sequence is:

1. Overall Appraisal of Head, Neck, Face and Skin
2. Lymph nodes of the Head and Neck
3. Salivary and Thyroid Glands
4. Temporomandibular joint

• Ask questions during the examination; “is there anything different to the normal appearance”

Additionally, look for:
• Asymmetry
• Hair loss 
• Eyes 
• Ears 
• Facial movements 
• Colour 
• Lesions on the skin

Question 3

Name and identify the location of 8 groups of lymph glands that an OHT needs to be aware of and be able to preform a examination with proper palpitation techniques

Answer 3

1. Occipital nodes
2. Postauricular nodes
3. Preauricular nodes
4. Submandibular nodes
5. Submental nodes
6. Cervical anterior chain
7. Cervical posterior chain
8. Supraclavicular nodes

Oral cancer spreads through the cervical chain of the lymph nodes in the neck

Question 4

What should you feel when palpating lymph nodes?

Answer 4

Normal
• Lymph nodes are usually not detectable
• No signs of tenderness upon palpation

Alarm bells: 
• Firm and tender 
• Enlarged and warm 
• Bilateral swelling 
• Freely movable • Fixed or freely movable 

Signs of possible malignant lymph nodes:
• Firm non tender
• Stuck to each other
• Fixed

Question 5

What is palpation?

Answer 5

• It is the examination of a part of the body using fingertips to move or compress a structure against the underlying tissue
• The most sensitive part of the hands should be used for palpation

Question 6

State and describe the location of the Temporo-mandibular joint

Answer 6

• The TMJ is where the maxilla and mandible meet
• The joint itself is typical to a ball and socket with a disc wedged between it
• One of the most frequently used joints in the body
• When muscles around the jaw are over strained the jaw becomes unbalanced (deviation)

Question 7

How do you assess palpation of the TMJ?

Answer 7

• Place index fingers in front of the tragus
• Ask the patient to open their mouth
• Slide fingers into the joint during the process
• Ask patient to move jaw to the right then left, then jaw forward
• Note any sounds or deviations

Question 8

What is the expected find when assessing the TMJ?

Answer 8

What to expect to find
• No deviations
• Smooth movements

Alarm bells
• Deviation upon opening and or closing
• Sounds- clicking, grinding and or popping
• History of locking when opening or closing
• History of frequent headaches
• Limited movements
• Pain or tenderness