Intraoral exam Flashcards
1
Q
Operator positioning
A
chair seat height - thighs slightly downhill, feet flat on floor
Chair backrest height - middle of back
Seat parallel to floor - avoid leaning forward
2
Q
Light positioning
A
arms length away.
mand - over mouth
max - over waist
3
Q
Keep you pt informed on
A
what you’re doing
4
Q
Most primary medical care providers still not comfortable
A
performing basic oral health assessments.
consider oral health outside of their realm of practice
5
Q
Look for
A
cancer, signs of systemic ds., tissue trauma, infections, pain, esthetic concerns, occlusal dysfunction, etc
6
Q
Oral cancer
A
90% - squamous
3% of all cancers
Overall, 57% 5-yr survival rate
2 men : 1 woman
7
Q
importance of early diagnosis
A
40% are found in stages 1/2 - 80% survival
60% are found in stage 3/4 - 33% survival (3yrs), 67% recurrence in 2 yrs
8
Q
Lesion description
A
number, size, shape, color, profile, base, border, texture
9
Q
Risk factors of oral cancer
A
tobacco (#1) alcohol (#2) viruses: HIV+, HPV Sun exposure Inadequate nutrition Genetic predisposition chronic inflammation radiation exposure carcinogen exposure
10
Q
Prevention of oral cancer
A
75% could be prevented by eliminating tobacco & alcohol use
Lip balm w/ sunscreen
HPV vaccine
Diet rich in fruits and veggies
11
Q
High risk areas of oral cancer
A
Floor of mouth, lateral border of tongue, ventral surface of tongue, oropharynx
12
Q
Sign and symptoms: oral cancer
A
non healing ulcer, bleeding, lymphadenopathy, hardness, pain, paresthesia, drooling
13
Q
Routine oral cancer exam
A
- Question pt about risk factors - tobacco, alcohol, sunlight, HPV
- Examine face - discolorations, swellings, asymmetry
- Palpate lymph nodes
- Palpate lips
- Palpate labial and buccal mucosa, vestibule, mucobuccal folds, frena, buccal mucosa
- Examine and bimanually palpate floor of mouth
- Examine/palpate tongue (dorsal, ventral, lateral borders, base)
- Examine hard and soft palate
- Examine tonsils and oropharynx
14
Q
Inspect with
Palpate with
A
eyes
fingers
15
Q
Bony hard
A
torus
16
Q
Induration
A
firm but not as hard as bone (solid rubber ball)
17
Q
firm
A
Yields to pressure but keeps its shape
18
Q
compressible
A
pressure alters its shape
19
Q
doughy
A
returns slowly to OG shape
20
Q
spongy
A
returns quickly to OG shape
21
Q
pitting
A
soft and leaves indentation - edema
22
Q
collapsing
A
contents expressed - abscess
23
Q
blanching
A
color change - freckled
24
Q
Discrete
A
separate, not running together
25
Confluent
running together, blended. Originally separate but now formed into one. Might consider mapping it
26
Papillary
Having small bump like elevations or projections
27
Verrucose lesion
covered with or full of wart-like growths; califlower-like surface
28
Sessile
attached to the surface on a broad base - immobile, fixed
| Lacks a stalk
29
Pedunculated lesion
elevated lesions having a narrow stem which acts as a base. Elongated stalk
30
Erythema
Red area of variable size and shape. usually in patches
31
Petechia
Round red pinpoint areas of hemorrhage. Usually cause by trauma, viral infection or bleeding problems (yellow sometimes)
32
Macule
Small circumscribed area of color change
Brown, black, blue red
not elevated or depressed
33
freckles
ephelis
34
Eschar
a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn. Ex: aspirin burn
35
Torus
bony elevation or prominence
36
Patch
Large circumscribed area of color or texture change (or both)
Not elevated or depressed
37
Ulcer
A denuded area extending below the basal layer
Gradual tissue disintegration.
Usually painful. Ex: aphthous or herpes simplex
38
Aphthous ulcer
flat, white, red halo, small, & hurts
39
Crust
An outer layer, covering, or scab, form a coagulation of blood, serum, pus, or any combination
40
Papule
A superficial, elevated, solid lesion. Any color. Solid base or pedunculate
41
Plaque
A solid, flat, raised area. Often keratinized (white). Ex: Snuff dipper's lesion
42
Nodule
An elevated, deep solid lesion. Overlying mucosa not fixed. Ex: Fibroma - bit have to get taken out
43
Vesicle
Small fluid filled, elevated lesion with a thin surface covering - small blister.
Lymph or serum
Ex: herpes simplex - before it bursts
44
Pustule
Small vesicular - type lesion containing purulent material rather than clear fluid. Creamy white or yellow.
Dental abscess - we pop it, may put a drain in. Immediate relief (inflammation causes the pain), milk it, and make sure to have suction up on it
45
Bulla
A large vesicle = large blister.
Contains serum
usually at the mucosal - submucosal junction
46
Sample intraoral sequence
Lips, buccal mucosa, buccal vestibules, tongue, oropharynx, palate, floor of mouth, lymph nodes
47
Lips
Outside = extra oral
evert - inside - bidigital palpation
palpate
lumps, bumps, etc
48
Linea alba
White line.
Parallel to occlusal plane
Asymptomatic
Caused by trauma - chewing cheek
49
Leukoedema
```
More common in black ppl.
"milky" white surface or blue-grey
symmetrical
doesn't rub off
disappears/decreases when stretched
normal
```
50
Lichen Planus
Interlacing white striae (Wickham) with erythema of the surrounding mucosa. usually appearing bilaterally, not painful only if erosions and ulcers occur
51
Fordyce granules
Sulfur-colored, very common, asymptomatic, 1-3mm papules in oral cavity, or lip vermillion
52
Hard palate
```
Anterior palate
Look for:
rugae (normal) = horizontal ridges
Torus palatines (normal) = bony lumps
Ulcerations
lesions
```
53
Torus palatinus
```
Bony lumps
asymptomatic
20-30% of ppl
Female:males = 2:1
No tx necessary - unless need dentures
```
54
Torus mandibularis
```
Bony lumps
asymptomatic
more common w/ bruxism
8-16% males = females
No tx necessary - unless need dentures
```
55
Soft palate
depress tongue
say "ah"
Look for: ulcers, patches, etc
56
Nicotine stomatitis
Lesions of the hard palate, lesion is white, rough, asymptomatic, and leathery appearing. Contains numerous red dots or macules
57
Bifiuvula
split or 2 uvula
58
Benign migratory glossitis (geographic tongue)
The lesions often heal in one area and then move (migrate) to a different part of the tongue. Erythematous - well demarcated areas of papillary atrophy. Usually asymptomatic but can cause discomfort, pain or burning sensation in some cases, often related to eating spicy or acidic foods
59
Leukoplakia
White or grayish thick keratitis patch-like lesion on the mucosa which cannot be rubbed off. More of a description than diagnoses
60
Hairy leukoplakia
Caused by Epstein-barr virus and is usually associated HIV infection or other immunosuppressive conditions. typically occurs on the lateral border of the tongue. Either unilateral or bilayer. White rough patches
61
Hairy tongue
Trapped debris, bacteria, fungus, coffee, tobacco, antibiotics and other drugs can cause
62
Ventral surface of the tongue
lingual varicosities = normal w/age
63
Floor of mouth palpation steps
Have pt light tongue, one finger under one side of the tongue, have pt close down half way, one finger of other hand goes under chin, gently press two fingers together, "walk" fingers to posterior and the external finger farther
64
Xerostomia
Diabetes, hormone changes (menopause or pregnancy), depression, anxiety, radiation for head and neck cancer, autoimmune ds. (sjogrens syndrome)
65
Xerostomia: subjective eval
Do you have difficulty swallowing? does your mouth feel dry? Do you sip liquids to help swallowing? Do you have any oral burning or soreness? Do you often have bad breath?
66
Xerostomia: clinica assessment
Reddened, pebbled surface of tongue, dry and cracked corners of the mouth, red or parched mucosal tissues. Test: mirror "stick" test: Place mirror against the buccal mucosa and tongue. Saliva pooling: check for saliva.......
67
Xerostomia symptoms
Candidiasis, angular chelitis, burning tongue, root & cervical caries, stomatitis, dysphagia
68
Evaluate the flow and consistency of the saliva
Tissues well moistened? thick or "ropy" consistency?
69
Sialolithiasis
stone in salivary gland
70
Candidiasis
white plaque, looks like hyperkeratosis but rubs off. Inside the corners, buccal mucosa, or lateral tongue
71
Thrush
Intraoral - tongue, buccal mucosa, soft palate
72
Candidiasis risk factors
Immunocompromised, pregnancy, poor oral hygiene, smoking, stress, depression, birth control pill, long term AB, Diabetes, dentures that dont fit, xerostomia, iron, B12 deficiency
73
Acute pseudomembranous candidiasis
Most common, tongue, buccal mucosa, floor, creamy white patches, easily wipe off leaving an erythematous base, pain with spicy/acidic foods, xerostomia, dysphagia
74
Chronic hyperplastic candidiasis
White plaque, looks like hyperkeratosis but rubs off, Inside the corners, buccal mucosa, or lateral tongue
75
Atrophic candidiasis
Under dentures, red on palate or tongue, burn with spicy foods and alcohol
76
Candidiasis treatment
Oral hygiene, yogurt, acidophilus, avoid alcohol simple sugars, medications (nystatin -rinse and tablets), ketaconozole, fluconozole
77
Herpes simplex
Primary herpes gingivostomatitis is seen mainly in children and is caused by HS1 in most cases. Less commonly, primary infection occurs in the young adult, Severe primary infections have oral lesions accompanied by high fever, malaise, cervical lymphadenopathy and dehydration
78
Herpes simplex - vesicles
develop in oral cavity (pharynx, palate, buccal mucosa, lips, or tongue)
Rapidly break down into small ulcers and are covered with an exudate. Lesions may extend to involve the lips and buccal mucosa - generally resolve w/o therapy in 2 weeks
79
Fever blisters (cold sores)
```
herpes simplex
50% of pop
starts <10 from adults
contagious - kissing
type 1 = mouth, lips, face
type 2 = genital
outer lips and attached gingiva
```
80
Fever blisters (cold sores) symptoms
prodromal tingling, multiple fluid-filled blisters, fever, swollen glands, aches, merge and collapse, yellowish crust, 2 weeks healing
81
Fever blisters (cold sores)
virus, dormant in nerve cells, recurs with immune weakness (stress, fever, illness, injury, sunburn)
82
Herpetic whitlow
infections of the thumbs or fingers. grouped, fluid or pus filled, usually, itch and/or painful
83
Herpes treatment
Topicals - antiviral cream (penciclovir - denavir), over the counter cream (docosanol - abreva)
Lysine (1-3 g per day)
Zinc oxide cream
84
Aphthous ulcers ("canker sores")
```
60% of us pop
starts around 10-20 yrs old
frequency varies
prodromal tingling
3 days of pain, 7 days healed
```
85
Canker sores sizes
minor <1cm
Major >1cm and deeper - may scar
Herpetiform - more numerous and vesicular
86
Canker sore visually
round or oval swelling, ruptures in 1 days, pale, yellow center, red halo, fever (rare), no other diseases
87
Canker sores vs cold sores
no blister, generally larger, rarely merge, movable intramural tissue (tongue, buccal mucosa, soft palate, inner lip)
88
Aphthous ulcers treatment
symptomatic - vicious benzocaine, oragel, abnesol
local anti-inflammatory - probably best, kenalog in orabase 2-4X/day
Sealing agent (ameseal)
Aphthasol - only FDA approved tx, paste =barrier. Apply 2-4X/day - must start early (prodromal stage)
