Intraoral exam Flashcards
Operator positioning
chair seat height - thighs slightly downhill, feet flat on floor
Chair backrest height - middle of back
Seat parallel to floor - avoid leaning forward
Light positioning
arms length away.
mand - over mouth
max - over waist
Keep you pt informed on
what you’re doing
Most primary medical care providers still not comfortable
performing basic oral health assessments.
consider oral health outside of their realm of practice
Look for
cancer, signs of systemic ds., tissue trauma, infections, pain, esthetic concerns, occlusal dysfunction, etc
Oral cancer
90% - squamous
3% of all cancers
Overall, 57% 5-yr survival rate
2 men : 1 woman
importance of early diagnosis
40% are found in stages 1/2 - 80% survival
60% are found in stage 3/4 - 33% survival (3yrs), 67% recurrence in 2 yrs
Lesion description
number, size, shape, color, profile, base, border, texture
Risk factors of oral cancer
tobacco (#1) alcohol (#2) viruses: HIV+, HPV Sun exposure Inadequate nutrition Genetic predisposition chronic inflammation radiation exposure carcinogen exposure
Prevention of oral cancer
75% could be prevented by eliminating tobacco & alcohol use
Lip balm w/ sunscreen
HPV vaccine
Diet rich in fruits and veggies
High risk areas of oral cancer
Floor of mouth, lateral border of tongue, ventral surface of tongue, oropharynx
Sign and symptoms: oral cancer
non healing ulcer, bleeding, lymphadenopathy, hardness, pain, paresthesia, drooling
Routine oral cancer exam
- 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
Inspect with
Palpate with
eyes
fingers
Bony hard
torus
Induration
firm but not as hard as bone (solid rubber ball)
firm
Yields to pressure but keeps its shape
compressible
pressure alters its shape
doughy
returns slowly to OG shape
spongy
returns quickly to OG shape
pitting
soft and leaves indentation - edema
collapsing
contents expressed - abscess
blanching
color change - freckled
Discrete
separate, not running together
Confluent
running together, blended. Originally separate but now formed into one. Might consider mapping it
Papillary
Having small bump like elevations or projections
Verrucose lesion
covered with or full of wart-like growths; califlower-like surface
Sessile
attached to the surface on a broad base - immobile, fixed
Lacks a stalk
Pedunculated lesion
elevated lesions having a narrow stem which acts as a base. Elongated stalk
Erythema
Red area of variable size and shape. usually in patches
Petechia
Round red pinpoint areas of hemorrhage. Usually cause by trauma, viral infection or bleeding problems (yellow sometimes)
Macule
Small circumscribed area of color change
Brown, black, blue red
not elevated or depressed
freckles
ephelis
Eschar
a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn. Ex: aspirin burn
Torus
bony elevation or prominence
Patch
Large circumscribed area of color or texture change (or both)
Not elevated or depressed
Ulcer
A denuded area extending below the basal layer
Gradual tissue disintegration.
Usually painful. Ex: aphthous or herpes simplex
Aphthous ulcer
flat, white, red halo, small, & hurts
Crust
An outer layer, covering, or scab, form a coagulation of blood, serum, pus, or any combination
Papule
A superficial, elevated, solid lesion. Any color. Solid base or pedunculate
Plaque
A solid, flat, raised area. Often keratinized (white). Ex: Snuff dipper’s lesion
Nodule
An elevated, deep solid lesion. Overlying mucosa not fixed. Ex: Fibroma - bit have to get taken out
Vesicle
Small fluid filled, elevated lesion with a thin surface covering - small blister.
Lymph or serum
Ex: herpes simplex - before it bursts
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
Bulla
A large vesicle = large blister.
Contains serum
usually at the mucosal - submucosal junction
Sample intraoral sequence
Lips, buccal mucosa, buccal vestibules, tongue, oropharynx, palate, floor of mouth, lymph nodes
Lips
Outside = extra oral
evert - inside - bidigital palpation
palpate
lumps, bumps, etc
Linea alba
White line.
Parallel to occlusal plane
Asymptomatic
Caused by trauma - chewing cheek
Leukoedema
More common in black ppl. "milky" white surface or blue-grey symmetrical doesn't rub off disappears/decreases when stretched normal
Lichen Planus
Interlacing white striae (Wickham) with erythema of the surrounding mucosa. usually appearing bilaterally, not painful only if erosions and ulcers occur
Fordyce granules
Sulfur-colored, very common, asymptomatic, 1-3mm papules in oral cavity, or lip vermillion
Hard palate
Anterior palate Look for: rugae (normal) = horizontal ridges Torus palatines (normal) = bony lumps Ulcerations lesions
Torus palatinus
Bony lumps asymptomatic 20-30% of ppl Female:males = 2:1 No tx necessary - unless need dentures
Torus mandibularis
Bony lumps asymptomatic more common w/ bruxism 8-16% males = females No tx necessary - unless need dentures
Soft palate
depress tongue
say “ah”
Look for: ulcers, patches, etc
Nicotine stomatitis
Lesions of the hard palate, lesion is white, rough, asymptomatic, and leathery appearing. Contains numerous red dots or macules
Bifiuvula
split or 2 uvula
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
Leukoplakia
White or grayish thick keratitis patch-like lesion on the mucosa which cannot be rubbed off. More of a description than diagnoses
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
Hairy tongue
Trapped debris, bacteria, fungus, coffee, tobacco, antibiotics and other drugs can cause
Ventral surface of the tongue
lingual varicosities = normal w/age
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
Xerostomia
Diabetes, hormone changes (menopause or pregnancy), depression, anxiety, radiation for head and neck cancer, autoimmune ds. (sjogrens syndrome)
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?
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…….
Xerostomia symptoms
Candidiasis, angular chelitis, burning tongue, root & cervical caries, stomatitis, dysphagia
Evaluate the flow and consistency of the saliva
Tissues well moistened? thick or “ropy” consistency?
Sialolithiasis
stone in salivary gland
Candidiasis
white plaque, looks like hyperkeratosis but rubs off. Inside the corners, buccal mucosa, or lateral tongue
Thrush
Intraoral - tongue, buccal mucosa, soft palate
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
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
Chronic hyperplastic candidiasis
White plaque, looks like hyperkeratosis but rubs off, Inside the corners, buccal mucosa, or lateral tongue
Atrophic candidiasis
Under dentures, red on palate or tongue, burn with spicy foods and alcohol
Candidiasis treatment
Oral hygiene, yogurt, acidophilus, avoid alcohol simple sugars, medications (nystatin -rinse and tablets), ketaconozole, fluconozole
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
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
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
Fever blisters (cold sores) symptoms
prodromal tingling, multiple fluid-filled blisters, fever, swollen glands, aches, merge and collapse, yellowish crust, 2 weeks healing
Fever blisters (cold sores)
virus, dormant in nerve cells, recurs with immune weakness (stress, fever, illness, injury, sunburn)
Herpetic whitlow
infections of the thumbs or fingers. grouped, fluid or pus filled, usually, itch and/or painful
Herpes treatment
Topicals - antiviral cream (penciclovir - denavir), over the counter cream (docosanol - abreva)
Lysine (1-3 g per day)
Zinc oxide cream
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
Canker sores sizes
minor <1cm
Major >1cm and deeper - may scar
Herpetiform - more numerous and vesicular
Canker sore visually
round or oval swelling, ruptures in 1 days, pale, yellow center, red halo, fever (rare), no other diseases
Canker sores vs cold sores
no blister, generally larger, rarely merge, movable intramural tissue (tongue, buccal mucosa, soft palate, inner lip)
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)
