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Patient Care 2 - Exam 1 > Intraoral exam > Flashcards

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

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2
Q

Light positioning

A

arms length away.
mand - over mouth
max - over waist

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3
Q

Keep you pt informed on

A

what you’re doing

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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

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5
Q

Look for

A

cancer, signs of systemic ds., tissue trauma, infections, pain, esthetic concerns, occlusal dysfunction, etc

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6
Q

Oral cancer

A

90% - squamous
3% of all cancers
Overall, 57% 5-yr survival rate
2 men : 1 woman

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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

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8
Q

Lesion description

A

number, size, shape, color, profile, base, border, texture

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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
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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

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11
Q

High risk areas of oral cancer

A

Floor of mouth, lateral border of tongue, ventral surface of tongue, oropharynx

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12
Q

Sign and symptoms: oral cancer

A

non healing ulcer, bleeding, lymphadenopathy, hardness, pain, paresthesia, drooling

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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
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14
Q

Inspect with

Palpate with

A

eyes

fingers

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15
Q

Bony hard

A

torus

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16
Q

Induration

A

firm but not as hard as bone (solid rubber ball)

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17
Q

firm

A

Yields to pressure but keeps its shape

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18
Q

compressible

A

pressure alters its shape

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19
Q

doughy

A

returns slowly to OG shape

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20
Q

spongy

A

returns quickly to OG shape

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21
Q

pitting

A

soft and leaves indentation - edema

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22
Q

collapsing

A

contents expressed - abscess

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23
Q

blanching

A

color change - freckled

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24
Q

Discrete

A

separate, not running together

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25
Q

Confluent

A

running together, blended. Originally separate but now formed into one. Might consider mapping it

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26
Q

Papillary

A

Having small bump like elevations or projections

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27
Q

Verrucose lesion

A

covered with or full of wart-like growths; califlower-like surface

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28
Q

Sessile

A

attached to the surface on a broad base - immobile, fixed

Lacks a stalk

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29
Q

Pedunculated lesion

A

elevated lesions having a narrow stem which acts as a base. Elongated stalk

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30
Q

Erythema

A

Red area of variable size and shape. usually in patches

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31
Q

Petechia

A

Round red pinpoint areas of hemorrhage. Usually cause by trauma, viral infection or bleeding problems (yellow sometimes)

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32
Q

Macule

A

Small circumscribed area of color change
Brown, black, blue red
not elevated or depressed

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33
Q

freckles

A

ephelis

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34
Q

Eschar

A

a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn. Ex: aspirin burn

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35
Q

Torus

A

bony elevation or prominence

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36
Q

Patch

A

Large circumscribed area of color or texture change (or both)
Not elevated or depressed

37
Q

Ulcer

A

A denuded area extending below the basal layer
Gradual tissue disintegration.
Usually painful. Ex: aphthous or herpes simplex

38
Q

Aphthous ulcer

A

flat, white, red halo, small, & hurts

39
Q

Crust

A

An outer layer, covering, or scab, form a coagulation of blood, serum, pus, or any combination

40
Q

Papule

A

A superficial, elevated, solid lesion. Any color. Solid base or pedunculate

41
Q

Plaque

A

A solid, flat, raised area. Often keratinized (white). Ex: Snuff dipper’s lesion

42
Q

Nodule

A

An elevated, deep solid lesion. Overlying mucosa not fixed. Ex: Fibroma - bit have to get taken out

43
Q

Vesicle

A

Small fluid filled, elevated lesion with a thin surface covering - small blister.
Lymph or serum
Ex: herpes simplex - before it bursts

44
Q

Pustule

A

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
Q

Bulla

A

A large vesicle = large blister.
Contains serum
usually at the mucosal - submucosal junction

46
Q

Sample intraoral sequence

A

Lips, buccal mucosa, buccal vestibules, tongue, oropharynx, palate, floor of mouth, lymph nodes

47
Q

Lips

A

Outside = extra oral
evert - inside - bidigital palpation
palpate
lumps, bumps, etc

48
Q

Linea alba

A

White line.
Parallel to occlusal plane
Asymptomatic
Caused by trauma - chewing cheek

49
Q

Leukoedema

A 
More common in black ppl.
"milky" white surface or blue-grey
symmetrical 
doesn't rub off
disappears/decreases when stretched 
normal
50
Q

Lichen Planus

A

Interlacing white striae (Wickham) with erythema of the surrounding mucosa. usually appearing bilaterally, not painful only if erosions and ulcers occur

51
Q

Fordyce granules

A

Sulfur-colored, very common, asymptomatic, 1-3mm papules in oral cavity, or lip vermillion

52
Q

Hard palate

A 
Anterior palate
Look for: 
rugae (normal) = horizontal ridges
Torus palatines (normal) = bony lumps
Ulcerations 
lesions
53
Q

Torus palatinus

A 
Bony lumps
asymptomatic
20-30% of ppl
Female:males = 2:1
No tx necessary - unless need dentures
54
Q

Torus mandibularis

A 
Bony lumps 
asymptomatic 
more common w/ bruxism 
8-16% males = females 
No tx necessary - unless need dentures
55
Q

Soft palate

A

depress tongue
say “ah”
Look for: ulcers, patches, etc

56
Q

Nicotine stomatitis

A

Lesions of the hard palate, lesion is white, rough, asymptomatic, and leathery appearing. Contains numerous red dots or macules

57
Q

Bifiuvula

A

split or 2 uvula

58
Q

Benign migratory glossitis (geographic tongue)

A

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
Q

Leukoplakia

A

White or grayish thick keratitis patch-like lesion on the mucosa which cannot be rubbed off. More of a description than diagnoses

60
Q

Hairy leukoplakia

A

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
Q

Hairy tongue

A

Trapped debris, bacteria, fungus, coffee, tobacco, antibiotics and other drugs can cause

62
Q

Ventral surface of the tongue

A

lingual varicosities = normal w/age

63
Q

Floor of mouth palpation steps

A

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
Q

Xerostomia

A

Diabetes, hormone changes (menopause or pregnancy), depression, anxiety, radiation for head and neck cancer, autoimmune ds. (sjogrens syndrome)

65
Q

Xerostomia: subjective eval

A

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
Q

Xerostomia: clinica assessment

A

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
Q

Xerostomia symptoms

A

Candidiasis, angular chelitis, burning tongue, root & cervical caries, stomatitis, dysphagia

68
Q

Evaluate the flow and consistency of the saliva

A

Tissues well moistened? thick or “ropy” consistency?

69
Q

Sialolithiasis

A

stone in salivary gland

70
Q

Candidiasis

A

white plaque, looks like hyperkeratosis but rubs off. Inside the corners, buccal mucosa, or lateral tongue

71
Q

Thrush

A

Intraoral - tongue, buccal mucosa, soft palate

72
Q

Candidiasis risk factors

A

Immunocompromised, pregnancy, poor oral hygiene, smoking, stress, depression, birth control pill, long term AB, Diabetes, dentures that dont fit, xerostomia, iron, B12 deficiency

73
Q

Acute pseudomembranous candidiasis

A

Most common, tongue, buccal mucosa, floor, creamy white patches, easily wipe off leaving an erythematous base, pain with spicy/acidic foods, xerostomia, dysphagia

74
Q

Chronic hyperplastic candidiasis

A

White plaque, looks like hyperkeratosis but rubs off, Inside the corners, buccal mucosa, or lateral tongue

75
Q

Atrophic candidiasis

A

Under dentures, red on palate or tongue, burn with spicy foods and alcohol

76
Q

Candidiasis treatment

A

Oral hygiene, yogurt, acidophilus, avoid alcohol simple sugars, medications (nystatin -rinse and tablets), ketaconozole, fluconozole

77
Q

Herpes simplex

A

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
Q

Herpes simplex - vesicles

A

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
Q

Fever blisters (cold sores)

A 
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
Q

Fever blisters (cold sores) symptoms

A

prodromal tingling, multiple fluid-filled blisters, fever, swollen glands, aches, merge and collapse, yellowish crust, 2 weeks healing

81
Q

Fever blisters (cold sores)

A

virus, dormant in nerve cells, recurs with immune weakness (stress, fever, illness, injury, sunburn)

82
Q

Herpetic whitlow

A

infections of the thumbs or fingers. grouped, fluid or pus filled, usually, itch and/or painful

83
Q

Herpes treatment

A

Topicals - antiviral cream (penciclovir - denavir), over the counter cream (docosanol - abreva)
Lysine (1-3 g per day)
Zinc oxide cream

84
Q

Aphthous ulcers (“canker sores”)

A 
60% of us pop
starts around 10-20 yrs old 
frequency varies
prodromal tingling 
3 days of pain, 7 days healed
85
Q

Canker sores sizes

A

minor <1cm
Major >1cm and deeper - may scar
Herpetiform - more numerous and vesicular

86
Q

Canker sore visually

A

round or oval swelling, ruptures in 1 days, pale, yellow center, red halo, fever (rare), no other diseases

87
Q

Canker sores vs cold sores

A

no blister, generally larger, rarely merge, movable intramural tissue (tongue, buccal mucosa, soft palate, inner lip)

88
Q

Aphthous ulcers treatment

A

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)

Patient Care 2 - Exam 1 (2 decks)

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