Oral Examination Flashcards
Tooth Anatomy
- The outer protective layer of the tooth is enamel, which is extremely hard.
- The middle layer is dentin.
- The pulp is composed of nerves and blood vessels that exit the tooth via the apices.
- The root connects to alveolar bone via the periodontal ligament.
Child
Goals of Exam
Clinicians can perform a thorough and systematic oral, head, and neck exam in a primary care setting.
Goals of the exam are:
* Identify existing problems requiring early dental referral, such as:
* Tooth eruption sequence abnormalities
* Developmental defects
* Caries
* Poor oral hygiene
* Assess risk for future problems
* Provide anticipatory guidance
Child
Primary Dentition
When Do Primary Teeth Erupt?
* Primary teeth (also called baby teeth or deciduous teeth) begin to erupt at age 6 months and this process is complete by 24 and 36 months. There is considerable variation of eruption patterns and the sequence of eruption is more important than the absolute dates.
- There is rarely need to be concerned about lack of eruption unless there is evidence of a syndrome or developmental issues; or if no teeth have erupted by 18 months of age.
- Incisors: 6-12 mo
- First Molars: 1 yr
- Second Molars: 2 yr
- Canines: 1-2 yrs
Child
Knee to Knee Oral Exam
Small children are best examined while lying down. For infants and toddlers, the knee-to-knee oral examination allows you to carefully examine the child’s teeth with assistance from a caregiver.
- Start by having the caregiver hug the child for reassurance.
- Position the child so his or her legs straddle the caregiver. The child can also sit sidesaddle across the caregiver’s lap.
- Next, the caregiver should hold the child’s hands and lean the child back into the examiner’s lap.
- Perform the examination while the caregiver holds the child’s hands and legs.
Child
Exam Components
The key to a successful oral exam is to be systematic. It can be performed in any clinical setting with readily available equipment and supplies.
Observe these features:
* Face and neck
* Gums
* Teeth: all surfaces, including the front, back, and top surfaces
* Eruption sequence of teeth
* Tongue
* Palate and posterior pharynx
* Hygiene
Palpate neck for adenopathy, temporomandibular joint for mobility and floor of mouth for masses.
Child
Face & Neck Exam
- inspect face/neck for symmetry and skin lesions
- palpate neck for adenopathy
Child
Anterior Teeth/Gums
Throughout the exam, reinforce good hygiene practices or teach parents and children where they can do a better job.
- Lift the upper and lower lip to view the gums and anterior surfaces of the teeth.
- Use a tongue depressor or gauze pad to help hold the lips.
- Note the state of oral hygiene including gums, plaque, brown spots, or frank caries.
- Closely inspect the gum line—a high risk area for dental caries with plaque and tartar build up.
Child
Lingual Teeth
The upper front lingual surfaces are at high risk for dental caries as they are not well protected by the tongue and saliva. These areas are often not brushed adequately and problems are harder to detect.
- View the inner (lingual) surfaces of the teeth—a mouth mirror can be helpful but is not mandatory. Most of the lingual teeth can be viewed with changes in examiner position
- If necessary, use a tongue blade or toothbrush to open the mouth.
Child
Tongue and Palate Assessment
- Examine the tongue and palate—a tongue depressor or toothbrush may help open the mouth.
- Assess for tongue lesions, the length of the frenulum, tongue mobility, and contours of the palate.
Adults
Goals of Adult Exam
Primary care clinicians can perform a rapid and complete oral, head, and neck examination of adults in a primary care setting.
Goals of the exam are to:
- Determine the health status of teeth and gums
- Identify abnormal oral lesions and signs of precancer or cancer
- Target anticipatory guidance
Adult
TMJ
- Palpate the temporomandibular joint (TMJ) for crepitus, pain, and tenderness while the patient opens and closes the mouth.
- Watch the point of the chin while the jaw is opening and closing for any lateral deviation.
Adult
Neck Anatomy
The final step in the oral exam is to inspect and palpate the major anatomic divisions of the neck
- The anterior triangle is defined by the mandible superiorly and the sternocleidomastoid posteriorly.
- The posterior triangle is bounded by the sternocleidomastoid anteriorly, the trapezius posteriorly, and the clavicle inferiorly.
- The submandibular area is bounded by the mandible laterally and anteriorly. The floor of the mouth bounds submandibular area superiorly.
Adult
Neck Palpation
Clinicians should examine for adenopathy or abnormal masses. Inspect, then palpate, both sides of the neck in the following regions:
- Anterior triangle (anterior cervical nodes)
- Posterior triangle (posterior cervical nodes)
- Submandibular areas (submandibular and submental nodes)
Adults
Face/Lip Exam
- Identify facial deformities, skin lesions, and peri-oral lesions.
- Closely examine sun-exposed areas including the forehead, ears, cheeks, nose and lips for abnormal lesions, paying close attention for potential actinic keratoses, basal cell, or squamous cell cancers.
- In tobacco users, pay close attention to the lips.
Oral Cancer Screening
Cancers most commonly occur on the tongue, floor of mouth, and lower lip vermilion border.
- Oral cancers are the 9th most common cancer in U.S.
- 90% of oral cancers are squamous cell carcinomas.
- 60% of oral cancers are advanced at time of detection.
- Most common in hidden areas: lateral tongue, mouth floor, soft palate, lower lip vermilion border.
- All unexplained lesions in the mouth lasting greater than 2 weeks should be referred for evaluation and biopsy.
- Oral cancers are life threatening and require immediate biopsy and referral for treatment
