week two - comp exams

Question 1

list the FOUR basic E/O assessment skills

Answer 1

1. observation
2. palpation - touch
3. auscultation - listening and detecting body sounds for variations
4. olfaction - sensing body odours to detect variations

Question 2

list 5 purposes of E/O exams

Answer 2

1. oral cancer screening
2. determine if pt is dentally fit
3. record baseline assessment information
4. determine if additional dx test are needed
5. enable early dx of pathology

Question 3

describe the observation skill in E/O exams

Answer 3

observe
- posture/gait
- body structure/symmetry
skeletal relationship - ortho assessment
asymm assoc w TMJD/malocclusions/neoplastic growths/musc atrophy or hypertrophy

• attitudes/behaviours/health literacy
• signs of abuse
• overall cleanliness
  hands - parafunctional habits
• skin/lips
  healthy lips = resilient, smoothm homogenous pink colour, distinct vermillion border
  damaged lips = indistinct/broken vermillion, colour variations, white blotches in lip tx , ulcerations/pitting [adv damage]
  look for suspicious lesions - doc size and physical characterisics

Question 4

describe the palpation skill in E/O exams

Answer 4

types
1. bilateral - two hands at same time to examine corresponding structures on opposite sides of body eg lymph nodes
2. bidigital - use of finger and thumb of one hand eg on lips
3. bimanual - use of fingers/thumb from both hands simultaneously

structures to palpate
lymph nodes
- ant/post auricular = BL technique
- cervical = BD nodes medial to SCM, BM for nodes post SCM
- submand = ask patient to touch roof of the mouth w the tongue - and pres under chin area

thyroid gland - BM technique
one hand supports trachea - other palpates
normal thyroid gland = most often not visible/palpable

salivary glands - parotid and submand - BL technique

sinuses - max and frontal

TMJ - BL technique
palpate joint whilst pt opens/closes/ protrudes/lat.excursion

MOM - masseter and temporalis
enlargment may indicate parafunctional habits

Question 5

describe the auscultation skill in E/O exams

Answer 5

• quality of speech/health literacy/ need for interpreter

TMJ
- abnormal sounds = THREE catergories
1. clicks
2. pops
3. crepitus

• clicks/pop usually assoc w auricular disc derangement
• creptitus usually asoc w some for of arthritis

Question 6

describe the olfaction skill in E/O exams

Answer 6

assess breath for
- alcohol
- halitosis
- fruity smell

Question 7

describe how to I/O palpate the labial and buccal mucosa

Answer 7

labial
- BD technique
- document lesions, ulcers, tenderness, lumps, swellings, sores

buccal
- BD technique + pull away from retromolar area
- healthy mucosa = moist, soft, red, pliable w no discernable indurations
- doc lesions, ulcers, tenderness, lumps, swellings, sores, linea alba, Fordyce’s granules, leukoedema

Question 8

describe the healthy appearance, I/O palpation and documentation of the attached gingiva/alveolar mucosa

Answer 8

healthy = pink, pale, homogenous in colour, clear demarcation of mucogingival junction
BD/BM palpation - pt bite tgt and use thumb/fingers to retract lip

doc
- inadequate attached gingiva [<1mm]
- frena problems [eg tight grenum pulls]
- traumatic lesions [ulcers, swellings, burns etc]

Question 9

describe the healthy appearance, I/O palpation and documentation of the mandible

Answer 9

healthy = homogenous coral pink, firm, no visible or palpable lesions

BD palpation along lingual and facial surfaces

doc
- tori and exotoses [bony outgrowths]
- partially erupted teeth
- pathologic findings

Question 10

describe the healthy appearance, I/O palpation and documentation of the oropharynx

Answer 10

healthy = vascular tx but otherwise homogenous in colour [reddish/pink]

place mirror w gentle pressure to depress dorsal surface tongue

doc
- ulcers, rednessm erosions, enlargement, growths
- dysphagia [difficulty swallowing]

Question 11

describe the healthy appearance, and documentation of the ant/post pharyngeal pillars

Answer 11

healthy = vascular, smooth, symmetrical

doc
- lesions, erythema assoc w tenderness or exudates
- signs of tonsillectomy [torn/absent pillars = signs of surgery]

Question 12

describe the healthy appearance and documentation of the tonsils

Answer 12

healthy = rough, lobular, coral-light pink
doc
- food debris, bacteria, hardened material
- swelling, asymmetry
- erythema and/or dysphagia may be assoc w mouth breathing or indicate nasal obstruction

Question 13

describe the healthy appearance, and documentation of the soft palate/uvula

Answer 13

healthy = smooth, reddish, loose tx, homogenous and spongey consistency
doc
- yellowish colouring, esp in older pts [due to adipose tx]
- excessively long/short uvulas that appear slightly asymmetrical or clefts

Question 14

describe the healthy appearance, I/O palpation and documentation of the hard palate

Answer 14

healthy = firm, dark pink, smooth consistency
single digit palpation against bone, incisive papilla, raphe, rugae and max tuberosity [AVOID SOFT PALATE]
doc
- pathological/non pathological eg Tori, stomatitis, hyperplasia, burns, lesions, enlargements, sinus tracts

Question 15

describe the healthy appearance, I/O palpation and documentation of the tongue

Answer 15

healthy = pink, rough surface texture on dorsal, smooth ventral surface, symmetrical
BD palpation - observe dorasl, ventral, lateral
doc
- biofilm, lesions, colour changes, ulcers, plaques, deep fissures

Question 16

describe the healthy appearance, I/O palpation and documentation of the FOM

Answer 16

healthy = moist tissue + very vascular
BM tech
doc
- lesions, ulcers, colour changes, tenderness, lumps, swellings, sores, tight frenal attachment

Question 17

describe what would be documented in a hard tissue examination

Answer 17

1. teeth
   - present/absent
   - partially erupted/erupted
   - missing from congenital reasons or diseases process
   - supernumerary teeth
2. defects/abnormalities
   - hypoplasia, hypomin, fluorosis
   - dens in dente
   - talon cusp
   - germination/fusion
   - amelogenesis/dentinogene imperfecta
   - micro/macrodontia
   - peg laterals/Taurodontism
3. caries
   - type and surfaces affected
   - acute, chronic, recurrent, arrested, cavitated, non-cavitated

Question 18

distinguish hypoplasia from hypomineralisation

Answer 18

hypoplasia
- enamel seemingly mineralised but THIN
- can appear white, yellow, brown

hypomineralisation
- less mineralised enamel = weaker tooth structure = more prone to breaking, erosion, caries
- manifests discoloured enamel [white area]

Question 19

describe normal occlusion

Answer 19

molar relo
- MB cusp of max first molar occ w MB groove of mand first molar

canine relo
- max canine occ w distal hald of mand canine and mesial half of mand first premolar

incisor relo
- mand incis occ at or below max incisor cingulum

Question 20

describe class I malocclusion

Answer 20

molar / canine relo similar to normal
mal-relos between other indiv/groups of teeth

incis relo
- may be open, end-end, overbite

Question 21

describe class II malocclusion

Answer 21

molar relo
- MB cusp of max first molar mesial to MB groove of mand first molar [overbite]

two divs
Class II Div I = max ant teeth = proclined = large overjet
Class II Div II = max teeth = retroclined = deep overbite

Question 22

describe class III malocclusion

Answer 22

molar relo
- MB cusp mand first molar distal to MB groove of mand first molar

incis relo
- cross bite [max teeth behind mand teeth]
- edge-edge

Question 23

distinguish a cross bite from a scissor bite

Answer 23

cross bite
- occludes w tooth in opposing arch in opposite relation to normal
- eg max teeth posterior to mand teeth

scissor bite
- max molars positioned outwards or mand molars positioned inwards
- when mouth closed = molars miss eachother w NO CONTACT

Question 24

describe lip competency/lip seal and gummy smile

Answer 24

lip seal competency
- upper/ lower lips should touch at rest
- incompetent seal = lips can close tgt when forced but remain open at rest - some max ant. teeth showing
- commonly assoc w airway obstructions or partial blockages eg enlarged tonsils
- results in mouth breathing = dry mouth, drying of ant.gingiva = ^ risk of periodontal disease

gummy smile
- aesthetic consequences rather than malocclusion
- pt may have snoring problem and incompetent lip seal

Question 25

distinguish primate spacing from leeway spacing in primary teeth

Answer 25

primate = normal spacing in devel dentition
- in max = space between lat incis and canines
- in mand = space between canines and first molars

leeway
- difference in width of prim molars and perm premolars