week two - comp exams Flashcards
list the FOUR basic E/O assessment skills
- observation
- palpation - touch
- auscultation - listening and detecting body sounds for variations
- olfaction - sensing body odours to detect variations
list 5 purposes of E/O exams
- oral cancer screening
- determine if pt is dentally fit
- record baseline assessment information
- determine if additional dx test are needed
- enable early dx of pathology
describe the observation skill in E/O exams
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
describe the palpation skill in E/O exams
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
describe the auscultation skill in E/O exams
- 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
describe the olfaction skill in E/O exams
assess breath for
- alcohol
- halitosis
- fruity smell
describe how to I/O palpate the labial and buccal mucosa
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
describe the healthy appearance, I/O palpation and documentation of the attached gingiva/alveolar mucosa
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]
describe the healthy appearance, I/O palpation and documentation of the mandible
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
describe the healthy appearance, I/O palpation and documentation of the oropharynx
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]
describe the healthy appearance, and documentation of the ant/post pharyngeal pillars
healthy = vascular, smooth, symmetrical
doc
- lesions, erythema assoc w tenderness or exudates
- signs of tonsillectomy [torn/absent pillars = signs of surgery]
describe the healthy appearance and documentation of the tonsils
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
describe the healthy appearance, and documentation of the soft palate/uvula
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
describe the healthy appearance, I/O palpation and documentation of the hard palate
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
describe the healthy appearance, I/O palpation and documentation of the tongue
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
describe the healthy appearance, I/O palpation and documentation of the FOM
healthy = moist tissue + very vascular
BM tech
doc
- lesions, ulcers, colour changes, tenderness, lumps, swellings, sores, tight frenal attachment
describe what would be documented in a hard tissue examination
- teeth
- present/absent
- partially erupted/erupted
- missing from congenital reasons or diseases process
- supernumerary teeth - defects/abnormalities
- hypoplasia, hypomin, fluorosis
- dens in dente
- talon cusp
- germination/fusion
- amelogenesis/dentinogene imperfecta
- micro/macrodontia
- peg laterals/Taurodontism - caries
- type and surfaces affected
- acute, chronic, recurrent, arrested, cavitated, non-cavitated
distinguish hypoplasia from hypomineralisation
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]
describe normal occlusion
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
describe class I malocclusion
molar / canine relo similar to normal
mal-relos between other indiv/groups of teeth
incis relo
- may be open, end-end, overbite
describe class II malocclusion
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
describe class III malocclusion
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
distinguish a cross bite from a scissor bite
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
describe lip competency/lip seal and gummy smile
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
distinguish primate spacing from leeway spacing in primary teeth
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
