Extraoral Examination I

Vital Signs

Temperature

Blood pressure

Pulse

Respiration

Temperature

Body is regulated by the hypothalamus of the brain

Ensures that the body’s metabolic processes function correctly

Extreme variations can lead to organ failure, coma, or death

Normal Body Temperature

37 degrees C

98.6 degrees F

Average Oral Temperature

97.5 degrees F

Mechanism of Thermoregulation

Afferent sensing

Central control

Efferent response

Afferent Sensing

Peripheral and central thermoreceptors sense increase or decrease in body temperature

Sends information to hypothalamus (central control)

Efferent Response

Activates SNS cholinergic fibers innervating sweat glands

Vasodilation vs vasoconstriction

Places to Obtain Body Temperature

Site close to highly perfused organs or great vessels are most reliable

Pulmonary a.

Tympanic membrane

Axilla, oral

Best Site for Body Temperature

Pulmonary a.

Pro - precise and repeatable

Con - invasive (ICU setting)

Good Site for Body Temperature

Tympanic membrane

Pro - repeatable and precise

Con - high risk for measurement error

Poor Site for Body Temperature

Axilla or oral region

Pro - widely available and easy

Con - inaccurate

Fever

Elevation of core body temperature

Causes - infection, inflammation, autoimmune process, medications, malignancy

Pyrogens

Substance that induces fever

Exogenous or endogenous

Cytokines IL-1, IL-6, TNF-a

Low Grade Fever

37.3 to 38 degrees C (99.1 to 100.4 F)

Moderate Grade Fever

38.1 to 39 degrees C (100.6 to 102.2 F)

High Grade Fever

39.1 to 41.0 degrees C (102.4 to 105.8 degrees F)

Hyperthermia

41 degrees C (105.8 degrees F)

Dentist Check Lift for Fever

Age and Sex

Onset

Predisposing factors

Systemic exam

Oral manifestations

Age and Sex

Children - mostly infectious

Elderly - chronic disease caused infectious disease, malignant tumors

Young - allergic disease

Onset

Acute

Chronic

Periodioc

Predisposing Factors

Trauma, cold

Exposure history

Malignancy

Chemotherapy

Systemic Exam

Enlarged lymph nodes

Skin

Eyes

Oral Manifestations

Caries

Residual roots

Periodontal swelling

Non-pharmacological Intervention

Weight loss

DASH diet

Sodium/caffeine reduction

Physical activity

Alcohol moderation

First Line Pharmacological Therapy

Thiazide diuretics

ACE inhibitors

Calcium channel blockers

Angiotensin II receptor blockers

Combination Therapy

Stage II hypertension

Resistant Hypertension

Recommend to add on spironolactone

Systolic BP

Pressure in arteries when heart contracts

Diastolic BP

Pressure in arteries when heart relaxes

Aneroid Sphingomemometer

Dial gauge (no mercury)

Stethoscope

Con - requires manual skill

Digital BP MOnitor

Upper arm monitor - most accurate digital option

BP Between Arms

Difference should be minimal

<5 mmHg difference is normal

Usually taken on left arm

Preoperative Risk Assessment

No cardiac conditions with at least 4 METs functional capacity, patient is low risk for simple procedures

Patient with BP less than 180/110 mmHg, there is no indication to cancel surgery solely based on BP alone

When to Defer Treatment

>180/110 mmHg without angina pectoris or acute CHF signs and symptoms

Normal HR

60-100 bpm

Factors Affecting HR

Physical activity

Stress

Anxiety

Medications

Low HR

Athletes - 40 bpm

Average - medical consult, especially with fatigue, lightheadedness, shortness of breath

Elevated HR

Consistently > 90 bpm

Should consult with physician

Maximum HR

220 - age

Respiration Rate

12 - 20 breaths per min

Ventilation

Breathing in (inspiration) + breathing out (expiration)

Bradypnea

Narcotics

Alcohol

Sleep apnea

Neurological conditions - stroke, head injury

<12 bpm

Tachypnea

Signs of worsening infection

Dehydration

Asthma

COPD

Stress

Pulmonary embolism

Heart failure

Drug overdose

>20 bpm