WILK ch13 & PAT ch12-14 Extraoral & Intraoral Examination

What is the primary rationale for performing an extraoral and intraoral examination?

Early identification of abnormalities and pathologies, especially oral cancer, as well as signs of thyroid disorders, eating disorders, nutritional deficiencies, and other systemic conditions.

What is the difference between a comprehensive examination and a screening examination?

A comprehensive examination is a thorough summary of all assessment components done at new patient and continuing care visits; a screening is a brief, preliminary examination used for initial triage.

What is a limited examination used for?

A brief examination performed for an emergency situation or management of an acute condition.

What is the difference between a sign and a symptom?

A sign is objective data observed by the clinician (e.g., color, shape); a symptom is a subjective abnormality reported by the patient (e.g., pain, bleeding).

What is a pathognomonic sign or symptom?

A sign or symptom unique to a specific disease that can be used to distinguish it from other conditions.

What is digital palpation, and give an example?

Palpation using a single finger; example is pressing the index finger against the lingual mandible to check for a torus mandibularis.

What is bidigital palpation, and give an example?

Palpation using the finger and thumb of the same hand; example is palpating the lips.

What is bimanual palpation, and give an example?

Palpation using a finger or fingers and thumb from each hand simultaneously; example is palpating the floor of the mouth intraorally and extraorally at the same time.

What is bilateral palpation, and give an example?

Palpation using both hands at once to examine corresponding structures on opposite sides of the body for comparison; example is palpating the submandibular lymph nodes under the chin.

What is transillumination, and what is it useful for?

Directing a strong light through soft tissue or a tooth to enhance examination; useful for detecting tooth irregularities and locating calculus.

What is auscultation, and give an example?

Examination using the sense of sound; example is listening for clicking of the temporomandibular joint during opening and closing.

What are the three divisions of oral mucosa?

Masticatory mucosa, lining mucosa, and specialized mucosa.

What distinguishes masticatory mucosa from lining mucosa?

Masticatory mucosa covers the gingiva and hard palate, is firmly attached, and is keratinized; lining mucosa covers areas like the cheeks and floor of mouth, is not firmly attached, and is not keratinized.

What does specialized mucosa cover and what does it contain?

It covers the dorsum of the tongue and contains papillae, some of which have taste buds.

What are the four types of tongue papillae?

Filiform, fungiform, circumvallate, and foliate.

Which type of papillae is the most numerous and contains no taste buds?

Filiform papillae.

Where are circumvallate papillae located and how many are there?

Arranged in a V shape between the body and base of the tongue; there are 10 to 14 of them.

What is the difference between a macule and a patch?

A macule is a flat, discolored lesion less than 1 cm in size; a patch is a flat, discolored lesion larger than 1 cm.

What distinguishes a papule, a plaque, and a nodule?

A papule is a small solid raised lesion under 1 cm; a plaque is a larger, flat-topped raised lesion over 1 cm with a "pasted-on" appearance; a nodule is a larger, marble-like raised lesion at least 1 cm and palpable.

What is the difference between a vesicle and a bulla?

A vesicle is a small fluid-filled blister 1 cm or less in diameter; a bulla is a larger fluid-filled blister greater than 1 cm in diameter.

What distinguishes a pustule from a vesicle or bulla?

A pustule contains pus, giving it a yellowish color, whereas vesicles and bullae contain serum, mucin, or blood.

What is the difference between an erosion and an ulcer?

An erosion is a shallow depressed lesion where only the epithelium above the basal layer is lost; an ulcer is a loss of continuity of the epithelium, often deeper, with a gray-to-yellow center and red border.

When is a depressed lesion considered deep versus superficial?

Superficial if the depth is less than 3 mm; deep if the depth is greater than 3 mm.

What does the ABCD-T mnemonic stand for?

Anatomic location, Border, Color and configuration, Diameter or dimensions, and Type.

What is the difference between a sessile and a pedunculated lesion?

A sessile lesion has a base as wide as the lesion itself; a pedunculated lesion is attached by a narrow stalk or pedicle.

What is the difference between leukoplakia and erythroplakia?

Leukoplakia is a white patch or plaque that cannot be scraped off or attributed to another disease; erythroplakia is a red, velvety patch that is less common but more likely to represent dysplasia or malignancy.

Why is any oral lesion that has not healed within two weeks considered significant?

It is considered suspicious for malignancy until proven otherwise and warrants biopsy or referral.

What are the four most common sites for oral cancer?

The lateral borders of the tongue, the floor of the mouth, the lips, and the soft palate.

What is the difference between an excisional and an incisional biopsy?

An excisional biopsy removes the entire lesion; an incisional biopsy removes only a representative section of the lesion.

What is lymphadenopathy?

The term for enlarged lymph nodes.

How can a clinician generally distinguish infection-related lymph node enlargement from cancer-related enlargement?

Infection-related enlargement typically appears suddenly and is tender to the touch, while cancer-related enlargement tends to come on gradually and painlessly.

What is metastasis?

The spread of cancer from its original tumor site to other parts of the body via clumps of cells transported by the blood or lymphatic system.

What are the three main pairs of salivary glands and their general locations?

Parotid glands (between the ear and jaw, over the masseter), submandibular glands (below the jaw toward the back of the mouth), and sublingual glands (under the tongue, beneath the floor of the mouth mucosa).

What is a goiter?

The term for an enlarged thyroid gland.

Why is the sternomastoid (sternocleidomastoid) muscle clinically significant to locate?

Because the cervical lymph nodes lie above, beneath, and posterior to this muscle.

What is the correct technique for effective palpation, and what technique should be avoided?

Effective technique compresses the structure against underlying tissue with consistent light pressure in a circular motion; "dancing" or lightly walking the fingertips over a structure should be avoided, as it is usually ineffective at detecting abnormalities.

Why is consistent sequencing important during a head and neck or intraoral examination?

Following the same systematic sequence every time minimizes the possibility of skipping an area and improves thoroughness, efficiency, and professionalism.

What should a clinician do before beginning the intraoral examination if a patient wears a prosthesis?

Ask the patient to remove the prosthesis so all areas of the mouth can be adequately inspected.