ExtraOral and Intraoral Exam and Techniques

Purpose of oral exam

Identifying conditiond that migght require special treatment considerations

• Deferral of routine care

• Diagnostic testing

• Special treatment adaptation

Provide a baseline/record of our treatment and diagnoses

what is this

Squamous cell carcinoma - cancer cell

what is this

Squamous cell carcinoma - cancer cell

pustule absess

pustule/fistula - the pus is flowing

What does oral exam identify conditions that might require diagnostic test

Clinical or physical signs of

abscess

Pt reports pain/sensitivity

Pustule/fistula

What is needed to do or start the intraoral exam

Antimicrobial pre-rinse

Mouth mirror/tongue depressor

Gauze

Perio probe

Patient’s chart and/or dental history

Black ink pen

What are the initial steps to do an extraoral exam

Visual: observe

Palpation: feel

Auscultation: listen for sound

Patient response: question patient about symptoms

Starting with a visual exam

Observe for:

 Color - face/ sick/ health

 Form

 Surface appearance

 Symmetry

 Size

 Exudate

 Movement - getting up from chair/walking

for the palpation step feel for:

Size

 Shape - measured with probe or a common sized item

 Symmetry

 Consistency - hard/soft/bumpy/smopth

 Mobile/fixed - free movement is mobile/ moves with muscle - fixed

 Tissue loss

 Relationship to adjacent structures - say near the tooth and what direction

Types of palpation

Digital - one finger

Bi-digital - between two fingers

Bi-manual - between two hands

Bi-lateral - same structure on opppostie side of the body

Ausculatation

Listen for sound produced

by certain body activities

 Ex. Tmj click/pop

PATIENT RESPONSE - Question patients about

Habits

Symptoms

History of findings

What is the Exam Sequence for oral exams

Call patients name in waiting room

Review medical history and previoys exam records

Inform patients that you will ne preforming an oral cancer screening

1. Extra oral exam

2. Wash hands

3. Clean gloves

4. Pre-rinse - can’t be alcohol-free - regualr listen

5. Intraoral Exam

Alchola free presince does not

kill the microbials in the mouth

What is ppe needed for extra oral

glasses, mask, gloves

What is ppe needed for intral oral exam

wHY DO YOU DO A SEQUESe for oral screening exam

So you are less likely to make mistakes, make things more timely, and help to maintain a professional atmosphere

How to classify conditions

Normal

Not normal

Atypical - ex; pits - Something that deviates from the normal but is not the

result of disease or trauma

Abnormal - ex;cheek bit, cancer - Something that deviates from the normal and is the result of disease or trauma

How do we describe lesion descriptions BY attached

Pedunculated: attached by stem or narrow connector

 Sessile: attached by broad base

sessile lesion

papilaary

verrucose

eythema lesion - systemic, chemical

petchia

broken tiny blood vesual

Indurated- lesion

ketosis - is just a calcus on the tounge

macule - similar to a frecal

papule - mot fluid fiiled

vesicle - is fluid filled like cold sores

bulla

pustule

ulcer

What is a way to determine which type of lesion are you looking at look at elevated lesion flow chart - study these all sticks out of the skin

How to determine a depressed lesion - look at depressed flow chart

flat lesion flow chart

How do we record our finding dor lesions

A. Asymmetry

B.Border Irregularity

C. Colour variegation

D. Diatmeter

E. Evolving

The extraoral examination begins once you see the patient in the waiting room. What should you be observing when you are getting your patient?

general appearance, skin, facial symmetry

For the general appearance when looking at you patient what should you be paying attention to?

posture, facial expression, eyes- clear, cloudy, yellow, red, weight- can affect medical considerations, hair-specifically women, extermities

What is the palpation method of examining lymph nodes

bilateral palpation

How does an active infection make the lymph nodes feel

Palpable, tender,

mobile.

How do chronic infections in the lymph nodes feels

Palpable, mobile.

How does cancer lymph nodes feel

Stony hard, palpable, fixed- not moving to much

What are all the lymph nodes that need to be checked

preauricular, postauricular, occipital, superficial, deep, posterior, supraclavicular, submental and submandibular

What are all the lymph nodes in the head area?

preauricular, postauricular, occipital, submental, submandibular

What are all the lymph nodes on the cervical area

superficial, deep, posterior, supraclavicular

what is the palation method used for salvatory gland extraoral examiniation

bilateral palpation

Bimanual palpation

What parts should be felt when palpating the salivary gland bilaterally and bimanually

• bilaterally: parotid, submandibular and submaxillary

• Bimanually - sublingual

When doing the extraoral exam on the thyroid gland what is the technique that should be used?

While the patient is swallowing, check for the following:

• rise/fall of the thyroid cartilage

• growths or swellings

When doing the thyroid gland for the extraoral exam we are using the -_____, ___ method

bimanual palpations

When doing the TMJ for the extraoral exam we are using which methods

1. Observe - range of motion, how it opens,

2. Palpate

3. Listen for sounds' - does it make a clicking sound

4. Question patients

What are examples of abnormal conditions

leukoplakia, keratinization, linea alba, nicotine stomatitis, ulcerations

what is the abnormal condition

Nicotine stomatitis

what is this abnormal condition on the sublingual area

leukoplakia

what is the atypical condition on the cheek area

fordyce granules

what is the atypical condition in the sublingual area

tunge tie

what is the in the soft palate

epa glotis

What are the first few things we do for all the oral exams

1. Review records - if the patient is on record; if not, go through the medical history

2. Provide a pre-rinse between each exam

3. Once in the mouth, look first and then touch

For the intraoral examination, what areas are we observing?

Oral habitis, occulsion, lips, frenuli, vestiblue, stenson ducts, gingiva, hard oalate, tonsillar, soft palate. tounge, sublingual area, whartons duct, sublingual lymph nodes, oral habits

What do we look for on the lips

changes in tissue color, texture, size, shape, blisters, ulcers, traumatic lesions, and pheltrom

How do we palpate the lips

bidigitally

How do we palpate/inspect the frenuli

freedom of tongue and cheek, grab lip and pull it way back upwards

What do we look for on the frenuli

maxillary labial, mandibular labial, buccal frenula, and sublingual frenula during observation of the tongue

Occlusion types - make sure to observe and record

Normal/Ideal Occlusion

•a.k.a. PERFECT!

•Class I Neutroclusion

•Class II Distoclusion

•Class III Mesioclusion

How do you paplate buccal muscosa

bidigitally - feel for masses, hardened tissue

What do you look for on the buccal mucosa

color, texture, ulcerations, growths, effects of smokeless tobacco, abrasions, traumantic lesions, check biting

What is this on the buccal mucosal

lenaalba -

what is this in the buccal mucosal

cheek biting

what is this on the buccal mucosal

lip niting

what is this

stensen duct - try miliking the duct - see if salvia comes out

What do we look for on the hard palate

general appearance, look at height, contour, color, rugae, incisive papilla

What motions do we use for paplate on the hard palagte

Palpate via finger sweep to observe any tori or growths

What do we look for on the soft palate, uvula area and tonsilar area

look for variations, Tonsil status, trauma, and petechia

What do we observe on the tongue

color, texture, shape, size, papilla, fissures, coating, mobility induration, masses or enlargements

what do we observe for in the sublingual area

lingual frenum, wharton’s duct, mucosal lining, lesions, growths

How to palpate the sublingual area

palpate bimanually and digitally

What do we palpate bimanually as well as digitally for the sublingual area

Bimanually - feel for masses, indurations on the floor

digitally - feel for tori by running your index finger along the alveolar ridge

Smell their breath while talking and observe

fruity breath is maybe diabetes, really bad breath may be tonsils, not having

When observing the gingiva look for

free and attached, inflammed ginigival tissue, abnormal pigmetation

What is an ex: of abnormal oigmentation

amalgam tattoo

When checking for oral habits look for -

Tobacco Use, Bruxism – Clenching, Mouth Breathing, Tongue Thrust, Nail Biting, Cheek Biting, Other