Preclinical Techniques - Extraoral and Intraoral Exam

what equipment is needed for the extraoral exam

mirror, gauze, gloves, eyewear, mask

how should the patient be positioned for EO exam

upright, sagittal plane of patients head is perpendicular to floor, maxillary arch is parallel to floor

you should remove a patients glasses for EO exam

true

explain procedure and rational to patient prior to and during procedure

true

you have to change gloves between EO and IO exams

True

how should a patient be positioned for and IO exam

patient in supine position, remove dental appliances, patient mouth at waist level of operator, pre procedural rinse administered

What is operator positioning for IO exam

-seated, weight evenly distributed for IO exam

-facing patient for visual EO exam (front position) and IO exam unless indicated

what is operator positioning for EO exam

- standing, weight evenly distributed, for EO

- behind patient for palpation of EO exam

what is digital palpation

Use of a single finger to examine tissues

what is bidigital palpation

use of one or more fingers and thumb to examine tissues by grasping and rolling tissue between thumb and tissue

what is manual palpation

Using all fingers of one hand to examine tissue

what is bimanual palpation

use of both hands by grasping tissue between them for examination

what is bilateral palpation

examination of structures on both sides of the face or neck simultaneously to detect differences between sides

what is circular compression

Moving the finger tips in a circular pattern over a structure while simultaneously applying pressure to the tissue

what is the order of the cursory EO exam

1. face

2. hair

3. scalp

4. eyes

5. nose

6. lips

7. ears

8. skin of neck

what should you look for when looking at face

symmetry, scars, lesions, texture, moles

what should you look for when looking at hair

texture, amount, and distribution, diseases

what should you look for when looking at scalp

lesions

what should you look for when looking at eyes

scleras (color, sign of irritation)

pupils (size, reactivity to light)

eyelids (color, swelling, habits (blinking))

what should you look for when looking at nose

symmetry, obstructions

what should you look for when looking at lips

symmetry, scars, lesions, color, texture, habits, chapping and breaks in skin, especially at corners

what should you look for when looking at ears

symmetry, form, color, texture (check behind ears)

what should you look for when looking at skin of neck

pigmentation, moles, texture, scars, lesions

with bony structures, note

abnormal anatomy, growths, crepitus, and pain

with muscles and soft tissues, observe

function, deviations between two sides, swellings, masses, tenderness

with glands, note

abnormal swellings, tenderness, hard masses, lack of movement

with lymph nodes note

palpable nodes and size, firmness, mobility, tenderness, duration, determine if can be traced to current or recent history of disease

what are concerning findings of lymph nodes

hard, fixed, firm, unilateral

for the facial area (infraorbital, buccal, mandibular) what is the palpation procedure

use firm, bilateral, circular compression

cover entire area

for the mentalis muscle what is the palpation procedure

-use firm, bilateral, circular compression

-ask patient to turn lower lip outward (pout) and pull lower lip over mandibular anterior teeth

-ask patient to swallow to observe function (wrinkling, tongue thrust)

for the inferior border of the mandible what is the palpation procedure

- use firm bilateral circular compression

- cover area from midline to angle

for the masseter muscle what is the palpation procedure

- use firm, bilateral, circular compression

- ask patient to clench, question about tenderness

for the temporalis muscle what is the palpation procedure

- use firm bilateral, circular compression

- ask patient to clench, question about tenderness

for the TMJ, what is the palpation procedure

- firm bilateral palpation with first fingers just anterior to tragus of ear

- have patient open and close in centric (ventral) movement

- protrusive movement

- lateral movement

- observe midline deviation- stand behind and look down nose

- listen and feel for clicking, popping in area

- question about tenderness and clicking or popping

for the parotid gland and anterior auricular area (pre auricular) what is the palpation procedure

use firm, bilateral, circular compression

for the auricular area (posterior and inferior) what is the palpation procedure

use firm, bilateral, circular compression

for the occipital area, what is the palpation procedure

- use firm bilateral circular compression

- cover area from back of neck to the sternocleidomastoid muscle

for the cervical lymph nodes/ sternocleidomastoid muscle what is the palpation procedure

- use firm circular bidigital compression

- have patient lower head and place chin in cupped hand. If palpating left have turn right and vise versa

- cover entire area from mastoid process to clavicle along sternocleidomastoid muscle

- hook thumb and fingers behind muscle to reach deep nodes

for the trachea/hyoid what is the palpation procedure

- use firm bilateral or bidigital palpation

- start between clavicle bones and work superiorly

- gently rock from side-to-side; should be moveable

- ask patients to swallow, should move up and down when patient swallows

for the submandibular/submental lymph nodes what is the palpation procedure

- ask patient to tilt head forward so muscles are relaxed

- Submandibular: displace tissue to right side with left hand, cup fingers of right, grasp tissue and roll over right side of mandible (opposite for left side). cover canine posterior to angle

- submental: use firm, manual, circular compression

apply pressure at internal surface of mandible at midline

What is the sequence of the intraoral cursory inspection

1. lips/labial mucosa

2. cheeks/buccal mucosa

3. alveolar vestibule

4. hard and soft palates

5. tonsilar, pharyngeal area

6. tongue

7. floor of mouth

8. alveolar processes

what is the palpation sequence for IO exam

1. lips/labial mucosa

2. cheeks/buccal mucosa

3. alveolar vestibule

4. palate

5. tonsilar area

6. tongue

7. floor of mouth

8. alveolar processes

with the lips during an IO exam, retract the lips out and move in a ___ motion

circular

do you palpate the soft palate

no

when palpating the floor of the mouth, you use firm bimanual palpation with finger of one hand ____ and other hand ___

intraorally, extraorally