8. DH 170: LO8A & B: EO & IO Exams

what are two essential components of providing optimal client care?

A thorough assessment of the head & neck and the oral cavity.

What is imperative for promoting optimal wellness, especially regarding oral cancer, and potentially preventing death?

Taking appropriate action after recognizing an abnormal condition.

What is a necessary skill related to assessment findings?

The ability to accurately describe findings, both verbally and in writing.

What is the estimated percentage of clients who have atypical or abnormal orofacial findings?

An estimated 10%.

Define "lesion."

A change in structure of an organ or tissue due to injury or disease (e.g., a wound, ulcer, abscess, or tumor).

Define "atypical finding."

A variation from normal (which is the majority of findings).

Define "abnormal finding."

A finding that could be serious, even fatal.

What types of findings are included under "Significant Findings" that must be accurately described and documented?

Both Atypical Findings and Abnormal Findings.

What purposes does documenting Significant Findings serve?

It enables effective communication with the client’s dentist or other healthcare professionals;

• it serves as baseline data; and it serves as a legal record.

What are the four primary assessment skills used during the EOE/IOE?

Observation, Auscultation, Olfaction, and Palpation.

Define Observation as an assessment skill.

Watching the client to detect atypical or abnormal findings.

Define Auscultation as an assessment skill.

Listening to sounds to detect atypical or abnormal findings.

Define Olfaction as an assessment skill.

Sensing odors to detect atypical or abnormal findings.

Define Palpation as an assessment skill.

Using touch to detect atypical or abnormal findings.

What should a clinician do first before palpating a lesion?

Visualize the lesion first (using observation).

What part of the hand should be used for palpation?

The pads of fingers.

To obtain maximum information about a lesion, against what type of structure should the clinician always palpate?

A firm or bony structure, such as bone or other fingers.

What are the six listed methods of palpation?

Digital, Bidigital, Manual, Bimanual, Bilateral, and Circular compression.

Define and state the use for Bilateral Palpation.

Using a finger or the fingers of both hands simultaneously to move or press tissue on opposite sides; used to compare both sides at the same time.

Define and state the use for Circular Compression.

Moving the fingertips in deliberate rotating fashion over tissue to be examined while exerting pressure; used to palpate suspected lesions for more information.

Define and state the use for Manual Palpation.

Simultaneously using all fingers of one hand to move or compress tissue; used to palpate lymph nodes and the thyroid gland.

Define and state the use for Bimanual Palpation.

Using the index finger of one hand and the fingers and thumb of the other to compress tissue (holding fingers closely together to avoid missing areas); used to palpate the Floor of Mouth (FOM), submandibular/sublingual glands, and lymph nodes.

Define and state the use for Digital Palpation.

Using an index finger to move or press against tissue; used to palpate vestibules, the floor of mouth, and the lingual border of the mandible.

Define and state the use for Bidigital Palpation.

Using fingers and thumb to move or compress tissue using a rolling motion; used to palpate lips, labial & buccal mucosa, and the tongue.

In the CNIH Assessment Procedures sequence, what step immediately precedes the Extra/Intra-Oral Examination?

Health History Assessment.

In the CNIH Assessment Procedures sequence, what step immediately follows the Extra/Intra-Oral Examination?

Gingival Assessment & Oral Hygiene Index.

What six descriptors must be included when documenting Significant Findings on the clinical form?

Location, size, shape, colour, texture, and consistency.

How is the location of a significant finding described?

By the region and nearest anatomical landmark, noting if it is unilateral or bilateral (e.g., "Lower RT lip, opposite #43").

How is the size of a significant finding measured and recorded?

In mm, using a periodontal probe to measure length x width (x height).

What terms are used to describe the shape of a significant finding?

Round, ovoid, or irregular; also noting if the borders are well-defined or poorly defined.

Which two colors of lesions are noted as predominating?

White and red lesions.

What surface appearances might be used to describe the texture of a significant finding?

Corrugated, crater, crust, fissured, induration, papillary, pseudomembrane, smooth, or verrucous.

What terms are used to describe the consistency of a significant finding, and what tissue examples are provided?

Soft (ex. adipose tissue), Firm/rubbery (ex. cartilage), or Hard (ex. bone/enamel).

When should a clinician check the "Within Normal Limits" box on the Extra-Oral Examination form?

When findings are normal or typical, and there are no atypical or abnormal findings.

When should a clinician check the "Variation from Normal" box and describe the finding?

When there is an Atypical/Abnormal Finding.

What does the overall evaluation of the client (EOE Overview Step 1) include?

Appearance & Movement, Speech & Hearing, Functional Level, and Personal Hygiene.

Before performing the EOE/IOE, what two assessments must the clinician ensure are completed?

Reviewing the client’s Health History and examining existing radiographs.

What must the clinician explain to the client to obtain verbal informed consent for the EOE, and what phrase must be used? (1b)

The assessment procedure; the clinician must use the phrase "Oral Cancer Screening" (OCSs are a legal responsibility for RDHs).

Besides explaining the procedure, what must the clinician ask the client to do before starting the EOE (1b)?

Remove eyeglasses.

What is the clinician's responsibility regarding consent to touch during the procedure?

Recognizing that a client controls consent, which may be withdrawn at any time; agreement (verbal or non-verbal) is required before a client may be touched.

What does the overall evaluation of physical characteristics (Step 2) observe, and where does this evaluation occur?

Abnormalities of the head, face, neck, hands, arms, legs, or speech that may require modification to dental hygiene care or medical/dental consultation; this occurs while the client is in the reception area and during movement into the operatory.

How should the head and neck be evaluated based on the regions of the head?

Visually dividing the head (& neck) into regions, ensuring they are symmetrical, and bilaterally palpating each region in sequence, moving from superior to inferior.

During the evaluation of the parietal and occipital regions (Step 3), what must the clinician inspect the entire scalp for?

By moving the hair, especially around the hairline, starting from one ear and proceeding to the other.

During the evaluation of the occipital nodes (Step 3), how is the client positioned, and what palpation method is used?

The client is asked to tilt their head forward, and the clinician uses circular motions to compress tissues against the base of the skull, covering the area slightly above and below the hairline.

What are some normal skin findings?

Symmetric, continuous, and firm skin.

What are examples of atypical skin findings?

Moles, freckles, scars, piercings, and tattoos.

What are the three most common types of skin cancer listed?

Basal cell carcinoma (BCC), Squamous cell carcinoma (SCC), and Melanoma (a less common but possibly fatal form).

Why are 85% of skin cancer lesions located on the head and neck?

Due to exposure to sunlight.

What is evaluated during the inspection of the temporal region and auricular nodes (Step 4)?

The external ear, scalp, face, and auricular nodes (anterior/preauricular and posterior) around each ear.

During the assessment of the eyes (Step 6), how is eye movement tested?

By asking the client to follow the clinician's index finger (without moving their head) left, right, up, and down.

What are some abnormal examples of findings related to the eyes?

Red eyes, swelling/bruising, tearing up, jaundice, cloudy iris, unusual pupil size, or inability to close one eye.

In the nasal region assessment (Step 7), where does the bilateral palpation start and end?

Starting at the root and ending at the tip.

When assessing the infraorbital and zygomatic regions (Step 8a), how does the clinician test the muscles of facial expression?

By asking the client to "smile wide".

How are the maxillary sinuses assessed (Step 8b)?

By verbal identification and bilateral palpation.

How does the clinician begin the TMJ assessment (Step 9a)?

By verbal identification and placement of fingers on the outer portion of the external acoustic meatus.

When assessing the TMJ (Step 9b), what movements is the client asked to perform, and what should the clinician note?

The client is asked to open and close several times, noting deviations, and then move the opened jaw from right to left and forward.

Where should the clinician stand to observe jaw deviations during the TMJ assessment?

Standing in front of the client.

If crepitus, clicking, popping, or clunking is felt or heard during the TMJ assessment (Step 9c), what follow-up questions should be asked?

Questions regarding discomfort, pain, headache, earache, or use of bruxing appliances.

During the bilateral palpation of the buccal region and masseter muscle (Step 10), what is the client asked to do to assess the masseter muscle?

Clench their teeth several times.

When palpating the mandible (Step 10), what should the clinician ensure is done?

Rolling the soft tissue over the inferior border of the mandible.

What action is performed during the palpation of the oral and mental region (Step 11)?

Verbal identification and bilateral palpation of the oral and mental regions.

When assessing the SCM muscle and associated nodes (Step 12), how is the SCM made more prominent?

When the client’s head is turned to one side and their chin is angled down slightly.

How are Superficial Cervical Nodes palpated? (Step 12)

The client looks straight ahead, and the clinician uses bilateral palpation starting from behind the ears and continuing the length of the SCMs' surface to the clavicles, palpating both SCMs at the same time.

What are the two options for palpating the Deep Cervical Nodes? (Step 12)

1) Client turns head to one side and angles chin downward; clinician uses one hand to palpate the entire length of the SCM while the free hand supports the head. 2) Client turns head to one side and angles chin downward; clinician uses both hands to palpate the entire length of the SCM (palpating each SCM separately).

During the palpation of the submental and submandibular triangles (Step 13a), what two structures are found in the submental triangle?

Both sublingual salivary glands and sublingual & submental nodes.

During the palpation of the submandibular triangle (Step 13a), what two structures are found?

Both submandibular glands and submandibular nodes.

How is the soft tissue handled when palpating the submandibular region (Step 13a)?

The clinician uses one hand to pull the soft tissue of the neck to the opposite side, and the other hand palpates (rolls) the soft tissue up and over the border of the mandible on the side being examined; then switch hands and repeat.

Describe the thyroid gland's location and shape.

It is a bowtie-shaped gland located in the anterior midline of the neck, lying over the trachea, just above the clavicles.

How does the clinician compare the two lobes of the thyroid gland (Step 13b)?

Using visual inspection and bimanual palpation, gently displacing the gland to the opposite side of the neck while the other hand manually palpates the displaced tissue; then switch hands and repeat.

How is thyroid gland mobility checked (Step 13b)?

The client is asked to swallow (possibly with water) while the student observes movement.

What is Lymphadenopathy?

Enlargement or inflammation of the lymph nodes.

How do nodes present during an acute infection?

Enlarged, soft, tender, and freely moveable.

How do nodes present in the case of cancer or chronic infection?

Enlarged, hard, non-tender, and fixed (immobile).

According to CNIH protocol, what is recommended if palpable cranial or cervical lymph nodes are found in the absence of other symptoms and without apparent cause? (14a)

Consultation with a physician and possible referral.

If a lesion is present (14b), what three key follow-up questions must the client be asked?

1) History of the lesion (Are they aware? Since when?), 2) Changes in the lesion (Has it changed in size/appearance?), and 3) Is it painful (or painful when palpated?).

If a lesion is new to the client and non-identifiable to the clinician, what two potential actions can the clinician take? (14b)

The clinician may have the client return in 2 weeks for a re-evaluation AND/OR the clinician may refer the client for further evaluation.

If a client is referred to a specialist, what information must be provided?

All pertinent information must be provided in writing.

After performing the EOE, what must the clinician do before proceeding to the IOE? (14c)

Change gloves.

What is an example of an appropriate Progress Note entry for a healthy patient? (14d)

"Extra-oral exam completed. No significant findings. Checked by Val Baldwin, RDH.".

What must be maintained throughout the procedure? (14e)

Asepsis (appropriate PPE worn, and all infection prevention and control protocols followed).

What two components are essential to providing optimal client care?

A thorough assessment of the head & neck and the oral cavity.

Regarding oral cancer, what action is imperative for promoting optimal wellness and potentially preventing death?

Taking appropriate action after recognizing an abnormal condition.

What skill is necessary related to assessment findings?

The ability to accurately describe findings, both verbally & in writing.

What is the estimated percentage of clients who have an atypical or abnormal orofacial finding?

An estimated 10%.

Define the term "Lesion."

A change in structure of an organ or tissue due to injury or disease (for example, a wound, ulcer, abscess or tumour).

Define "Atypical Finding."

A variation from normal (which is the majority of findings).

Define "Abnormal Finding."

A finding that could be serious, even fatal.

What two types of findings are included under "Significant Findings" that must be accurately described and documented?

Both Atypical Findings and Abnormal Findings.

Name three purposes that documenting Significant Findings serves.

It enables effective communication with the client’s dentist, or other healthcare professionals; it serves as baseline data; and it serves as a legal record.

II. Assessment Skills and Palpation Techniques
What are the four main assessment skills reviewed in the source material?

Observation, Auscultation, Olfaction, and Palpation.

Define Observation as an assessment skill.

Watching the client to detect atypical or abnormal findings.

Define Auscultation as an assessment skill.

Listening to sounds to detect atypical or abnormal findings.

Define Olfaction as an assessment skill.

Sensing odours to detect atypical or abnormal findings.

Define Palpation as an assessment skill.

Using touch to detect atypical or abnormal findings.

What must the clinician do before palpating a lesion?

Visualize the lesion first (using observation).

What part of the hand should be used for palpation?

The pads of fingers.

To obtain maximum information about a lesion, against what type of structure should the clinician always palpate?

A firm or bony structure such as bone, or other fingers.

Name the six methods of palpation reviewed.

Digital palpation, Bidigital palpation, Manual palpation, Bimanual palpation, Bilateral palpation, and Circular compression.

What is Digital Palpation, and what is one example of its use?

Using an index finger to move or press against tissue; used to palpate vestibules, floor of mouth, or the lingual border of the mandible.

What is Bidigital Palpation, and what is one example of its use?

Using fingers and thumb to move or compress tissue using a rolling motion; used to palpate lips, labial & buccal mucosa, or the tongue.