Concepts M1- Extraoral and Intraoral Exams

Rationale for EIO exam

A: ASSESS for ABNORMALITIES

B: Establish BASELINE for comparison of future findings

C: Screen for CANCER

D: Identify DEVIATIONS from normal

Oral cancer

Accounts for 3-4% of cancers

> early detection can lead to 90% cure rate

Principle method of oral cancer detection

Observation by the dental professional

Common sites for oral cancer

- Lateral border of the tongue

- Oropharynx, hard and soft palate

- Lower lip

- Floor of the mouth

Standard of care importance

Failure to perform and diagnose oral cancer screening can be considered malpractice

Hygienist responsibilities

- Complete a thorough oral exam

- Ask about tobacco and alcohol use

- Inform pt about their risky habits to oral cancer

- Follow through on referrals to specialists

Assessment techniques

- Observation/ inspection

- Palpation

- Auscultation

- Olfaction

Observation/ inspection

Act of viewing and watching the client to collect data

Palpation

Act of using the sense of touch to collect data

Auscultation

Act of listening to and detecting body sounds in order to determine variations normal

Olfaction

Act of sensing body odors to detect variations from normal and potential disease

Digital palpation

Use of a single finger to move or press against tissue such as palate and alveolar ridge

Bidigital palpation

Use of one or

more fingers and

thumb to move or

compress tissue such as

cheeks, tongue, lips

Bimanual palpation

Use finger of one hand and the thumb of the other hand simultaneously to move or compress tissue

Bilateral palpation

Use fingers of both hands simultaneously to move or press on contralateral sides of the head/neck, checks for symmetry

Thyroid gland

Secretes thyroid hormone that controls the body's metabolic rate

> check for nodules during exam

Thyroid gland location

- Middle of lower neck over trachea

- Shaped like a bow tie

Goiter

Enlarged thyroid gland due to iodine deficiency

Graves disease

Autoimmune disease, HYPERthyroidism

- gittery, hyperactive

- "thyroid" eye disease- bulging eyes

- can lead to thyroid enlargement

Hypothyroidism symptoms

Hashimoto's disease for example

- weight gain

- faint when tired

- often cold

Lymphatic system

- Network of lymph nodes connected by vessels, which plays a role in defense against infection

Lymph fluid

Carries nutrients and waste between body tissues and bloodstream

Lymph node function

Filter and trap bacteria, fungi, and waste

Lymph nodes

Vary in size from head of pin to baked bean

> 400-700 in the body

> 170-300 in neck

Lymph node major chains

in anterior and posterior of neck and under chin

Lymphadenopathy (enlarged lymph node)

Occurs when infected, if there is an inflammatory condition, or cancer

Lymph node enlargement due to a virus

½ to 1 inch

Lymph node enlargement due to bacterial infection

over 1 inch

Cancer can lead to

Painless lymph nodes

Normal lymph nodes are

Undetectable

Infected lymph nodes

- Firm

- Tender

- Enlarged

- Freely movable

- Swollen grape

Extraoral exam

Client is upright

- Have patient remove glasses

- Visually observe the symmetry of head, neck, eyes, nose, mouth, ears and complexion

Things to look for in an extraoral exam

- Lump

- Swelling

- Moles

- Freely movable node

- Fixed nodule

- Asymmetry

Other things to look for in an extraoral exam

- Irregular shape

- Firm or hard consistency

- Tender areas

- Red or discolored area

- Wound, bruise, scar

Cursory exam

Tongue blade used, move cheeks side to side look and back of throat before going in with hands in mirror

Intraoral exam

Client in a supine position

- Begin by using a tongue depressor to do a cursory examination of the oral cavity

- Follow cursory exam with initial visual exam using the mirror

Cursory exam purpose

Quick look into the mouth to notice dentures, partial orthodontics for example to be aware

Varicosity

increased prominence of superficial veins

Epithelial tag on frenum

variation of normal due to chronic irritation or how frenum rests

Exostosis

bony growth (benign) arising from the surface of bone

Leukoedema

deviation from normal

- benign, milky, bluish-white opaque appearance of the buccal mucosa that occurs commonly in black African Americans

Frictional keratosis

usually due to cheek biting, and is thicker than linea alba

Torus palatinus

Tori can

interfere with x-ray when placing film in the mouth

Nicotine stomatitis

usually causes by the heat from smoking, vaping, or even from very hot liquids

- inflammation of the minor salivary ducts of the soft palate

Inflamed palatine tonsils/ exudate

Edematous

abnormal accumulation of fluid in the tissues resulting in swelling

Bifurcated uvula

Tonsil stones (tonsilloliths)

- debris trapped in crypts

- food can get in between and then calcify

Geographic tongue

AKA benign migratory glossitis

Scalloped tongue

due to how the tongue rests against the teeth, such as when the tongue is larger than the arch

- can become more prominent with age

Fissured tongue

cracks in tongue

> more common in older individuals, those with xerostomia

Ankyloglossia

"tongue-tied" short lingual frenum

- if significant enough, can be surgically corrected in childhood

- can interefere with a baby's ability to feed and nurse

Macule

flat, colored spot on the skin (ex: freckle)

- circumscribed, nonraised area of epidermis altered in color from its surroundings

Patch

a flat, discolored area on the skin larger than 1 cm

- circumscribed pigmented or textured area larger than a macule

Erosion

denudation of epithelium above the basal cell layer

Ulcer

loss of epithelium that extends below the basal cell layer

ex. canker sore

Papule

elevated, solid lesion less than 1 cm in diameter

Plaque

flat, raised area larger than 1 cm in diameter

Nodule

raised, solid mass that has the dimension of depth and is less than 1 cm in diameter

Tumor

solid, raised benign or malignant mass that has the dimension of depth and is larger than 1 cm in diameter

Vesicle

circumscribed, fluid-filled skin elevation less than 1 cm in diameter

Pustule

vesicle filled with purulent exudate

Bulla

fluid-filled mucocutaneous elevation greater than 1 cm in diameter

Regarding to history of the lesion, ask

if patient is aware, how long its been there, change in size and appearance, symptoms

Lesion location descriptors

- Localized

- Generalized

- Single lesion

- Multiple lesion

Lesion characteristics

- Size

- Shape

- Color

- Surface texture

- Consistency (soft, hard, firm)

Attachment of raised lesions

sessile or pedunculated

Sessile

such as a mole

Pedunculated

such as epthelial tag

Excisional biopsy

entire lesion is removed to send for biopsy

Incisional biopsy

section of the lesion is removed