Lecture 1: Extraoral Examinations

What is the importance of the extraoral and intraoral soft tissue examination?

It is essential for any new patient exam and must be performed thoroughly to ensure no parts are missed.

What are the classifications for oral abnormalities according to the lecture?

Normal (WNL), Atypical, and Pathologic.

Define Atypical in the context of oral health.

It refers to findings not present in all individuals but still within normal limits.

What does Pathologic indicate in an oral examination?

It is associated with infection, trauma, neoplastic growth, or errors in development.

What should be explained to the patient before an oral examination?

The steps that will be followed during the examination and address any questions they may have.

How should a dental professional appear to a patient during an examination?

Calm, organized, and competent, even if they do not feel that way initially.

What is Hemiplegia?

Paralysis on one side of the body, usually due to stroke.

What is Paraplegia?

Paralysis affecting both sides of the body.

Define Hemiparesis.

Weakness on one side of the body.

Define Paraparesis.

Weakness affecting both sides of the body.

What is Ataxia Gait?

An abnormal, uncoordinated movement causing a staggering and unsteady gait.

What are the signs of Parkinsonian gait?

Motor disturbances including resting tremor, muscle rigidity, and postural instability.

Describe the characteristics of a Parkinson’s gait.

Taking small, shuffling steps and moving slowly, characterized by jerky movements.

What does 'freezing of gait' refer to in Parkinson's disease?

The inability to pick up feet, making individuals feel 'stuck' in place.

What is the prevalence of falls in Parkinson’s patients?

Falls are common in 5-85% of patients.

What should one avoid when interacting with wheelchair users?

Avoid making presumptions about their physical abilities.

When greeting a wheelchair user, how should you interact?

Greet them the same way you would anyone else and speak directly to them.

What is the first step for a wheelchair transfer?

Leave the patient in the wheelchair if possible, especially in private practice where there's more room.

What should you do before transferring a patient from a wheelchair?

Position the wheelchair as close as possible and lock all wheels in place.

What are the two evaluations for stature and habitus?

Stature: Short or Tall; Habitus: Thin, Obese.

What is Marfan's syndrome?

A genetic disorder affecting the body's connective tissue.

List some symptoms associated with Marfan's syndrome.

Tall stature, thin build, arachnodactyly, wingspan greater than height, chest concavity, and possible heart murmur.

What spinal abnormality is linked with Marfan syndrome?

Kyphosis, also known as roundback.

What is the proper way to check for head lice?

Discreetly observe the hair for nits, which are white egg cases, not dandruff.

What should be done if a patient has head lice?

Dismiss the patient, vacuum the chair, and use a fresh headrest cover for every patient.

What are the primary facial landmarks to assess in a facial examination?

Outer canthus, Inner canthus, Ala, Philtrum, Tragus, Nasion.

What does HEENT stand for in a head and neck exam?

Head, Eyes, Ears, Nose, and Throat.

What facial forms should be assessed in the exam?

Symmetry, Head shape, Eyes, Ears, Nose, and Throat.

Define a normal profile in dental terms.

A facial profile where the jaw is aligned with the forehead.

What is a prognathic profile?

A facial profile where the jaw protrudes more than normal.

What is required for treatment in cases of retrognathic profiles?

Typically requires orthodontic and oral surgery intervention.

What are the symptoms of head and neck malignancies?

Lumps in the neck, hoarseness, a scratchy throat that doesn’t improve, pain in the neck, jaw, or ears.

What should a dentist be aware of when treating cancer patients?

The type and extent of cancer, potential complications like adverse bleeding, side effects of drugs, and infection.

What are some side effects of chemotherapy that a dentist should consider?

Immunocompromised status, xerostomia, mucosal irritation, and cervical caries.

What are the visual characteristics of basal cell carcinoma?

Most common skin cancer, irregular borders, tends to grow slowly, and can appear as a sore or lesion that won’t heal.

What are the visual characteristics of squamous cell carcinoma?

Irregular borders, crusty surface, persistent thick rough scaly patches that may bleed.

What is melanoma?

A type of skin cancer characterized by multiple colors, irregular borders, and asymmetrical form.

What does ptosis indicate in an eye examination?

Lid lag, sometimes a sign of a past stroke.

What is ocular hypertelorism?

Excess spacing between the eyes.

How should pupils react when assessed?

Pupils should react equally to light.

What does exophthalmos indicate?

An abnormal protrusion of the eye, potentially a sign of hyperthyroidism.

What condition does yellow sclera indicate?

Possible hepatotoxicity.

What indicates swollen lymph nodes?

Firm, tender, enlarged, and warm nodes usually indicate infection.

What are characteristics of malignant lymph nodes?

They tend to be firm, non-tender, matted, fixed, and increase in size over time.

List the cervical lymph nodes by name according to the lecture.

Submental, submandibular, tonsillar/jugulodigastric, preauricular, postauricular, occipital, anterior cervical chain, supraclavicular, post cervical chain.

Define lymphadenopathy.

Abnormalities in lymph nodes in terms of size, consistency, tenderness, and mobility.

What are clues to routine swelling from recent infection regarding lymph nodes?

Tenderness, mobility, predictable locations, and long duration without change.

What is the common cause of mumps?

An infection of the parotid gland resulting in cheek swelling and sore lymph nodes.

What is significant about the thyroid gland in examinations?

It is located inferior to the larynx, often not palpable, and thyroid diseases are usually life-long conditions.

How do you perform a thyroid exam?

Gently place fingers on either side of the Adam's Apple and slide just below it while asking the patient to swallow.

What is the purpose of asking about lip abnormalities?

To assess conditions such as angular cheilitis, which may indicate fungal infection.

What is angular cheilitis?

An inflammation at the corners of the mouth, commonly attributed to candida infection.

What is TMD?

Temporomandibular Disorders, a collection of symptoms affecting the jaw.

How prevalent are TMD symptoms in the U.S.?

They affect approximately 20% of the U.S. population, with a higher prevalence in women.

List some common symptoms of TMD.

Joint pain, headaches, tinnitus, insomnia, and sensitive teeth.

What are potential causes of TMD?

Bruxism, clenching, stress, malocclusion, arthritis, trauma, and stimulants.

How many broad diagnostic classes are there for TMD?

Three broad classes: muscles, soft tissue of the joint, and hard tissues of the joint.

What is referred pain in relation to TMD?

Pain that may arise from muscles like temporalis referring to anterior teeth or masseter referring to posterior teeth.

What is involved in TMJ diagnostic exams?

Measure range of motion, palpate for crepitus, and assess tenderness in muscles.

What are indicators of excessive tooth mobility?

Widened periodontal ligament seen radiographically and migration without periodontal disease.

What is the recommended treatment for TMD?

Night guards, medications, physical therapy, and in very rare cases, surgery.

What do night guards accomplish for TMD patients?

They redistribute occlusal forces and help relax masticatory muscles.

What medications are used to manage TMD?

Anti-inflammatory drugs, anti-anxiety medications, muscle relaxers, and Botox.

What is the first step in treating TMD?

Joint rest and reducing jaw movement.

How can hot or cold compresses help TMD patients?

They can relieve pain and soothe muscle discomfort.

What is the importance of the extraoral and intraoral soft tissue examination?

It is essential for any new patient exam and must be performed thoroughly to ensure no parts are missed.

What are the classifications for oral abnormalities according to the lecture?

Normal (WNL), Atypical, and Pathologic.

Define Atypical in the context of oral health.

It refers to findings not present in all individuals but still within normal limits.

What does Pathologic indicate in an oral examination?

It is associated with infection, trauma, neoplastic growth, or errors in development.

What should be explained to the patient before an oral examination?

The steps that will be followed during the examination and address any questions they may have.

How should a dental professional appear to a patient during an examination?

Calm, organized, and competent, even if they do not feel that way initially.

What is Hemiplegia?

Paralysis on $1$ side of the body, usually due to stroke.

What is Paraplegia?

Paralysis affecting both sides of the body.

Define Hemiparesis.

Weakness on $1$ side of the body.

Define Paraparesis.

Weakness affecting both sides of the body.

What is Ataxia Gait?

An abnormal, uncoordinated movement causing a staggering and unsteady gait.

What are the signs of Parkinsonian gait?

Motor disturbances including resting tremor, muscle rigidity, and postural instability.

Describe the characteristics of a Parkinson’s gait.

Taking small, shuffling steps and moving slowly, characterized by jerky movements.

What does 'freezing of gait' refer to in Parkinson's disease?

The inability to pick up feet, making individuals feel 'stuck' in place.

What is the prevalence of falls in Parkinson’s patients?

Falls are common in $5-85\%$ of patients.

What should one avoid when interacting with wheelchair users?

Avoid making presumptions about their physical abilities.

When greeting a wheelchair user, how should you interact?

Greet them the same way you would anyone else and speak directly to them.

What is the first step for a wheelchair transfer?

Leave the patient in the wheelchair if possible, especially in private practice where there's more room.

What should you do before transferring a patient from a wheelchair?

Position the wheelchair as close as possible and lock all wheels in place.

What are the two evaluations for stature and habitus?

Stature: Short or Tall; Habitus: Thin, Obese.

What is Marfan's syndrome?

A genetic disorder affecting the body's connective tissue.

List some symptoms associated with Marfan's syndrome.

Tall stature, thin build, arachnodactyly, wingspan greater than height, chest concavity, and possible heart murmur.

Define Arachnodactyly in the context of Marfan's.

A condition where fingers and toes are abnormally long and slender, similar to spider legs.

What is the Wingspan characteristic in Marfan's syndrome?

The patient's total arm-to-arm span is significantly greater than their vertical height.

Define Chest Concavity (Pectus Excavatum).

A condition where the breastbone sinks into the chest, a physical sign seen in Marfan's syndrome.

What spinal abnormality is linked with Marfan syndrome?

Kyphosis, also known as roundback or an exaggerated outward curve of the spine.

What is the proper way to check for head lice?

Discreetly observe the hair for nits, which are white egg cases, not dandruff.

What should be done if a patient has head lice?

Dismiss the patient, vacuum the chair, and use a fresh headrest cover for every patient.

What are the primary facial landmarks to assess in a facial examination?

Outer canthus, Inner canthus, Ala, Philtrum, Tragus, Nasion.

Define the Outer Canthus.

The lateral (outer) corner of the eye where the eyelids meet.

Define the Inner Canthus.

The medial (inner) corner of the eye near the nose.

Identify the Ala of the nose.

The wing-like, flared lateral wall of each nostril.

Describe the Philtrum.

The vertical groove in the midline between the nose and the upper lip.

What is the Tragus?

The small cartilaginous prominence located in front of the external ear canal.

Define the Nasion.

The midpoint on the skull where the bridge of the nose meets the forehead.