Examination

EO Examination

  • TMJ

  • Muscles of mastication

  • Lymph nodes

  • Facial symmetry

  • Lesion recording

IO

  • Dental chart and BPE

  • Soft tissues (oral med checklist)

  • Occlusion

Basic TMJ Examination

  • Two parts

    • Mechanical

    • Muscular

  • Assess the interaction between the two parts

  • A methodical approach looking for changes in function leading to the patient’s symptoms

  1. Opening and closing of the mouth observation

    • Should be a straight line

    • Opening should be about 45mm at the interincisal position

    • Action is smooth and even

  2. Palpation of the joint

    • Check for tenderness, swelling, clicking or crepitus

    • Can use little finger in auditory canal for maximum feedback

Muscles of mastication examination

  1. Examine the temporalis muscle

    • Use either the index or the middle finger to palpate the muscle against the lateral aspect

  2. Examine the masseter muscle

    • Palate at the angle of the mandible

  • This can identify any tender areas and the site of pain origin

    • Feel from the origin of the masseter with index finger in the buccal sulcus of the mouth against the external finger

    • Palpating against each other is important to compare one against the other and identify areas of tenderness

  1. Distal to maxillary tuberosity

    • Stimulate the lateral pterygoid muscle

    • Alternative is to ask the patient to move the mandible against resistance both in protrusive and lateral movements

    • Patient will report pain/tenderness in relation to function

Record

  • History

  • Predisposing, precipitating and perpetuating factors

  • Clinical finding

  • Formulate diagnosis

Lymph node examiantion

The key lymph nodes to examine are the buccal, submandibular, the deep cervical, superficial cervical, parotid, retroauricular and occipital

  • Examination should be very precise and consistent

  1. Under the chin

    • Check the submandibular

    • Work posteriorly for the preauricular

    • To the back of the skulls for the occipital

  2. Upwards

    • Work up to the parotid and buccal

    • Work down the superficial of the neck (jugulodigastric)

    • Work down towards the more clavicular

  • Finger pressure is sufficient to leave small transit marks on the skin and palpate the lymph nodes

    1. Work down the neck to ensure nothing has been missed

IO

  • The oral examination should start with the careful check for the high risk areas of oral cancer

  1. Ask the patient to protrude their tongue

  2. Ask the patient to lift their tongue to the roof of their mouth

  3. Examine the lower gums

  4. Examine the inside of the lower lips and vestibule

  5. Examine the outside of the lower lips

  6. Examine both the right and the left buccal mucosa

  7. Examine the inner and outer surface of the upper lips

  8. Examine the upper gum

  9. Examine the hard palate and the soft palate

  10. Also examine the oral pharynx and tonsils

Salivary gland examination

  • SUbmandibular gland

    • Use one finger inside the mouth and fingers outside the mouth for bimanial palpation to work along the end of the gland

    • Determine if there are any hard areas, tender areas or firm areas

  • Parotid gland

    • Locate the parotid duct (buccal to U6)

    • Gently massage the gland to promote the release of saliva (or pus)

    • Determine any tenderness

Normal anatomy

  • Linear alba - white lines along cheeks

  • Tori - bony aberrations/ecostosis

  • Fissured tongue

  • Racial pigmentation

  • Forcyth spots - minor salivary gland

  • Foliate papillae - back of the tongue

  • Lingual varices - expanded veins under the tongue