Extra & Intra Oral Exam PDF

Extra/Intra oral examination Questions to ask patient if abnormality is detected: (ALWAYS review medical history) 4. How often do you get ulcers? 1. How long has it been there? 5. Do you remember biting your lip/tongue? 2. How are you fee...

Extra/Intra oral examination Questions to ask patient if abnormality is detected: (ALWAYS review medical history) 4. How often do you get ulcers? 1. How long has it been there? 5. Do you remember biting your lip/tongue? 2. How are you feeling in yourself? 6. Do you remember burning yourself? 3. Are you experiencing pain? 7. Are you aware of clenching or grinding your teeth? Intra & Extra oral examination — Step by step 1. Introduce yourself and nurse to patient. Nothing abnormal detected = NAD Explain reason for appointment and gain consent from patient. “Hello I’m Emily and I will be your student dental therapist today and this is ….. my nurse. Today I will be checking your jaw for any issues and also your lymph nodes and soft tissues as part of an oral cancer screening. Do you have any questions and are you happy for me to continue?” 2. Extra oral - Face - Visual examination of face and top of head. Look for; Asymmetry Swelling Signs of infection Bruises Cuts Colours Describe and record what you see (Location, size, colour, duration, pain ass.) Lymph nodes - Stand behind patient. Ensure patient is relaxed with head slightly forward and chin tipped. Use pads of fingers in on/off motion to feel lymph nodes. Check both sides for comparison. Palpate and feel for any tenderness, swelling or abnormalities. Normal/healthy = small (pea sized), not tender to touch, mobile. With 2 fingers, start from TMJ (in front of ear) and sweep down (preauricular, parotid and tonsillar) Below chin (submental) Along border of mandible (submandibular) Back of ear (posterior auricular) Further back (occipital) Down neck (superficial cervical, posterior cervical) Above collarbone (supraclavicular) Describe and record what you feel (Location, size, duration, pain ass.) Recent infection may cause lymph nodes to be swollen and tender to touch. TMJ - Stand behind patient Place 2 fingers on R and L joint (just in front of ear) with passive lateral pressure Check both sides for comparison Ask patient to open and close slowly Describe and record what you see and feel (Tenderness, pain/discomfort, deviation, clicking or limited opening) Stand in front of patient and ask them to open and close slowly Describe and record any further deviations Bruxism is a common cause of TMD = Results in pain, stiffness on opening, headaches, neck aches and tooth pain. 3. Intra oral - Any sores that do not Lay patient back and ask them to open heal or keep Look around at soft tissues in a methodical manner growing require an Describe and record what you see urgent referral (Location, size, colour, duration, pain ass.) 1. Lips - 4. Hard and soft palate - Examine outside then inside If denture/appliance is worn then ask patient to Use fingers to stretch lips upwards and remove to carry out full examination outwards and downwards and outwards Use mirror to view Look for any; trauma, cold sores, ulcers, Look for any; thrush, ulceration, stomatitis, tori, mucocele, fordyce spots, swellings. swellings. 2. Buccal mucosa - 5. Tongue - Use thumb and fingers to retract and feel Ask patient to stick their tongue out Should be; smooth, moist and pink Ask patient to move their tongue to the left and the Look for any; trauma, white/lacy patches, right ulceration, cheek biting, burns, granulomas. May need to use gauze to carry out full exam Record any unusual appearance; geographic, 3. Vestibules and fauces - fissured, black hairy, glossitis, swellings, coated Use mirror or fingers to retract (normal). Use mirror to push down on back of tongue whilst asking patient to say “ahh” to check 6. Floor of mouth - fauces. Ask patient to lift tongue to roof of mouth Look for any; ulceration, abnormal frenulum, Check ventral surface of tongue and FoM tonsillar calcification, swellings. Look for any unusual appearance; tori, ranula, salivary stone. Extra Oral Purpose of extra oral examination = Areas = Identify any undisclosed or undiagnosed Upper Face - Lower Face - conditions Forehead Lower part of nose Eyes Lips Cheeks/cheekbones Chin Upper part of nose General symmetry Normal/healthy = small (pea sized), not Palpate and feel for swelling, tender to touch, mobile. tenderness or abnormalities. Abnormal = tender to touch, fixed and swollen. Lymph nodes How to carry out examination: 1. Stand behind patient 2. Ensure patient is relaxed Make careful notes if abnormality is 3. Head slightly forward & chin tipped detected - size, location, downwards - relaxes muscles consistency and history Often swollen and 4. Use pads of fingertips in on/off tender to touch due to motion - both sides at a time recent infections Lymphadenopathy = Swelling/disease of the lymph glands  Palpate both sides Problems are common and result and ask patient to in pain and difficulty opening open and close Examining for any; tenderness, pain, deviation, clicking or limited opening Temporomandibular joint (TMJ) How to carry out examination: Passive lateral pressure 1. Stand behind patient 2. Ensure patient is relaxed Bruxism = common cause 3. Exam both sides at a time with tips of of TMD, caused by stress fingers and gentle pressure 4. Visually looks for deviations in front of patient Results in pain, stiffness on opening, headaches, neck aches and tooth pain TMD = Temporomandibular joint dysfunction Faces aren’t completely symmetrical Looking for any deviation from ‘’normal’’ Symmetry Any signigicant Face asymmetries must be noted and discussed with patient How to carry out examination: 1. Stand in front of patient 2. Look for any deviations or May be due to; trauma, surgery, asymmetries infections, nerve paralysis  Best to ask patient if Can be due to; thyroid normal or abnormal for them issues, drugs, infections or medical conditions Eyes Make a note of anything abnormal Look for; colour changes, and discuss with patient pupils, dryness or irritation Questions to ask patient if abnormality is detected: (ALWAYS review medical history) 4. How often do you get ulcers? 1. How long has it been there? 5. Do you remember biting your lip/tongue? 2. How are you feeling in yourself? 6. Do you remember burning yourself? 3. Are you experiencing pain? 7. Are you aware of clenching or grinding your teeth? Inflamed, red and sore - difficult to Cracking at open mouth Recommend UV lip corners of mouth - protection and hydration 1 or both Fungal infection Dry/chapped Angular Ask patient history Cheilitis and any treatment Lips Herpes Labialis Sore, ulcer, blister, red/ Squamous cell white patch - doesn’t carcinoma Lies dormant in nerve go away or heal DO NOT treat cells but can be activated patients with cold leading to outbreak sores present Malignant Urgent referral required lesion Mild/severe Intra Oral Areas = Lips Mucosa Tongue Sore and painful Hard & soft palates The vestibules Vary in size Floor of mouth The fauces Common on mucous Possible causes; membranes anemia/vit Check for; colour, deficiency Apthous ulcers breaks, lumps Major, minor or and vessels traumatic Usually heal within 14 days How to carry out examination: Lips 1. Stretch lips upwards and outwards Fordyce 2. Stretch lips downwards and outwards spots Mucocele Harmless & Harmless & Fluid filled painless painless Disruption of cyst saliva flow Chronic trauma Benign Painful sore Check for; colour, breaks, Traumatic ulcerative lumps, vessels and textures granuloma Sensitivity to Chronic acid, spicy and inflammatory Buccal hot foods disease Aspirin burn mucosa Lichen planus Acid/chemical burn Can be painful, White/red lacey patches Cheek biting Linea alba burning sensation Thickening of Benign Horizontal white line tissue from friction  White patches/ Check for; colour, breaks, Can be scrapped off bumps lumps, vessels and textures Anti-fungal medication Thrush Bony growth on can be prescribed hard palate Hard and soft Tori palate Nicotinus stomatitis Benign Don’t usually cause pain Caused by heat Not painful Ulceration and nicotine Smoking, alcohol, dentures, surgery or system disease Likely from Stained and chlorhexidine enlarged Harmless Not papillae abnormal Needs a good brush Check for; colour, breaks, Black hairy lumps, vessels and textures Coated How to carry out examination: Can migrate over time 1. Use gauze to pull tongue out 2. To the left Tongue Geographic 3. To the right Smooth, red, 4. Tongue to roof of mouth Harmless depapillation Painful white/ Fissured red patch Squamous cell Glossitis Deep prominant grooves carcinoma Urgent referral Smooth required Inflammed, and colour swollen and Burning/numbess change sore  Bony growth on Saliva fluid Not serious or painful Harmless floor of mouth collection/cyst Mandibular Lingual ranula Can be inconvenient tori & uncomfortable Floor of mouth Check for; colour, breaks, Lingual Can block lumps, vessels and textures salivary stone saliva flow Floor of Small stone mouth cancer in salvia gland Sore that doesn’t Urgent heal or keeps referral growing required Red, white or dark patch Space between oral cavity and pharynx Painful ulcers Herpangina Check for; colour, Vital infection Space between breaks, lumps, Fauces cheeks and gingiva vessels & textures Limited lip Vestibules Tonsillar Hard lumps movement calcification Abnormal labial frenulum Bad breath/ Gaps Speech taste, sore between issues throat teeth