Extra Intra Oral Examination PDF

– Review the Clinic Form and process for the hard tissue Review from – Review the symbols for hard tissue documentation last week – Review documentation. Hard Tissue – Review ADPIED process Extraoral and Intraoral Clinical Assessment D & W Chapter 16 Wilkins Chapter 13...

– Review the Clinic Form and process for the hard tissue Review from – Review the symbols for hard tissue documentation last week – Review documentation. Hard Tissue – Review ADPIED process Extraoral and Intraoral Clinical Assessment D & W Chapter 16 Wilkins Chapter 13 2  – Purpose is to ensure that a thorough assessment has been completed of the Head & Neck areas to provide client specific Extra Oral & care/ – Any changes or areas that may be suspect may be identified by Intra Oral doing a thorough examination. Assessment – The dental hygienist determines the abnormal findings. An assessment is done to locate what is within normal limits (WNL) and then to identify if it is abnormal. 3  – Lesion: indicates change in structure of an organ or part attributable to injury or disease Assessment – Atypical finding: a finding that is a variation from normal Procedure – Abnormal finding: a finding that could prove to be a serious, possibly even prove to be fatal finding 4 Rationale for Early identification of abnormalities and the Extraoral pathologies and Intraoral May reveal signs of: Examination Thyroid disorders Eating disorders Nutritional deficiencies Sexually transmitted diseases Systemic conditions 5  – Observation: – Palpation: Assessment Skills – Auscultation: Table 16.1 – Olfaction: 6  – Digital palpation Palpation – Bidigital palpation Methods – Manual palpation – Bimanual palpation – Bilateral palpation Table 16-2 – Circular compression 7 Figure 13-1 Palpation of the Lip 8 Figure 13-2 Bimanual Palpation 9 Extraoral Clinical Assessment 10  – Normal face and head findings: – Symmetric – Skin continuous and firm with normal variations of pigmentation Conducting – Atypical findings: Extraoral – Moles, freckles, scars Assessments – Piercings, tattoos – Abnormal findings: – Needle marks from drug use – Trauma caused by domestic violence 11  1. Overall appraisal of patient 2. Face 3. Skin Sequence of 4. Eyes Examination 5. Nodes 6. Glands 7. Temporomandibular joint 8. Lips 12  – Overall evaluation, including skin – Frontal region – Parietal and occipital regions Extraoral – Temporal and auricular Clinical regions Assessment – Orbital regions, including eyes of Head – Nasal region, including Regions nose – Infraorbital and zygomatic regions Procedure 16-1 – Buccal regions – Mental region, including chin 13  Anterior and posterior Submandibular and Anterior midline cervical triangles submental triangles cervical region sternocleidomastoid submandibular and hyoid bone thyroid (SCM) muscles and Salivary Glands sublingual salivary associated lymph cartilage thyroid glands and associated gland larynx and Associated lymph nodes nodes Structures From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 4, St Louis, 2012, Saunders. 14  Lymph nodes – Palpable - may pinpoint where a disease process is active; – helps determine whether it has become widespread Extraoral Clinical Assessment Figs. 16.1-4 Box 16.2 15 Figure 13-4 Assessment of the Temporomandibular Joint 17  1. Preliminary examination of lips and intraoral 7. Breath odor mucosa 8. Labial and buccal mucosa 2. View palate, lips, labial 9. Tongue and buccal mucosa, and mucobuccal folds 10. Floor of mouth 3. Examine and palpate 11. Saliva Intraoral tongue 12. Hard palate 4. Observe mucosa of floor Examination of mouth 13. Soft palate, uvula 14. Tonsillar region, throat 5. Examine hard and soft palates, tonsillar areas, and pharynx 6. Note amount and consistency of saliva 18 Anatomical I. Oral Mucosa A. Masticatory Mucosa Landmarks of B. Lining Mucosa the Oral Cavity C. Specialized Mucosa 19 Examine the Lips From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 4, St Louis, 2012, Saunders. 20 Palate and Pharynx Figs. 16.10- 11 Figures courtesy Margaret M. Walsh, RDH, MS, MA, EdD, UCSF, Master of Science in Dental Hygiene Program Director, UCSF School of Dentistry, San Francisco, CA. 21 Tongue Figs. 16.10- 11 16.14 From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 4, St Louis, 2012, Saunders. 22 Assessing the Tongue Figures courtesy Margaret M. Walsh, RDH, MS, MA, EdD, UCSF, Master of Science in Dental Hygiene Program Director, UCSF School of Dentistry, San Francisco, CA. 23 Buccal and Labial Mucosa From Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 4, St Louis, 2012, Saunders. 24  – More than 75% of head and neck cancers originate in the oral cavity Oral and – Recent rise in cases of pharyngeal cancer related to Oropharyngeal HPV infection Cancer – Strongly associated with certain risk factors – Tobacco use – Alcohol abuse Box 16.4 – HPV infection – Extraoral lesions on lower lip 25  – Most common sites: – Lower lip (38%) – Lateral border of the tongue (30%) – Floor of the mouth (14%) – Soft palate complex (11%) Oral Squamous Cell Carcinoma Ibsen (2018) 26  – Most common types of skin cancer: – Basal cell carcinoma (BCC) – Squamous cell carcinoma (SCC) Skin Cancer – Carcinoma in situ: earliest form – Melanoma: less common, possibly fatal form of skin cancer 27  – Chronicity – Does not show healing – Erosion and resolution within a – Erythroplakia Cancer 2-week window, as most traumatic or – Erythroleukoplakia Progression infective lesions do – Fissured – Does not respond to – Fixation Table 16.9 treatment – Induration – Changes in color, shape, – Leukoplakia and size over time – Lymphadenopathy – Ulceration 28  – Review of patient’s risk for oral and oropharyngeal cancer Patient Self- – Educate patient about common symptoms of cancer Examination – http://www.cdho.org/docs/default-source/pdfs/oral- Box 16.6 health-rpt/article-7-step-oral-cancer- screening.pdf?sfvrsn=81d681a0_12 29  – Location and distribution Documenting – Dental hygiene – Size and shape and Describing diagnosis – Color changes Significant – Collaboration and – Texture Findings referral – Attachment and – Specific descriptive depth Table 16.6 items – Consistency – Mobility – Symptomatology 30  IMPORTANT Terminology Used to Indicate Consistency of a Lesion 31  Elevated Depressed Morphologic Flat Categories 32  Blisterform Vesicle Pustule Bulla Nonblisterform Elevated Papule Nodule Lesions Tumor Plaque 33  Ulcer: – Loss of continuity of epithelium Erosion: Shallow Does not extend through epithelium to underlying tissue Depressed Lesions 34  Macule Circumscribed Not elevated above surrounding skin or mucosa Identified by color Flat Lesions 35 Terminology Used to Describe Lesion Surface Texture 36  Updated histories and extra- and intraoral Clinical examination for all adult patients Recommendations Follow innocuous lesions in adult patients for Evaluation of Biopsy for suspicious lesions in adult patients Oral Lesions Can perform cytologic adjuncts when patient refuses biopsy or referral 37 Abscess & Palatal redness? – Causes? Apthous ulcer ?? Cause?? Extra oral – https://www.google.com/search?q=extra+oral+examination+in+d entistry+2022&rlz=1C5GCEM_enCA1017CA1017&source=lnms&tb examination m=vid&sa=X&ved=2ahUKEwin9vG1itz8AhUYEFkFHbA7AvsQ_AU oA3oECAEQBQ&cshid=1674421825846923&biw=776&bih=727&dp process. r=2#fpstate=ive&vld=cid:21a68039,vid:  Removal and microscopic examination of tissue for diagnosis Indications Biopsy Pathology report Diagnostic criteria 41  Details of the oral examination Recommendations for frequency of exam Documentation Review of lifestyle habits Progress note at first maintenance appointment 42