oral diagnosis m2

7/29/2019 Oral Diagnosis m2

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ORAL DIAGNOSIS M2

PHYSICAL EXAMINATION

1. PROCEDURAL STEPS/PROCEDURES

a. GPA (General Patient Appraisal)

b. EXTRAORAL EXAM (Head & Neck)

c. INTRAORAL EXAM

GPA

Identifying features of the patient as to the

demographic data (age, gender, race)

Body built of the patient

o Slim, normal, athletic, obese

Anatomic proportions

o Tissue symmetry

Mental orientation & emotional status of the patient

Posture of the patient, movements and speech

o How the patient walks

o How the patient talks

Determination of the vital signs of the patient

VITAL SIGNS

1. BLOOD PRESSURE

Normal is 120/80mmHg

2. PULSE RATE

QUANTITATIVE - # of pulse per minute

QUALITATIVE amplitude or rhythm

NORMAL PR 60-90 bpm

AMPLITUDE force/surge of blood against

the artery

PULSE AMPLITUDE

0 = no palpable pulse

1 = faint pulse (thready pulse)

o Due to: dehydration and/or advance

state if atherosclerosis

2 = normal ulse

3 = strong pulse manifested when the persion is in

its active state

4= bounding pulse pulse that is easy to find

and very hard to oliterate; seen in persons who have

hyperthyroidism

PULSE POINTS

RADIAL

o Typically used

o Palpated on the lateral of the wrist

TEMPORAL

CAROTID

o Useful in emergencies

INGUINAL

ANTECUBITAL FOSSA

o Palpated on the medial

o Felt when taking BP

3. RESPIRATORY RATE

Observe the rise and fall of the chest

Normal in adults is 12 20/min

Normal in children is 24 30/min

10 or 30 indicative of Cardiovascular

Disease

TACHYPNEA 7/min; slow

APNEA no breathing

CHEYNE STOKES RESPIRATION shallow

fast breaths; present in CVD and CHD

(coronary heart disease)

4. TEMPERATURE

Taken through ears, mouth, axilla

Normal oral/ear temp is 36.5 C

Person is febrile if temp is 37.8C or

5. HEIGHT & WEIGHT

Done only on conscious patients

*when unconscious, only take BP, RR & PR

EXTRAORAL EXAM (head & neck)

4 perspective/views

1. FRONTAL


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Facial symmetry & form

Alignment of pupil, eyes, ears, nose

2. SUBMENTAL

Ask the patient to tilt the head upward

Under the jaw, anatomic triangles of the

neck

i. Submental

ii. Submandibular

iii. Cervical

Ask the patient to move head on the side

i. Cervical lymph nodes

1. Anterior, medial, lateral,

superficial, deep

ii. Jugulodigastric & juguloomohyoid

lymph nodes

1. Can be felt when there is

tonsillar infection or when

there are malignancies

iii. Clavicular lymph nodes

3. LATERAL

Check the facial profile

i. Class I, II, III

4. SUPRAORBITAL

Recline the back rest of the chair and go

behind the patient

INTRAORAL EXAM

2 stage process

1. SOFT TISSUE EXAM

a. Lips, cheeks, vestibule, palate, gingiva,

tongue, floor of the mouth

2. HARD TISSUE EXAM

a. Teeth and occlusion

4 senses

1. Eyes - inspection

2. Ears auscultation, percussion

3. Nose - smell

4. Hands - palpation

GENERAL METHODS/TECHNIQUES

1. Visual examination

Passive Visual Examination

i. INSPECTION

1. Observe discretely

2. Usually done without the

knowledge of the patient

Active Visual Examination

i. EXTRAORAL & INTRAORAL

1. Asking the patient to do

something

2. Antrum of Highmore

maxillary sinus

TRANSILLUMINATION

Special diagnostic technique that utilizes a light

passing through a thin tissue to check for fluids

Dull light normal

No light abnormal due to blockage of pus

2. PALPATION

Touch & sight

a. Presence of pain upon pressure application

b. Degree of tissue compressibility

COMPRESSIBLE

a. SPONGY

Offers minimal resistance to pressure

Returns to normal form quickly

b. DOUGHY

Offers greater resistance to pressure than

spongy

Returns slowly

Dermoid cyst (cystic lesion)

c. PITTING

Not usually seen in the oral cavity

Example is pedal edema


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d. COLLAPSING

Expression of pus

Easily compressible

Doesnt return to normal form

NON-COMPRESSIBLE

a. BONY HARD

Hard, rigid and calcified

b. INDURATED

Hard but without characteristic rigidity and

calcification

Feature of many malignant neoplasms

c. FIRM MASS

STRUCTURES PALPATED

Muscles

Bone/teeth

Glandular tissues

Lymph nodes

-Rosette Go 080510

oral diagnosis m2

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