RISK FACTORSRISK FACTORS

SYMPTOMSSYMPTOMS

SIGNSSIGNS

Accelerate dzAccelerate dz

Indicate Dz - SeverityIndicate Dz - Severity

Reveal asymptomatic dz’sReveal asymptomatic dz’s

SIGNIFICANCE OF HISTORY AND EXAMSIGNIFICANCE OF HISTORY AND EXAMSIGNIFICANCE OF HISTORY AND EXAMSIGNIFICANCE OF HISTORY AND EXAM

HISTORYRisk Factors

Symptoms

EXAM

SignsSignsPAINPAIN FUNCTIONFUNCTION

ASYMTOMATIC PROBLEMSASYMTOMATIC PROBLEMS

Cardiac arrhythmia Cardiac arrhythmia

HypertensionHypertension

Oral cancerOral cancer

STANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENT

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

RADIOLOGYRADIOLOGYRADIOLOGYRADIOLOGY

Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)

PlanPlanPlanPlan

ReassessmentReassessmentReassessmentReassessment

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the and document findings in the proper write-upproper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform regional Perform regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the cardinal features of inflammationKnow the cardinal features of inflammation- Know how to describe a lesion or a node/lump/mass.Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM

STANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENT

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

RADIOLOGYRADIOLOGYRADIOLOGYRADIOLOGY

Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)

PlanPlanPlanPlan

ReassessmentReassessmentReassessmentReassessment

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

VITAL SIGNS:VITAL SIGNS:

Pulse: 68 reg.

BP: 130/85 RAS (right arm sitting)

STANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENTSTANDARD PATIENT ASSESSMENT

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

HISTORYHISTORYCC (Chief Complaint)CC (Chief Complaint)HPI (History of present Illness)HPI (History of present Illness)PDHx (Past Dental History)PDHx (Past Dental History)PMHx (Past Medical History)PMHx (Past Medical History)ROS (Review of System) ROS (Review of System) SHx (Social History)SHx (Social History)FHx (Family History)FHx (Family History)Meds (Medications)Meds (Medications)All (Allergies)All (Allergies)

RADIOLOGYRADIOLOGYRADIOLOGYRADIOLOGY

Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)Ass/Dx (Assessment / Diagnosis)

PlanPlanPlanPlan

ReassessmentReassessmentReassessmentReassessment

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

EXAMEXAMVS (Vital Signs)VS (Vital Signs)E/O (Extraoral)E/O (Extraoral)I/O (Intraoral)I/O (Intraoral)Tests (Vitality/Mobility)Tests (Vitality/Mobility)

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the proper write-up and document findings in the proper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform regional Perform regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the cardinal features of inflammationKnow the cardinal features of inflammation- Know how to describe a lesion or a node/lump/mass.Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM

DISASTERSDISASTERSDISASTERSDISASTERS

RISK FACTORS FOR SCCRISK FACTORS FOR SCCRISK FACTORS FOR SCCRISK FACTORS FOR SCC

Dz

RISK FACTORS (RF)

1 RF

2 RF

3 RF

4 RF

The concept of

TUMORTUMOR

local

regional

systemic

local T

N

M

INFECTIONINFECTION PAINPAIN

INFECTIONINFECTION NEOPLASMNEOPLASM

CERVICAL LYMPH NODE ENLARGEMENT CERVICAL LYMPH NODE ENLARGEMENT

•bacterial •viral (local / systemic)•fungal•postinfect. fibrosed node

•< 40 yrs: lymphoma

•> 40 yrs: metastatic SCC

OTHERSOTHERS

•leukemia•connective tissue diseases (e.g. lupus erythematosus)•sarcoidosis

1)1) Rule out lymphadenopathy caused by infectionRule out lymphadenopathy caused by infectionbacterial (odontogenic, tonsils)bacterial (odontogenic, tonsils)viral (respiratory epithelium)viral (respiratory epithelium)

1)1) Rule out lymphadenopathy caused by infectionRule out lymphadenopathy caused by infectionbacterial (odontogenic, tonsils)bacterial (odontogenic, tonsils)viral (respiratory epithelium)viral (respiratory epithelium)

2)2) SearchSearch for oral squamous cell carcinoma for oral squamous cell carcinoma2)2) SearchSearch for oral squamous cell carcinoma for oral squamous cell carcinoma

3)3) Follow up in 2 weeksFollow up in 2 weeks: if still present, refer to ENT specialist for : if still present, refer to ENT specialist for evaluationevaluation

3)3) Follow up in 2 weeksFollow up in 2 weeks: if still present, refer to ENT specialist for : if still present, refer to ENT specialist for evaluationevaluation

Asymmetric enlargement of one or more cervical lymph nodes in an adult Asymmetric enlargement of one or more cervical lymph nodes in an adult over 40 is almost always cancerous and usually is due to metastasis from a over 40 is almost always cancerous and usually is due to metastasis from a primary lesion in the mouth or pharynx. primary lesion in the mouth or pharynx.

Asymmetric enlargement of one or more cervical lymph nodes in an adult Asymmetric enlargement of one or more cervical lymph nodes in an adult over 40 is almost always cancerous and usually is due to metastasis from a over 40 is almost always cancerous and usually is due to metastasis from a primary lesion in the mouth or pharynx. primary lesion in the mouth or pharynx.

Diagnostic approach for Head and Neck TumorsDiagnostic approach for Head and Neck TumorsDiagnostic approach for Head and Neck TumorsDiagnostic approach for Head and Neck Tumors

Importance of early diagnosis of squamous cell carcinomaImportance of early diagnosis of squamous cell carcinoma

60%

stage III & IV

60%

stage III & IV

2/3 recurrence < 2 yrs2/3 recurrence < 2 yrs

< 1/3 survive 3 yrs. < 1/3 survive 3 yrs.

40%

stage I & II

40%

stage I & II

80-90% cure80-90% cure

Second primary tumor in successfully treated patients within 5-7 years: up to 40% !!! Follow-up important!!!Second primary tumor in successfully treated patients within 5-7 years: up to 40% !!! Follow-up important!!!

therefore…….therefore…….

...know the H&N anatomy!!!

...performing a H&N exam for EVERY dental check-up!!!

...following up on suspicious signs!!!

Differential diagnosis of lateral tumors of the neckDifferential diagnosis of lateral tumors of the neck

• Salivary gland (sublingual / submandibular / parotis)

• Lymph node

• Soft tissue tumor (Lipoma, Fibroma)

• Neurofibroma

• Esophageal diverticulum

• Laryngocele

• Branchial cyst

• Carotid aneurysm

• Hyoid bone

• Transverse process of cervical spine

• Salivary gland (sublingual / submandibular / parotis)

• Lymph node

• Soft tissue tumor (Lipoma, Fibroma)

• Neurofibroma

• Esophageal diverticulum

• Laryngocele

• Branchial cyst

• Carotid aneurysm

• Hyoid bone

• Transverse process of cervical spine

Differential diagnosis of midline tumors of the neckDifferential diagnosis of midline tumors of the neck

• Thyroid

• Dermoid cyst

• Sebaceous cyst

• Thyroglossal duct

• Lymphnode

• Thyroid

• Dermoid cyst

• Sebaceous cyst

• Thyroglossal duct

• Lymphnode

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the proper write-up and document findings in the proper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform regional Perform regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the Know the cardinal features of inflammationcardinal features of inflammation- Know how to describe a lesion or a node/lump/mass.Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM

CARDINAL FEATURES OF INFLAMMATIONCARDINAL FEATURES OF INFLAMMATION

RednessRedness

HeatHeat

SwellingSwelling

PainPain

DysfunctionDysfunction

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the proper write-up and document findings in the proper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform regional Perform regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the cardinal features of inflammationKnow the cardinal features of inflammation- Know how to Know how to describe a lesion or a node/lump/mass.describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM

DESCRIPTION OF MASSES / LYMPHNODES

•Location

•Size (< 1cm >)

•Tenderness

•Consistency

•Mobility

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the proper write-up and document findings in the proper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform regional Perform regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the cardinal features of inflammationKnow the cardinal features of inflammation- Know how to describe a lesion or a node/lump/mass.Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONYou are required to demonstrate the following diagnostic procedures:You are required to demonstrate the following diagnostic procedures:

- - Take Take vital signsvital signs and document findings in the proper write-up and document findings in the proper write-up- Palpate Palpate regional lymph nodesregional lymph nodes and and landmarks of the necklandmarks of the neck (hyoid bone, (hyoid bone,

stylohyoid process, thyroid and cricoid cartilage, thyroid gland, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). mastoid process, vertebral processes, carotids).

- Perform a Perform a neurologic examneurologic exam of cranial nerves of cranial nerves- Perform Perform regional regional muscle exammuscle exam (know origins and insertions of muscles (know origins and insertions of muscles

of mastication and major neck muscles)of mastication and major neck muscles)- Perform an Perform an intraoral examintraoral exam, identifying intraoral anatomic landmarks , identifying intraoral anatomic landmarks

(mucocutaneous junction; labial or lingual frenum; Stenson’s duct; (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)Fordyce granules, if present)

- Perform Perform examination of salivary gland functionexamination of salivary gland function - Know the cardinal features of inflammationKnow the cardinal features of inflammation- Know how to describe a lesion or a node/lump/mass.Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAMCOMPETENCY EXAM