ORAL DIAGNOSIS M2 PHYSICAL EXAMINATION 1. PROCEDURAL STEPS/PROCEDURES a. b. c.

GPA Identifying features of the patient as to the demographic data (age, gender, race) Body built of the patient o Slim, normal, athletic, obese GPA (General Patient Appraisal) EXTRAORAL EXAM (Head & Neck) INTRAORAL EXAM

4= bounding pulse pulse that is easy to find and very hard to oliterate; seen in persons who have hyperthyroidism

PULSE POINTS RADIAL o o Typically used Palpated on the lateral of the wrist

TEMPORAL CAROTID o Useful in emergencies

INGUINAL ANTECUBITAL FOSSA o o Palpated on the medial Felt when taking BP

Anatomic proportions o Tissue symmetry

Mental orientation & emotional status of the patient Posture of the patient, movements and speech o o How the patient walks How the patient talks 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)

Determination of the vital signs of the patient

VITAL SIGNS 1. BLOOD PRESSURE 2. Normal is 120/80mmHg

PULSE RATE QUANTITATIVE - # of pulse per minute QUALITATIVE amplitude or rhythm NORMAL PR 60-90 bpm AMPLITUDE force/surge of blood against the artery 4.

TEMPERATURE Taken through ears, mouth, axilla Normal oral/ear temp is 36.5 C Person is febrile if temp is 37.8C or

PULSE AMPLITUDE 0 = no palpable pulse 1 = faint pulse (thready pulse) o Due to: dehydration and/or advance state if atherosclerosis 5.

HEIGHT & WEIGHT Done only on conscious patients

*when unconscious, only take BP, RR & PR EXTRAORAL EXAM (head & neck) 4 perspective/views 1. FRONTAL

2 = normal ulse 3 = strong pulse manifested when the persion is in its active state

 2.

Facial symmetry & form Alignment of pupil, eyes, ears, nose GENERAL METHODS/TECHNIQUES 1. Visual examination Passive Visual Examination i. INSPECTION 1. 2. Observe discretely Usually done without the knowledge of the patient

SUBMENTAL Ask the patient to tilt the head upward Under the jaw, anatomic triangles of the neck i. ii. iii. Submental Submandibular Cervical

Active Visual Examination i. EXTRAORAL & INTRAORAL 1. Asking the patient to do something Antrum of Highmore maxillary sinus

Ask the patient to move head on the side i. Cervical lymph nodes 1. Anterior, medial, lateral, superficial, deep

2.

ii.

Jugulodigastric & juguloomohyoid lymph nodes 1. Can be felt when there is tonsillar infection or when there are malignancies

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

iii. 3. LATERAL

Clavicular lymph nodes

Check the facial profile i. Class I, II, III

2.

PALPATION a. b. Touch & sight

4.

SUPRAORBITAL Recline the back rest of the chair and go behind the patient

Presence of pain upon pressure application Degree of tissue compressibility

INTRAORAL EXAM 2 stage process 1. SOFT TISSUE EXAM a. Lips, cheeks, vestibule, palate, gingiva, tongue, floor of the mouth

COMPRESSIBLE a. SPONGY Offers minimal resistance to pressure Returns to normal form quickly

2.

HARD TISSUE EXAM b. a. Teeth and occlusion Offers greater resistance to pressure than spongy Returns slowly Dermoid cyst (cystic lesion) DOUGHY

4 senses 1. 2. 3. 4. Eyes - inspection Ears auscultation, percussion Nose - smell Hands - palpation c.

PITTING

Not usually seen in the oral cavity Example is pedal edema

d.

COLLAPSING Expression of pus Easily compressible Doesnt return to normal form

NON-COMPRESSIBLE a. BONY HARD b. Hard, rigid and calcified

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