ORAL EXAMINATION

Dr. Kristina Corazon L. Robles

Periodontal Medicine
Graduate School

CASE HISTORY
The approach to history taking needs to be tailored to the type of complaint being investigated.
Use open rather than closed (those usually eliciting a yes/no response) questions wherever
possible to avoid leading the patient.

The history will cover:

the complaint
the history of the complaint
past dental history
social and family history
medical history

CASE HISTORY
The complaint
What is the problem?
Record the patients symptoms. If there are
several symptoms, make a list, but with the
principal problem first.

CASE HISTORY
History of the complaint
When did the problem(s) start?
Identify the duration of the problem.
Ask whether this is the first incidence
of the problem or the latest of a series
of recurrences.

CASE HISTORY
Past Dental History
Do you see your dentist regularly?
Establish whether the patient is a regular
or irregular attender.
Obtain a general picture of their
treatment experience (fillings, dentures,
local and general anaesthetic
experience).

CASE HISTORY
Social and family history
Just a few questions about yourself.

AGE
MARITAL STATUS
JOB
ALCOHOL CONSUMPTION
SOCIAL HABITS

Family history
*genetic disorders

Medical history

CASE HISTORY

Now some questions about your general health.

Allergies
Cardiovascular (heart or chest problems)
Respiratory (chest trouble)
Central nervous system (fits, faints or epilepsy)
Current and recent drug therapy
Bleeding disorders
History of rheumatic fever
History of jaundice or hepatitis

Medical history
Current medical treatment: a negative
response should be further confirmed by
asking whether the patient has visited their
general practitioner recently.
Past medical history: previous
occurrences of hospitalization or medical
care.
Any other current health problems: a
negative response can be confirmed, with
so you are fit and well?

CASE HISTORY

DIAGNOSTIC ARMAMENTARIUM

CLINICAL EXAMINATION
Extraoral examination
Visual areas would cover:
general patient condition
symmetry
swellings
lips/perioral tissues

Palpation would cover:

lymph nodes
temporomandibular joint
salivary glands
problem-specific examination.

CLINICAL EXAMINATION

Extraoral examination (Palpation)

Problem-specific examination
Swelling/lump- The procedure must
encompass a range of observations,
including:
anatomical site
shape and size
colour
single or multiple
surface texture/warmth
tenderness
fluctuation
sensation/pulsation.

CLINICAL EXAMINATION
Paraesthesia/anaesthesia (Palpation)
It is important to identify the extent of
the affected area and the degree of
alteration in sensation.
Fairly fine, but blunt-ended, instrument
for this at first (e.g. handle of a mouth
mirror)

CLINICAL EXAMINATION
Paralysis/motor disturbance
In the maxillofacial region, the
motor nerves that are likely to be
under consideration are the:
facial nerve
hypoglossal nerve
nerves controlling the muscles
that move the eyes.

CLINICAL EXAMINATION
Intraoral examination

CLINICAL EXAMINATION
Swelling/lump
Most oral swellings are
inflammatory, caused by periapical
or periodontal infections.

 Ulcer

CLINICAL EXAMINATION

-Examination of an ulcer should

include assessment of eight important
characteristics:
site
single/multiple
size
shape
base of the ulcer
edge
pain

CLINICAL EXAMINATION
TEETH / DENTITION
Examination will involve:
visual
assessing restorations
assessing mobility
periodontal probing
thermal tests
pressure tests

IMAGING MODALITIES

CONVENTIONAL RADIOGRAPHY
Intraoral Periapical and Bitewing radiographs

INTRAORAL PERIAPICAL
The clinical applications of periapical radiographs are:
Diagnosis and monitoring of caries
Assessment of periodontal bone levels
Assessment of periapical granuloma and small radicular cysts
Assessment of traumatic injuries to the teeth and the alveolar bone
Assessment of teeth and retained roots prior to extraction
Assessment of working length and obturation in endodontics
Assessment of unerupted teeth
Assessment of root resorption.

CONVENTIONAL RADIOGRAPHY
Panoramic / OPG

DIGITAL IMAGING
The principal of digital imaging
relies on substituting the
conventional film with a digital
sensor. Everything else remains
the same as conventional
radiography.

COMPUTED TOMOGRAPHY / CT SCAN

Original "Siretom

Dedicated head CT scanner, 1974

COMPUTED TOMOGRAPHY / CT SCAN

ADVANTAGES OF CT SCAN
Elimination of superimposition of
structures encountered in plain film
imaging
Multiplanar imaging- allowing objects to be
visualized in all three axial, coronal and
sagittal planes usually with the benefit of a
visual 3D model
High contrast resolution

CONE BEAM COMPUTED TOMOGRAPHY

CONE BEAM COMPUTED TOMOGRAPHY

Digital Volumetric Tomography(DVT)
Digital Volumetric Reconstruction(DVR)

USES IN THE DENTISTRY:

Assessment of impacted and supernumerary teeth
Complex Cases of Skeletal Abnormalities Requiring
Orthodontic and Surgical Management
Bony pathology: Large cysts and odontogenic
tumors
Complicated endodontic procedures
Implant dentistry

CONE BEAM COMPUTED TOMOGRAPHY

Images are ready to be

viewed nearly
immediately, are
dimensionally accurate,
and are non-magnified
(Ballrick,
et
al,
2008)
with measurements at a

MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI) detects the
presence and concentration of hydrogen atoms
within the patients body as they spin
randomly in their own environment.

MAGNETIC RESONANCE IMAGING

Advantages

Examination of soft tissue

pathology:

There is no ionizing radiation involved

It offers true multiplanar acquisition of data. Developmental: Branchial cleft
cysts, hemangioma and
Excellent soft tissue demonstration
lymphangioma and venous vascular
Offers information on bone quality
malformations

Inflammatory: Osteomyelitis,
simple ranula and plunging ranula
Functional analysis
TMJ imaging

MAGNETIC RESONANCE IMAGING

Masseteric hypertrophy
Intracranial pathology
Trigeminal neuralgia (vascular loop)
Exclude intracranial cause of
atypical facial pain
Benign soft tissue and salivary
tumors
Malignant tumors: Squamous cell
carcinoma, salivary tumors and nodal
staging.

RATORY PROCEDURES / EXAMINATION

LABORATORY PROCEDURES /
EXAMINATION
Microbiology
Viruses
A viral swab can be used to collect virus from fresh
vesicles and must be forwarded in special transport
medium to the virology laboratory

Bacteria
may be identified by forwarding a swab or specimen of
pus to the laboratory, with a request for culture and
antibiotic sensitivity

LABORATORY PROCEDURES /
EXAMINATION
Fungi
Candida species is the most common
organism to cause oral fungal
infection.
Direct smears from the infected
mucosa and the denture fitting surface
can be stained by the periodic acidSchiff or Grams method.

LABORATORY PROCEDURES /
EXAMINATION
Aspiration biopsy
Fluid from suspected cysts can be
collected with a standard gauge needle
and syringe
Infection after aspiration biopsy can be a
problem and indeed the technique tends
to be restricted to atypical cystic lesions
where neoplasia is suspected.

LABORATORY PROCEDURES /
EXAMINATION
Incisional/excisional biopsy
Tissue removal under local or general
anaesthesia
It is fixed in at least 10 times its
volume of 10% neutral buffered
formalin or similar fixative.
Forwarded to the
histopathologist/laboratory

LABORATORY PROCEDURES /
EXAMINATION
Excisional biopsy
The entire lesion is removed
and submitted for diagnosis.
It is suitable for benign polyps,
papillomas, mucocoeles,
epulides and other small
reactive lesions.

LABORATORY PROCEDURES /
EXAMINATION
Incisional biopsy
It is used for generalised mucosal disorders
such as lichen planus or for the diagnosis of
other red and white patches.
Non-healing ulcers are often investigated by
incisional biopsy; here it is important to
include the margin of the ulcer with some
normal tissue and to obtain a sufficiently
large sample (normally 10 mm 10 mm) to
identify or exclude cancer.

LABORATORY PROCEDURES /
EXAMINATION
Haematology
Full blood count and assay of haematinics
is an important investigation for patients
presenting with lingual papillary atrophy
or recurrent oral ulceration.
Coagulation studies and platelet counts
may be required when excessive bleeding
is encountered.

LABORATORY PROCEDURES /
EXAMINATION
Hemoglobin
Oxygen carrier of the blood
It is decreased in hemorrhage and anemias
increased in hemoconcentration and polycythemia.
The normal range is 14 to 18 g/dL of blood in
men and 12 to 16 g/dL of blood in women.

LABORATORY PROCEDURES /
EXAMINATION
Hematocrit
Hematocrit reflects the
relative volume of cells and
plasma in the blood.
In anemias and after blood
loss, it is lowered and is
elevated in polycythemia
and dehydration.

LABORATORY PROCEDURES /
EXAMINATION
Red Blood Cells Count
The RBCs contain HgB.

LABORATORY PROCEDURES /
EXAMINATION
White Blood Cells Count
An increase in the WBC count is seen in
leukemias, bacterial infections, infectious
mononucleosis, and certain parasitic infections
as well as after exercise and emotional stress.
A decrease in the WBC count is seen in
aplastic anemia, lupus erythematosus, acute
viral infections, and drug and chemical
toxicity.

LABORATORY PROCEDURES /
EXAMINATION
White Blood Cells Count

LABORATORY PROCEDURES /
EXAMINATION
Blood Glucose
Blood glucose tests are performed to
evaluate glucose metabolism.
Basic tests for disorders of blood glucose are
the fasting blood sugar test, the glucose
tolerance test, and the random blood sugar
test.
The normal range for blood glucose is 70 to
100 mg/dL of serum.

LABORATORY PROCEDURES /
EXAMINATION
Blood Urea Nitrogen
An increased value may be seen in extensive
kidney disease, congestive heart failure, and
dehydration. Protein intake may also directly
affect BUN values. If renal disease is
suspected, a more reliable assessment is the
serum creatinine test.
The ratio of BUN to creatinine is 1O : l . The
normal range for BUN is 8 to 23 mg/dL of
blood.

LABORATORY PROCEDURES /
EXAMINATION
Serology
There are a variety of serologic tests for the
screening of syphilis. All are nonspecific
tests and may give both false-positive and
false-negative results.
Interpretation of these serologic tests
requires correlation with the patient's history
and clinical findings.

LABORATORY PROCEDURES /
EXAMINATION
Biochemistry
Estimation of alkaline phosphatase in
Pagets disease of bone, and serum
calcium to exclude hyperparathyroidism
when a giant cell granuloma is diagnosed.
Biochemical estimation of cyst fluid for
protein content is sometimes undertaken
as part of the diagnosis of keratocystic
odontogenic tumour.

LABORATORY PROCEDURES /
EXAMINATION
Immunology
Examples of tests in dentistry include
detection of antibodies against extractable
nuclear antigens, including SS-A and SSB, for the diagnosis of Sjgrens syndrome
and autoantibodies in vesiculo-bullous
diseases.
HIV testing should only be undertaken by
specialists and does not fall directly into
the remit of dentistry.

BIBLIOGRAPHY
Warnakulasuriya, S., & Tilakaratne, W. M.
(2014).Oral medicine and pathology: A guide
to diagnosis and management. New Delhi:
Jaypee Brothers Medical (P).
Coulthard, P., & Heasman, P. A. (2013).Master
dentistry. Edinburgh: Elsevier.
Rose, L. F. (2000).Periodontal medicine.
Hamilton, Ont.: B.C. Decker.