Examination of the oral cavity2 tour

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  • 1. Examination of the Face& Oral Cavity Dr. Natheer H Al-Rawi Dr. Natheer Al-Rawi 1

2. Oral Examination Many diseases (systemic or local) have signsthat appear on the face, head & neck or intra-orally Making a complete examination can help youcreate a differential diagnosis in cases ofabnormalities and make treatmentrecommendations based on accurateassessment of the signs & symptoms of diseaseDr. Natheer Al-Rawi2 3. Oral Examination Each disease process may have individualmanifestations in an individual patient And there may be individual host reaction tothe disease Careful assessment will guide the clinician toaccurate diagnosis Dr. Natheer Al-Rawi 3 4. Scope of Responsibility Diseases of the head & neck Diseases of the supporting hard & soft tissues Diseases of the lips, tongue, salivary glands,oral mucosa Diseases of the oral tissues which are acomponent of systemic diseaseDr. Natheer Al-Rawi4 5. Equipment Assure that you have all the supplies necessaryto complete an oral examination Mirror Tissue retractor (tongue blade) Dry gauze Explorer You must dry some of the tissues in order toobserve the any color changes Dr. Natheer Al-Rawi5 6. Exam of the Head & Neck; Oral Cavity Be systematic Consistently complete the exam in the sameorder Dr. Natheer Al-Rawi 6 7. Extra-oral examination Observe: color of skin Examination area of head & neck Determine: gross functioning of cranial nerves Normal vs. abnormal Paralysis Stroke, trauma, Bells PalsyDr. Natheer Al-Rawi 7 8. Extra-oral examination TMJ Palpate upon opening What is the maximum inter maxillary space? Is the opening symmetrical? Is there popping, clicking, grinding? Use your stethoscope to listen to soundsDr. Natheer Al-Rawi8 9. Extra-oral examination Lymph node palpation Dr. Natheer Al-Rawi 9 10. Extra-oral examination Thyroid Gland Palpation Place hands over thetrachea Have the patient swallow The thyroid gland movesupward Dr. Natheer Al-Rawi 10 11. Exam: Lips Observe the color & its consistency-intra-orallyand externally Is the vermillion border distinct? Bi-digitally palpate the tissue around the lips.Check for nodules, bullae, abnormalities,mucocele, fibroma Dr. Natheer Al-Rawi 11 12. Exam: Lips Evert the lip and examine the tissue Observe frenum attachment/tissue tension Clear mucous filled pockets may be seen onthe inner side of the lip (mucocele). This is afrequent, non-pathologic entity whichrepresents a blocked minor salivary gland Dr. Natheer Al-Rawi12 13. Exam: Lips-palpation Color, consistency Area for blocked minor salivary glands Lesions, ulcersDr. Natheer Al-Rawi13 14. Exam: Lips Frenum: Attachment Level of attached gingivaDr. Natheer Al-Rawi 14 15. Exam: Lips-sun exposure Dr. Natheer Al-Rawi 15 16. Exam: Lips Palpate in the vestibule,observe color Dr. Natheer Al-Rawi 16 17. Examination: Buccal Mucosa Observe color, character of the mucosa Normal variations in color among ethnic groups Amalgam tattoo Palpate tissue Observe Stensons duct opening forinflammation or signs of blockage Visualize muscle attachments, hamular notch,pterygomandibular folds Dr. Natheer Al-Rawi 17 18. Examination: Buccal Mucosa Linea alba Stensons duct Dr. Natheer Al-Rawi 18 19. Examination: Buccal Mucosa Lesions white, red Lichen Planus, LeukedemaDr. Natheer Al-Rawi 19 20. Gingiva Note color, tone, texture,architecture &mucogingivalrelationships Dr. Natheer Al-Rawi 20 21. Gingiva How would you describe the gingiva? Marginal vs. generalized? Erythematous vs. fibrous Drug reactions: Anti-epileptic, calcium channelblockers, immunosuppressantDr. Natheer Al-Rawi 21 22. Exam: Hard palate Minor salivary glands, attached gingiva Note presence of tori: tx plan any pre-prosthetic surgeryDr. Natheer Al-Rawi 22 23. Exam: Soft palate How does soft palate raise upon aah? Vibrating line, tonsilar pillars, tonsils,oropharynx Dr. Natheer Al-Rawi 23 24. Exam: Tonsils Tucked in at base of anterior & posteriortonsilar pillarsDr. Natheer Al-Rawi 24 25. Exam: Tongue The tongue and the floor of the mouth are themost common places for oral cancer to occur It can occur other places; so visualize all areas You may observe: Circumvalate papillae, epiglottisDr. Natheer Al-Rawi 25 26. Exam: Tongue Wrap the tongue in a dry gauze and gently pullit from side to side to observe the lateralborders Retract the tongue to view the inferior tissues Dr. Natheer Al-Rawi26 27. Exam: Tongue Dr. Natheer Al-Rawi 27 28. Exam: Tongue You may observe lingualvaricosities Dr. Natheer Al-Rawi 28 29. Exam: Tongue You may observe geographic tongue (erythemamigrans)Dr. Natheer Al-Rawi 29 30. Exam: Tongue You may observe drug reactionDr. Natheer Al-Rawi 30 31. Exam: Tongue Observe signs of nutritional deficiencies, immunedysfunction Dr. Natheer Al-Rawi31 32. Exam: Tongue You may observe oralcancer Dr. Natheer Al-Rawi 32 33. Exam: Floor of mouth Visualize, palpate - bimanually Whartons duct Must dry to observe Does lesion wipe off?Dr. Natheer Al-Rawi 33 34. Palpation of the floor of the mouthDr. Natheer Al-Rawi 34 35. Exam: Floor of mouthDr. Natheer Al-Rawi 35 36. Exam: Floor of mouth Squamous Cell Carcinoma Dr. Natheer Al-Rawi 36 37. Exam: Floor of mouth Squamous Cell Carcinoma Dr. Natheer Al-Rawi 37 38. Exam: Leukoplakic areaEdentulous Mandibular RidgeDr. Natheer Al-Rawi 38 39. Exam: Maxilla & Mandible Size, shape, contour Pre-prosthetic treatmentTori removal Tuberosity reduction Soft or hard tissue or both Dr. Natheer Al-Rawi 39 40. Exam: Maxilla & Mandible Dr. Natheer Al-Rawi 40 41. Exam: Maxilla & Mandible Evaluate for Epulisfissuratum If you make a newdenture will the excesstissue resolve?Dr. Natheer Al-Rawi 41 42. Occlusion Orthodontic classification InterferencesDr. Natheer Al-Rawi 42 43. OcclusionDr. Natheer Al-Rawi 43 44. Systematic Oral Examination Done at initial exam & at recalls unless patienthistory requires sooner You must visualize all areas of the oral cavity Do good, do not harm, do justice, respectautonomy Dr. Natheer Al-Rawi 44 45. Visualize all areasDr. Natheer Al-Rawi 45 46. Watch the vedioDr. Natheer Al-Rawi 46 47. Thank You Dr. Natheer Al-Rawi 47