Examination of the oral cavity2 tour


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Examination of the oral cavity2 tour

  1. 1. Examination of the Face & Oral Cavity Dr. Natheer H Al-Rawi Dr. Natheer Al-Rawi 1
  2. 2. Oral Examination Many diseases (systemic or local) have signs that appear on the face, head & neck or intra- orally Making a complete examination can help you create a differential diagnosis in cases of abnormalities and make treatment recommendations based on accurate assessment of the signs & symptoms of disease Dr. Natheer Al-Rawi 2
  3. 3. Oral Examination Each disease process may have individual manifestations in an individual patient And there may be individual host reaction to the disease Careful assessment will guide the clinician to accurate diagnosis Dr. Natheer Al-Rawi 3
  4. 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 a component of systemic disease Dr. Natheer Al-Rawi 4
  5. 5. Equipment Assure that you have all the supplies necessary to complete an oral examination  Mirror  Tissue retractor (tongue blade)  Dry gauze  Explorer You must dry some of the tissues in order to observe the any color changes Dr. Natheer Al-Rawi 5
  6. 6. Exam of the Head & Neck; Oral Cavity Be systematic Consistently complete the exam in the same order Dr. Natheer Al-Rawi 6
  7. 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, Bell’s Palsy Dr. Natheer Al-Rawi 7
  8. 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 sounds Dr. Natheer Al-Rawi 8
  9. 9. Extra-oral examination Lymph node palpation Dr. Natheer Al-Rawi 9
  10. 10. Extra-oral examination Thyroid Gland Palpation  Place hands over the trachea  Have the patient swallow  The thyroid gland moves upward Dr. Natheer Al-Rawi 10
  11. 11. Exam: Lips Observe the color & its consistency-intra-orally and 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. 12. Exam: Lips Evert the lip and examine the tissue Observe frenum attachment/tissue tension Clear mucous filled pockets may be seen on the inner side of the lip (mucocele). This is a frequent, non-pathologic entity which represents a blocked minor salivary gland Dr. Natheer Al-Rawi 12
  13. 13. Exam: Lips-palpation Color, consistency Area for blocked minor salivary glands Lesions, ulcers Dr. Natheer Al-Rawi 13
  14. 14. Exam: Lips Frenum:  Attachment  Level of attached gingiva Dr. Natheer Al-Rawi 14
  15. 15. Exam: Lips-sun exposure Dr. Natheer Al-Rawi 15
  16. 16. Exam: Lips Palpate in the vestibule, observe color Dr. Natheer Al-Rawi 16
  17. 17. Examination: Buccal Mucosa Observe color, character of the mucosa  Normal variations in color among ethnic groups  Amalgam tattoo Palpate tissue Observe Stenson’s duct opening for inflammation or signs of blockage Visualize muscle attachments, hamular notch, pterygomandibular folds Dr. Natheer Al-Rawi 17
  18. 18. Examination: Buccal Mucosa Linea alba Stenson’s duct Dr. Natheer Al-Rawi 18
  19. 19. Examination: Buccal Mucosa Lesions – white, red Lichen Planus, Leukedema Dr. Natheer Al-Rawi 19
  20. 20. Gingiva Note color, tone, texture, architecture & mucogingival relationships Dr. Natheer Al-Rawi 20
  21. 21. Gingiva How would you describe the gingiva?  Marginal vs. generalized?  Erythematous vs. fibrous Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant Dr. Natheer Al-Rawi 21
  22. 22. Exam: Hard palate Minor salivary glands, attached gingiva Note presence of tori: tx plan any pre- prosthetic surgery Dr. Natheer Al-Rawi 22
  23. 23. Exam: Soft palate How does soft palate raise upon “aah”? Vibrating line, tonsilar pillars, tonsils, oropharynx Dr. Natheer Al-Rawi 23
  24. 24. Exam: Tonsils Tucked in at base of anterior & posterior tonsilar pillars Dr. Natheer Al-Rawi 24
  25. 25. Exam: Tongue The tongue and the floor of the mouth are the most common places for oral cancer to occur It can occur other places; so visualize all areas You may observe:  Circumvalate papillae, epiglottis Dr. Natheer Al-Rawi 25
  26. 26. Exam: Tongue Wrap the tongue in a dry gauze and gently pull it from side to side to observe the lateral borders Retract the tongue to view the inferior tissues Dr. Natheer Al-Rawi 26
  27. 27. Exam: Tongue Dr. Natheer Al-Rawi 27
  28. 28. Exam: Tongue You may observe lingual varicosities Dr. Natheer Al-Rawi 28
  29. 29. Exam: Tongue You may observe geographic tongue (erythema migrans) Dr. Natheer Al-Rawi 29
  30. 30. Exam: Tongue You may observe drug reaction Dr. Natheer Al-Rawi 30
  31. 31. Exam: Tongue Observe signs of nutritional deficiencies, immune dysfunction Dr. Natheer Al-Rawi 31
  32. 32. Exam: Tongue You may observe oral cancer Dr. Natheer Al-Rawi 32
  33. 33. Exam: Floor of mouth Visualize, palpate - bimanually Wharton’s duct Must dry to observe  Does “lesion” wipe off? Dr. Natheer Al-Rawi 33
  34. 34. Palpation of the floor of the mouth Dr. Natheer Al-Rawi 34
  35. 35. Exam: Floor of mouth Dr. Natheer Al-Rawi 35
  36. 36. Exam: Floor of mouth Squamous Cell Carcinoma Dr. Natheer Al-Rawi 36
  37. 37. Exam: Floor of mouth Squamous Cell Carcinoma Dr. Natheer Al-Rawi 37
  38. 38. Exam: Leukoplakic areaEdentulous Mandibular Ridge Dr. Natheer Al-Rawi 38
  39. 39. Exam: Maxilla & Mandible• Size, shape, contour• Pre-prosthetic treatment •Tori removal • Tuberosity reduction •Soft or hard tissue or both Dr. Natheer Al-Rawi 39
  40. 40. Exam: Maxilla & Mandible Dr. Natheer Al-Rawi 40
  41. 41. Exam: Maxilla & Mandible Evaluate for Epulis fissuratum If you make a new denture will the excess tissue resolve? Dr. Natheer Al-Rawi 41
  42. 42. Occlusion Orthodontic classification Interferences Dr. Natheer Al-Rawi 42
  43. 43. Occlusion Dr. Natheer Al-Rawi 43
  44. 44. Systematic Oral Examination Done at initial exam & at recalls unless patient history requires sooner You must visualize all areas of the oral cavity Do good, do not harm, do justice, respect autonomy Dr. Natheer Al-Rawi 44
  45. 45. Visualize all areas Dr. Natheer Al-Rawi 45
  46. 46.  Watch the vedio Dr. Natheer Al-Rawi 46
  47. 47. Thank You Dr. Natheer Al-Rawi 47