Screening Examination Early clinical experience


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Screening Examination Early clinical experience

  1. 1. Screening Examination Early clinical experience Dent 1010
  2. 2. Objectives <ul><li>To provide the rationale for the screening examination </li></ul><ul><li>To prove an overview of the techniques for the screening examination </li></ul><ul><li>To emphasize how important it is to provide a full examination at every full examination and whenever the patient returns for their regular “check-up” </li></ul>
  3. 3. Rationale <ul><li>These are the steps to follow when planning </li></ul><ul><li>patient care: </li></ul><ul><li>Data gathering including patient input. </li></ul><ul><li>Data analysis/interpretation of the information </li></ul><ul><li>Formulation of the diagnosis and prognosis. </li></ul><ul><li>Development of the treatment plan </li></ul><ul><li>Communicating findings and presenting rainbow of options to patient </li></ul>
  4. 4. Data gathering <ul><li>Making sense of a whole lot of information </li></ul><ul><li>Looking for cancer, other growths, other pathology that can be intercepted </li></ul><ul><li>Gathering as much information about the patient as possible </li></ul>
  5. 5. Methods of Examination <ul><li>Use sight, sound, smell, and touch </li></ul><ul><li>Observation </li></ul><ul><li>Palpation & Percussion </li></ul><ul><li>Smell </li></ul>
  6. 6. Observation <ul><li>Start as soon as the person answers the telephone – assess voice, hearing, memory, ‘busyness’, </li></ul><ul><li>enthusiasm </li></ul><ul><li>Continue assessment when they are greeted in the waiting room </li></ul><ul><li>- gait, ease, appearance </li></ul><ul><li>Continue observation throughout appointments </li></ul>
  7. 7. Palpation <ul><li>Using the hands to examine to provide more </li></ul><ul><li>information about the salivary glands, lymph </li></ul><ul><li>nodes, (thyroid gland, TMJ) by compressing </li></ul><ul><li>structures against other fingers, hand, bone or other </li></ul><ul><li>tissues </li></ul><ul><li>Digital </li></ul><ul><li>Bidigital </li></ul><ul><li>Bimanual </li></ul><ul><li>Bilateral </li></ul>
  8. 8. Correct technique <ul><li>Just use fingertips </li></ul><ul><li>Compress tissue about 10mm in a circular motion – use some pressure </li></ul><ul><li>When ready to move on, lift and move and then circular motion in new area </li></ul>
  9. 9. Digital
  10. 10. Bidigital
  11. 11. Bimanual
  12. 12. Bilateral palpation
  13. 13. Percussion <ul><li>Tapping </li></ul><ul><li>In dentistry used mostly for teeth – best just to use one finger or may use other end of mirror handle </li></ul>
  14. 14. Screening Examination
  15. 15. Important to develop a routine <ul><li>Start with observation at 12 o’clock position </li></ul><ul><li>Palpate temporalis – ask about pain or tenderness </li></ul>
  16. 16. Move to TMJ <ul><li>Have patient open slowly, fully and watch as they open – deviation? sounds? pain? </li></ul><ul><li>Watch as they slowly close </li></ul>
  17. 17. Ask about history of any sinus pain <ul><li>Palpate both maxillary and frontal sinuses </li></ul>
  18. 18. Move to angle of mandible <ul><li>Palpate parotid gland (‘mumps’ gland while here) </li></ul><ul><li>Ask about tenderness </li></ul>
  19. 19. Move to submandibular salivary glands <ul><li>Palpate asking about tenderness </li></ul>
  20. 20. Begin neck palpation <ul><li>Remember correct palpation technique </li></ul><ul><li>Constantly looking for any tenderness or change in consistency </li></ul>
  21. 21. Lymph nodes
  22. 22. Perioral exam <ul><li>Ala </li></ul><ul><li>Nasiolabial fold </li></ul><ul><li>Philtrum </li></ul><ul><li>Vermillion border </li></ul><ul><li>Commissure of lips </li></ul><ul><li>Look for symmetry, scar tissue, swelling </li></ul>
  23. 23. Intraoral soft tissue <ul><li>Examine and palpate mucosal surface of lips </li></ul><ul><li>Check for scar tissue, bite marks, growths </li></ul>
  24. 25. Check cheeks <ul><li>Again, palpate for swelling – easiest bidigital </li></ul>
  25. 26. Move to floor of mouth <ul><li>Palpate in floor of mouth bidigitally to examine the submandibular and sublingual salivary glands </li></ul>
  26. 27. Examination of the tongue <ul><li>Using a gauze, have patient extend tongue </li></ul><ul><li>Hold tongue and examine dorsal, ventral, and lateral surfaces and floor of mouth and throat </li></ul>
  27. 28. Abnormal or Normal?
  28. 29. Throat
  29. 30. Teeth <ul><li>COUNT TEETH </li></ul><ul><li>Start with quadrant 1, go to 2, 3,and 4 </li></ul><ul><li>Check every surface </li></ul>
  30. 32. Summary <ul><li>Use sight, hearing, touch, and smell for examination purposes </li></ul><ul><li>The more information you gather, the better the examination – the better you can diagnose, predict outcome (prognosis) and the better the treatment plan </li></ul>