Dr. Devi Dpt. of Prosthodontics Amrita School Of Dentistry Kochi

1. Patient Examination
Dr.Devi
3rd year
10-7-17

2. •Introduction
•Steps of examination
•Vitals signs
• General examination
•Head and neck examination
• Conclusion
•References

3. Introduction
Signs
Symptoms

4. Steps in a comprehensive history
•Date of history recording
•Identifying data
•Source of referral
•Source of history
•Chief complaint
•HOPI
•Past history
•General state of health
•Childhood illness –MMR/chicken pox/polio
•Adult illness –
psychatric/accidents/injuries/operations/hospitalization
s
•Current health status
•Allergies

5. •Diet
•Habits
•Current medications
•Family history
•Review of systems & General
Examination
•Extra oral examination
•Intra oral examination
• Diagnosis
•Treatment plan & Prognosis
PATIENT
EXAMINATION

6. General Physical Examination
1. General appearance
2. Vital signs
3. Head examination
4. Neck examination
5. Upper limb examination
6. Lower limb examination
7. Lymph node examination

7. 1. General appearance
1. Consciousness & Orientation
2. Cooperation
3. Mentality
4. Memory
5. Body built
6. Pregnant patients
5

8. 2. Vital signs
1. Pallor /Icterus/Cynosis/Clubbing/
Lymphadenopathy/ Edema
2. Pulse
3. Blood pressure
4. Respiratory rate
5. Temperature
P
I
C
C
L
E

9. Pallor
-Anemia : which is the most common cause
-Leukemia
-Heart disease
-Shock : whether it is septic , Anaphylactic,
Cardiogenic, Neurogenic and hypovolemic
shock
- syncope =decrease in the blood supply to
the brain=hypotension leading to pallor
•Conjunctiva/ tongue/ oral
mucosa/ hard palate

11. Pulse
Represents the Expansile impulse
produced by ventricular ejection and
transmitted to along the arteries

12. Method of palpation
Pulses over the radial
artery- above the
wrist

13. Rate
Rhythm
Volume
Special character
Equality on both sides
Peripheral pulsations
State of arterial wall
60-100 bpm
Tachycardia
Bradycardia
Regular / irregular

14. Icterus
Yellowish pigmentation of Sclera, Skin and
Mucous membranes.
This condition is also termed as JAUNDICE.
French word jaune meaning yellow.
More appropriate to be considered as a
symptom rather than a disease.

15. Yellow discoloration will be because of
accumulation of Bile Pigments in the Sclera,
Mucous membranes, Skin, Nails.
Bile pigments have affinity to tissues
containing ELASTIN.

17. Cyanosis
•Bluish / greyish/ slate like / dark purple
•Excessive amount of reduced haemoglobin in
arterial blood
•> 5g/dl reduced Hb
•Congenital cyanotic heart disease /chronic
bronchitis / emphysema / pulmonary disease /
polycythemia

18. Clubbing
The selective bulbous enlargement of the
distal segment of the fingers & toes due
to proliferation of connective tissue
particularly on dorsal surface

19. Blood pressure
Blood pressure is defined as the lateral
pressure exerted by flowing blood on the
walls of the arteries.

20. Blood pressure

21. Examination sequence
•Support the arm comfortably at about heart level
•Apply cuff to the arm
•Identify the brachial pulse
•Inflate the cuff until the pulse is impalpable
•Note the pressure on the manometer which is a
rough estimate of systolic pressure
•Now inflate the cuff another 10mmHg and listen
through the stethoscope over the brachial artery
•Deflate the cuff slowly until regular heart sounds
can be just heard .

22. •This is the systolic pressure
•Continue to deflate the cuff slowly until the
sounds disappear
•Record the point at which the sounds just
disappear as diastolic pressure

23. • Normal - 120/80 mmHg.
• Pre hypertension – 120-139/80-
90mmHg
• Stage I Hypertension-140-
159/90-99 mmHg
• Stage II Hypertension-
>/160/100mmHg

24. Respiratory rate
•16-20 / min
•Tachypnoea
•4:1
•Acute pulmonary infections/ obstructive
airway disease/ high altitude/ acute pulmonary
oedema

25. Temperature
•Reflects the balance between the
heat produced and the heat lost from
the body

26. Pyrexia, Hyperthermia, Fever
- body temperature above the usual range
Febrile
- a client who has a fever
Afebrile
- a client who does not have fever
Hypothermia
- core body temperature below the lower limit
of normal

27. HEAD & NECK Examination
• TMJ
•Muscles of mastication
•Paranasal sinuses
•Salivary glands
•Lymph nodes

28. TMJ
•Inspection :
swelling/symmetry/devi
ation while opening
/range of opening
•Palpation: at opening &
closing position –
tenderness
•Protrusive and lateral
movements- free of
pain/deviation/discomfo
rt

29. •Active range of motion :extent of voluntary
movement
•Passive range of motion : maximal movement
of joint when manipulated
-Soft & bouncy feeling- muscular / other soft
tissue restriction
-Hard feeling- osseous abnormalities meniscal
displacement / fibrotic contracture
•Lateral movement : line is drawn in b/w CI of
maxilla & mandible = 8-12 mm

30. Auscultation : Joint sounds
•Clicking : brief sounds occurring at some
point : - disc displacement
•Crepitus : diffuse sustained sound :- change
in the osseous contour
•Pop : single sound + short duration + loud

31. Muscles of mastication
Masseter :
Palpated bilaterally
Placed on zygomatic arch
Droped down
Palpate on the inferior
border of the ramus
Okeson’s Text book of TMJ

32. Deep portion is made
accessible by placing
index finger inside the
mouth, just ant. To
ant. Border of
ascending ramus , &
pinching the muscle
b/w the finger and
thumb
The TMJ BOOK ,, Kaplan

33. Temporalis
• 3 functional areas
•Anterior region : palpated above the
zygomatic arch and anterior to the TMJ , runs
in vertical direction
•Middle region : palpated directed above the
TMJ and superior to the zygomatic arch . Fibres
run in an oblique direction
•Posterior region : palpated above and behind
the ear , run in horizontal direction

35. Lateral pterygoid
•Lateral to maxillary
tuberosity and
medial to coronoid
process

36. Medial peterygoid
Forms a sling with masseter
Can be palpated medial and posterior
to pterygomandibular raphe

37. Paranasal sinus

38. Salivary glands
•Parotid gland : palpated by
using fingers placed over the
glands in front of the ears to
detect the pain or swelling
•Early enlargement of the
parotid gland – out ward
deflection of the lower part of
the ear lob
•Parotid duct / stensen’s duct
:palpated with jaws clenched
Oral and maxillofacial medice :scully

39. •Submandibular gland : palpated bymanually
between fingers inside the mouth and extraorally

40. Lymphnode examination
Lymphadenopathy
Localised / generalised
Deep cervical nodes
Long chain- IJV
A-S/ A-I/ P-S/ P-I

41. PERIPHERAL NODES DEEP CERVICAL
NODES
•Submental
•Submandiblar
•Buccal & mandibular
(facial)
•Preauricular (parotid)
•Postauricular ( mastoid)
•Occipital
•Anterior cervical
•Superficial cervical
•Prelaryngeal
•Pretracheal
•Paratracheal
•Retropharyngeal

42. Method of palpation
Submandibular & submental LN : gently
introduce the tip of the finger underneath the
mandible and move side to side
 cervical nodes : patient’s neck is turned and
flexed to one side

43. Upper limb & lower limb
examination
•Oedema : excessive
accumulation of fluid in tissue
spaces
•Generalised / localised
•Causes : cardiac failure / renal
causes / chronic liver disease /
hypoalbunemia

44. Very hard nodes Malignancy
Firm, rubbery nod Lymphoma
Softer nodes Infective or inflammatory
conditions
Matted nodes
A group of lymph nodes that
feels connected and move as
a unit is said to be matted.
Malignant:
• Metastatic carcinoma
• Lymphomas
Other:
• Tuberculosis
Shotty nodes Viral aetiology

45. Tenderness
When a lymph node increases in size its
capsule stretches and causes pain.
But pain may also be seen when there is
hemorrhage into the necrotic center of a
malignant node.
The presence or absence of tenderness does
not necessarily differentiate benign from
malignant nodes.

46. There are 3 basic classes of lymph nodes.
1. Fibrotic nodes are palpated as scarred jelly
bean-like structures that are freely movable and
escape from the clinician’s fingers. They are
usually representative of previous infection.
2. Tender, enlarged, and inflamed nodes are
usually indicative of an active infection.
3. Stony hard and fixed nodes feel like marbles
that cannot be moved from the underlying
structures and usually represent some form of
neoplasia.

47. •A few conditions are known to cause
generalized lymphadenopathy
•Eg: Lymphomas, Tuberculosis,
lymphatic leukemia, Sarcoidosis
etc…

48. Intra-oral examination
•Lips- cyanosis / angular chelitis
•Maxillary and mandibular arch
•Dentulous-
•Edentulous - complete / partial -
classification
•Teeth present – tooth numbering system

49. •Buccal mucosa
•Floor of the mouth
•Tongue
•Palate
•Gingiva
•Periodontal status- mobilty /
pockets/ BOP/ recession / furcation
•Saliva
•Oral hygiene

50. •Occlusion
•Attrition
•Molar relation
•Rotation / spacing /supraeruption / any
other abnormality
•Supernumerary teeth/ hypodontia /
decalcification
•Dental caries / abrasion / erosion/
abfraction
•CHS

51. Conclusion
Proper examination helps to provide ideal
treatments to the patient

52. References :
•A guide to Physical examination and history taking , Barbara
Bates , 4th edition
•Macleod’ s clinical examination
•Oral and maxillofacial medicine, Scully
•Burket’s oral medicine and radiology
•Funfamentals of fixed prosthodontics , Shillingberg
•Book of prosthodontics , Rosenstiel

53. THANK YOU !!!