Intra and Oral Examination

Question 1

how often should an adult receive an oral health assessment

Answer 1

every 24 months

Question 2

how often should a child receive an oral health assessment

Answer 2

every 12 months

Question 3

what does an extra oral examination examine

Answer 3

the structures and what is going on beneath the surface of the skin - what we cannot see

Question 4

what can be noticed from the initial interaction with patients

Answer 4

• stature and size
• general appearance, behaviour and attitude
• exposed skin
• hands
• mental acuity and ability to communicate
• do they need someone with them for support reasons

Question 5

what should the approach be to a suitable extra oral examination

Answer 5

• be consistently methodical, adopting a regular way of carrying it out
• adequate lighting and comfortable position for both you and patient
• two dental mirrors - one to reflect and retract the soft tissue, one to see inside the mouth
• insist on removing the dentures, cannot do an adequate soft tissue examination with the dentures still in the mouth
• will take a minute
• have an ability to describe and record your findings

Question 6

give a summary of the steps to an extra oral examination

Answer 6

• begins when you bring patient into surgery - gain a general appraisal of them
• take a history
• inspect, palpate and assess the function of muscles, nerves etc
• look for asymmetry of abnormalities
• look at the colour of the skin and the scalp
• eyes, nose, lips and ears
• look for swelling
• inspect lymph nodes
• facial bones
• the temperomandibular joint
• muscles of mastication

Question 7

what are different things to look for on the patients skin/scalp

Answer 7

colour - grey (heart conditions) yellow (jaundice)
is it sweaty, clammy, are there scars or any signs of trauma
be able to describe lesions and part of the head that they are situated on. if you do not know what it is, just describe it; look for suspicious features
infections in the mouth can create an extra oral draining sinus. this happens when the source of the infection is not removed, the infection wil keep coming back and can surround a tooth or spread into the soft tissues around the tooth like in the cheek. it can be seen in conditions like dental abscesses

Question 8

explain what an extra oral draining sinus is

Answer 8

infections in the mouth can create an extra oral draining sinus. this happens when the source of the infection is not removed, the infection wil keep coming back and can surround a tooth or spread into the soft tissues around the tooth like in the cheek. it can be seen in conditions like dental abscesses

Question 9

what is a subconjunctival haemorrhage

Answer 9

bleeding into the whites of the eyes

Question 10

how can the lips present pathology that can be observed in an extra oral examination

Answer 10

orofacial granulomatosis, angio-edema, angular cholitis

Question 11

how can you feel for the texture of the swelling and what does it represent about the mass you are feeling

Answer 11

solid swelling is more concerning as it could be due to a tumour, whereas fluctuant swelling is more likely due to an infection due to the fluid. feel for temperature and tenderness of the swelling, look for whether the palpation bothers the patient

Question 12

what is bells palsy

Answer 12

facial paralysis

Question 13

what are the different lymph nodes

Answer 13

parotid, submental, submandibular, occipital, cervical chain

Question 14

how do you feel for temperol mandibular joint malfunction

Answer 14

look at the head of the ramus of the mandible, use two fingers and place in front of the ear and ask the patient to open and close their mouth. feel for tenderness and sounds of clicking or rustling

Question 15

what do you consider when looking for trauma on a patient during the extra oral examination

Answer 15

is it soft tissue only, bone injury only, or does it involve both

Question 16

what are the SDCEP guidelines for extra oral eaxmination

Answer 16

there are diagrams on extra oral examination on how to assess the head and neck of patients, including a checklist to ensure you assessed every element you should have

Question 17

how many cranial nerves are there

Answer 17

12

Question 18

what are the cranial nerves

Answer 18

12 pairs of nerves that emerge from the brain that connect the brian to the head and neck. they can be motor or sensory or both. they are a good example of how to example what is going on underneath the surface. good for testing eye movement and testing the sense of smell.

Question 19

what is the brief summary of what to include in an extra oral examination

Answer 19

asymmetry, skin, facial features, lymph nodes, tmj, muscles of mastication, mouth opening

Question 20

when do you conduct an intra oral examination

Answer 20

after history taking and before special investigationsw

Question 21

what are the sites to include in an intra oral examination

Answer 21

lips
gingivae
labial mucosa
buccal mucosa
tongue
floor of the mouth, ventral borders
floor of the mouth and the ventral tongue
the dorsum of the tongue
the hard and soft palates
the oropharynx including the tonsils
use of the two mirror technique

Question 22

how do you use the two mirror technique when looking at the intra oral environment

Answer 22

use one of the mirrors to compress the tongue or move soft tissue out of the way.

Question 23

how would you examine the tongue

Answer 23

use gauze to hold the tongue by the tip so you can manoeuvre and have a look underneath

Question 24

how do you look at the labial mucosa

Answer 24

reflection of the lip - would otherwise be hidden and would not be easily seen if there was swelling. measure the diameter, is it fluctuant or firm, does anything come out if squeezed, is there a gap between the lower central incisors that lead to the formation of the swelling

Question 25

why is there concern when looking at the oropharynx

Answer 25

papillae on the back of the tongue are known as the circumvallate papillae and they can be huge which can seem concerning

Question 26

why is it important to look at the oropharynx when conducting an intra oral examination

Answer 26

easy to miss, is more uncomfortable for the patient. should look at the soft palate, uvula, tonsils. if the uvula doesnt vibrate properly or is moved to the side, that is pathology you want to notice

Question 27

provide a recap of intra oral examination

Answer 27

• it is only in seeing normality that you will appreciate the various ranges of abnormality
• take every opportunity to examine patients
• take every opportunity to examine fellow students
• with patient consent, share your findings
• be methodical, dont cut corners when examining patients