Chapter 13

Question 1

What is the essential goal of an extraoral examination?

A. To asses periodontal health
B. Identification of abnormalities and pathologies, especially oral cancer
C. To measure tooth mobility
D. To diagnose diseases

Answer 1

B. Identification of abnormalities and pathologies, especially oral cancer

Question 2

The essential goal of the IOE and EOE is to

Answer 2

Detect possible early signs of cancer

Question 3

What are the components of an Examination?

Answer 3

Total patient being treated

Exam is all-inclusive

Assesses risks for cancer

Exam is done at new patient exam, comp exam and every continuing care appt

Question 4

What are the 10 risks during an examination?

Answer 4

History of previous cancer

Family history of SCC

Tobacco use

Alcohol use

Cultural and genetic susceptibility

Sun expose w/o sunscreen

Diet

Surgeries like organ transplant and bone marrow transplant as well as long term use of immunosuppressants

HPV vaccination status

Contraction of HPV from orogenital contact

Question 5

What are the five types of exams?

Answer 5

Comp
Screening
Limited
Follow-up
Continuing care/ re-eval

Question 6

What are the six methods of examination for IO and EO?

Answer 6

Visual, palation, instrumentation, percussion, electricity test, auscultation

Question 7

Examination using direct observation in a systematic sequence; also includes radiographic examination and transillumination

Answer 7

Visual examination— one method of examination

Question 8

Examination using the sense of touch thru tissue manipulation or pressure on an area with the gloved fingers of one or both hands.

Answer 8

Palpation- one method of examination

Question 9

The four types of palpation

Answer 9

Digital, Bidigital, Bimanual, BIlateral

Question 10

Palpation by use of a single finger

Answer 10

Digital

Question 11

Palpation by use of the finger and the thumb

Answer 11

Bidigital

Question 12

Palpation by use of finger or fingers and thumb from each hand applied simultaneously in coordination

Answer 12

Bimanual

Question 13

Two hands are used at the same time to examine corresponding structures on opposite sides of the body

Answer 13

Bilateral

Question 14

Examination using a perio probe or explorer

Answer 14

Instrumentation—one method of examination

Question 15

Examination using the act of tapping a surface or tooth with an instrument and assessing sound or response of patient

Answer 15

Percussion—one method of examination

Question 16

Examination using an electrical pulp vitality tester

Answer 16

Electrical test- one method of examination

Question 17

Examination by use of sound.

Answer 17

Auscultation— one method of examination

Question 18

Difference between signs and symptoms

Answer 18

Signs: objective; The abnormality is able to be observed as data by the clinician

Symptoms: subjective. The deviation from normal is felt by the patient or an subjective abnormality is observed.

Question 19

Three steps to preparing for IO and EO

Answer 19

1. Review healthy history and any existing medical record and existing dental record (like radiographs, dental caries) as well ask periodontal and cancer risk factors
2. Examine Radiographs
3. Explain procedure to patient

Question 20

What are the three groups of oral mucosa?

Answer 20

Masticatory, Lining and Specialized

Question 21

Keratinized stratified squamous epithelium firmly attached to underlying structures; this mucosa covers the gingiva (except free margin) and the hard palate

Answer 21

Masticatory mucosa

Question 22

Nonkeratinized stratified squamous epithelium not firmly attached to underlying tissues; this mucosa is found covering the buccal, labial, part of alveolar region, soft palate, floor of mouth and ventral of tongue

Answer 22

Lining epithelium

Question 23

This type of mucosa covers the dorsum of the tongue and is composed at the papillae of the tongue

Answer 23

Specialized mucosa

Question 24

What are the four types of papillae?

Answer 24

Fungiform
Filiforme
Circumvallate
Foliate

Question 25

Which papillae contain taste buds?

Answer 25

All of them except the filiform which is just for texture

Question 26

What are the four reasons why having a sequence of examination is important?

Answer 26

Minimize exclusion, efficient, improves patient confidence, and promotes professionalism

Question 27

What is the sequence of the EOE?

Answer 27

General appraise of head and neck Cervical Lymph Nodes Salivary and Thyroid Glands TMJ

Question 28

What abnormalities are to be assessed during the general appraisal of the heck and neck portion of EOE?

Answer 28

Injuries Hair loss Jaw movements during speech Asymmetry of the face Twitching or paralysis Signs of abuse Acne and other skin lesions Color changes of the skin Swelling Masses in the neck

Question 29

What abnormalities are to be assessed during the cervical lymph nodes of EOE?

Answer 29

Lymphadenopathy from either infection will have arose suddenly which will affect lymph nodes on both side of body and make them enlarged, tender, grape like and movable or malignancy which will have developed gradually and painlessly and affect lymph nodes on only one side of body and make them hard, fixed to underlying structures, nonmovable, not tender and clumped together

Question 30

What abnormalities are to be assessed during the salivary glands and thyroid gland portion of EOE?

Answer 30

Enlarged, swollen, tender, and hard/firm salivary glands Palpable, Asymmetrical, off the midline, enlarged, fixed to underlying structures thyroid gland; may also have nodules

Question 31

What are some abnormalities when examining the TMJ during EOE?

Answer 31

Popping or clicking Grating sensation when opening and closing jaw Asymmetrical movements Limited range of movement Tenderness or pain reported by patient

Question 32

What is the systematic sequence for the IOE?

Answer 32

1. Lips and vermillion border 2.Oral cavity and mucosal surfaces 3.Underlying structures of the lips and cheeks 4.Floor of the mouth 5.Salivary gland function 6. The tongue 7. Palate, tonsils and oropharynx

Question 33

The abnormalities to notice during the lips and vermillion border portion of IOE would be?

Answer 33

Changes in color/pigment or texture Chapped All lesions especially herpetic lesions Trauma or injury Swelling Lip biting Changes in shape Irregular vermillion border Lips that do not meet at rest Cheiolosis at the commissures Lip pits Asymmetry of mouth

Question 34

What are the abnormalities noticed during the oral cavity and mucosal surfaces portion of the IOE?

Answer 34

Lesions Línea alba Cheek biting Trauma Injury Change in color or texture Swelling Leukoplakia Lichen planus Halitosis Dry mucosa

Question 35

What are the abnormalities noticed during the underlying structures of the lips and cheeks portion of the IOE?

Answer 35

Swelling Nodules Changes in texture Tenderness Minor salivary glands feels like beads

Question 36

What abnormalities are to be noted during the floor of the mouth portion of the IOE?

Answer 36

Changes in color or texture Lesions or other surfaces abnormalities Swelling: Mucocele/ ranula (trauma of the salivary gland duct); salivary caniculi or stones Leukoplakia Soft tissues have hard area and discomfort when palpated

Question 37

What are some abnormalities to be noted during the salivary gland function portion of the IOE?

Answer 37

Xerostomia Swelling in floor of mouth from blocked or traumatized saliva glands or ducts

Question 38

What abnormalities should be noted during the tongue portion of the IOE?

Answer 38

Ulceration Lesions Swelling Nodules detected when palpated Variation in size, color and texture Inflammation and odor from food accumulation Assymetrical shape Dry mouth Papillae absent Fissured or pebbly dorsal surface Geographic tongue Macroglossia Ankyloglossia Black hairy tongue (use of antibiotics)

Question 39

What are some abnormalities to be noted in the palate, tonsils and oropharynx portion of the IOE?

Answer 39

Palate: • Swelling • Lesions • Tumors • Cleft palate • Changes in color (red, white, gray) • Changes in texture are common in smokers, such as cobblestone appearance. • Snuff dipper's or tobacco chewer's patch • Petechia (discrete red spots on palate due to trauma) • Ulcerations • Trauma Paralysis will cause the soft palate to sag on the affected side of the face and the uvula to pull to the unaffected side. Tonsils: • Inflamed tonsils • Enlarged tonsils • Areas of exudates (pus) evident Oropharynx: • Markedly reddened and inflamed • Sore throat • Discomfort when swallowing or eating Uvula: • Deviates from midline

Question 40

How can we prepare a patient of EOE?

Answer 40

Have them sit upright Explain the procedure to them Ask them to remove glasses, objects in mouth and clothing obstructing the view of the neck

Question 41

How can we the clinician prepare for an EOE after/during general assessment?

Answer 41

Wash hands Don exam gloves Stand posterior to patient to see back of head, ears and neck. Look for abnormalities

Question 42

Eight types of cervical lymph nodes to be palpated

Answer 42

Cervical Preauricular Post-auricular Submental Submandibular Subclavicular Anterior cervical Posterior cervical

Question 43

Eight types of cervical lymph nodes to be palpated

Answer 43

Cervical Preauricular Post-auricular Submental Submandibular Subclavicular Anterior cervical Posterior cervical