EO/IO Inspection Quiz 3 Flashcards Preview

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Flashcards in EO/IO Inspection Quiz 3 Deck (67):
1

Objectives of Oral Exam (1)

Note Normal Deviations
Oral Cancer Screening
Determine need for postponement of treatment
Early detection of lesions

2

Objectives of Oral exam (2)
Identify

Identify conditions that may require medical eval
Identify need for treatment adaptation

3

Objectives of Oral exam (3)
Provide

Provide baseline comparison
Provides info for legal record

4

Compare: Normal/Normal Deviations/Abnormal

Symmetry/Asymmetry
Color
Size (mm/cm)
Location
Shape (define border)
Consistency (hard, soft, fluid inside)
Texture (rough, smooth)
Painful (are they aware)
Mobility (deeply rooted, mobile)

5

History of Lesion

Duration (When first noticed?)
Changes (in size and look)
Sign/Symptoms associated w/ it (differentiate)
Reoccurrence (Did you have it and now it's back)

6

Systematic Sequence

Increases patient confidence in you
Prevents overlooking and missing imp. details
Increase efficiency and conserves time

7

Types of Exams

Complete
Screening (limited, classify)
Limited (emergency, important to them)
Follow-up
Maintenance (reoccuring 3,4,6 months)

8

Method used in Conducting an Oral Exam

Observation, Palpation, Ausculation (clicking/popping), Olfactation, Instrumentation, Percussion (tap to check teeth) Electrical (pulp tester)

9

Palpation

Digital, Bidigital, Manual, Bimanual, Bilateral, Circular Compression

10

Most Common Sites in the Oral Cavity for Lesions

Lateral border of tongue
Gingiva
Soft Palate complex (HPV)
Floor of mouth
Lower lip (More common in men)
Salivary Glands

11

Oral Cancer Risk Factors

Age, Gender (M>F) Sunlight, Tobacco/Alcohol use (combined as well) Previous malignancy, Area, Environmental/Occupational, Socioeconomic, Specific Disease (HIV), Repeated Trauma

12

Questions to ask the patient
**Make sure to always ask questions

Are they aware?
Do they know when the lesion occured?
Have they noticed any changes?
Are they having any symptoms?
Have they had any testing?

13

Careful Communication

Be reassuring
Don't act alarmed
Stress the need for a follow-up
Could be normal/treatable
Referral just means to get checked out, could be normal/benign

14

Oral Inspection Form (Extraoral)

General Appearance
Skin
Eyes
Facial Symmetry
Lymph Nodes
Glands
TMJ
Breath Odor
Lips

15

Oral Inspection Form (Intraoral)

Labial and Buccal Mucosa
Alveolar Ridge
Hard Palate (8+9 and back)
Soft Palate
Floor of mouth
Tongue
Pharynx
Tonsillar region
Salivary Ducts
Papilla
Marginal and attached Gingiva

16

Sequence of Exam (Extraoral)

Overall appearance, Face, Skin, Eyes, Neck, Nodes

17

Sequence of Exam, Nodes

Pre/Post auricular
Occipital
Submental and submandibular
Cervical chain
Supraclavicular TMJ joint
Symmetry
Sound
Asymptomatic/Symptomatic

18

Sequence of Exam (Intraoral)

Lips(P), Breath odor(O), labial and Buccal mucosa, Tongue(P), Floor of mouth, Saliva(d), Hard then soft palate(P), Uvula(D), Tonsillar region/throat(D), other

19

Sequence of Exam (Labial and Buccal Mucosa)

Vestibule (P) Muccobuccal folds (P) Frena (O movement, attachment) Opening of stenson's duct (Express) Buccal mucosa (P)

20

Sequence of Exam (Tongue)

Dorsal & Ventral sides (P) Lateral borders (retract, P, use mirror) Base of tongue (O attachment) Extension (describe deviation, sometimes veers)

21

Where are women most likely to get oral cancer?

Baseline of tongue

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Sequence of Exam (Floor of mouth)

Ventral surface of tongue (P) Whartons duct(Express) Mucosa(palpate, use mirror) Frena (attachment)

23

Occlusal Screening/Oral habits

Angle's Classification
Habits
Occlusal Discrepancies

24

Periodontal Exam

Papilla
Marginal Gingiva
Attached Gingiva

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Periodontal Summary Statement

AAP Case Type

26

Describing and Documenting SF

Size and Shape, Color, Location and Configuration, Texture, attachment and depth, consistency, mobility, symptomatology

27

Size and shape (SF)

Determined by L,W,H
Margin traits: Smooth/flat, raised/elevated/depressed
Contour of the border: Regular/irregular

28

Color (SF)

Most common: red, white,red and white, pink
Others: yellow, black, brown or blue

29

Location and Configuration (SF)

Generalized or localized
Discrete, grouped, confluent, or coalescing, linear

30

Flat Lesions

Are on the same level as the normal skin and oral mucosa
Macule or patch

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Macule

Small flat, discolored spot that exhibits no change in skin texture or thickness
Less than 1 cm in size
Color: brown, black, red, or any color lighter than skin
EX: freckles, petechia

32

Patch

Flat, discolored area on skin or mucosa
Greater than 1 cm in size
EX:Snuff patch, Birth marks

33

Elevated Lesions-Nonblisterform

Area where surface of the lesions are raised above the normal level of the skin or oral mucosa
Denser/Firmer cell filled
EX: Papules, Plaque, Nodule, Tumor

34

Papule

A solid raised lesions that is usually less than 1 cm in diameter
Ex: moles and skin tags

35

Plaque

Superficial raised lesion often formed by the coalescence of closely grouped papules. Greater than 1 cm in diameter and slightly raised by still flat
Ex: leukoplakia, psoriasis

36

Nodule

Raised marble-like lesion dectectable by touch usually 1 cm or more in diameter- hard mass
Ex: wart, enlarged lymph node

37

Tumor

General swelling or enlargement, 2 cm or greater in width

38

Fluid Filled Lesions-Blisterforms

Elevated lesions filled with clear fluid or pus
Softer, more fluctuant
EX: Vesicle, Bulla, Pustule, Wheal

39

Vesicle

Small blister filled with a clear fluid, Usually less than 1 cm in diameter

40

Bulla

Large blister filled with clear fluid. Greater than 1 cm in diameter
EX: Burn blister

41

Pustule

Small raised lesion filled with pustule
EX: acne, boil, abscess

42

Wheal

Raised, irregular area of localized edema. Usually from an allergic reaction lasting 24 hours
EX: Mosquito bite, Hives

43

Depressed Lesions

Surface of the lesion is below the normal level of the skin or oral mucosa. Can be superficial or deep
EX: Ulcer, Erosion

44

Ulcer

Crater-like Lesion of the skin or mucosa where the top of 2 layers of skin are lost
Superficial is less than 3 mm depth
Deep ulcer is greater than 3 mm depth

45

Erosion

Shallow, depressed lesion that does not extend through the epithelium to the underlying tissue
(usually 1st layers, lip pickers)

46

Linear Cracks

Crack
Fissure

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Crack

Long narrow break in the surface of the skin or mucosa
EX: lips crack

48

Fissure

Linear crack in the top two layers of skin or mucosa
EX: corners of mouth

49

Other Descriptive Terms

Exophytic (growing outside)
Petechiae (pinpoint red dot)
Sclerosis (hardening)
Verrucous (wartlike)

50

DBCTA

Diameter, Border, Color, Type, Anatomic Location

51

Oral Cancer

Devastating when detected late
50% survival rate w/n 5 years after treatment
Squamous cell carcinoma makes up 90% of all malignant neoplasms in oral cavity. Associated with sun, tobacco, alcohol, and HPV

52

Appearance of Early Cancer

White area, Red area, Red and White area, Ulcers, Masses, Pigmentation (Doesn't need to be all, can be just one)

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Diagnostic Aids

Toluidine Blue
Chemiluminescence

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Toluidine Blue

Identify changes in mucosa that could be malignant. Rinse or painted on. Rinsed w/ acetic acid and the retaining dye should be biopsied.

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Chemiluminescence

Rinse w/ 1% acetic acid and used light which will help detect abnormal cells

56

Checking Suspicious lesions

Biopsy
Exfoliative cytology
Cytologic Smear

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Biopsy

Total or partial removal of the lesion by excision means so the tissue can be examined for the purpose of diagnosis (Best Method)

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Exfoliative Cytology

Diagnostic Aid in which cells are removed from the lesion and slides fixed and mailed in for results.
Usually comes back as suspicious so need biopsy anyway

59

Cytologic Smear

Diagnostic aid in which cells are removed from the lesion for microscopic evaluation.
Can get false positives, not reliable

60

Healthy Characteristics of Gingiva

Pink, Flat, Knife-like edge, Stippling (looks like an orange peel)

61

Unhealthy Characteristics of Gingiva

Erythemic, Bulbous, and Rolling (on marginal)
Cratered (Blown up with fluid), Irregular border, Blunted, Smooth, Smooth/Shiny (w/ a lot of edema)

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Papilla Healthy

Pink, Melatonic, Flat, Firm, Stippled
Can be either healthy/unhealthy: Pointed, Shiny, Smooth

63

Papilla Unhealthy

Erythemic, Cyanotic, Bulbous, Blunted, Cratered, Edematous, Irregular, Fibrotic

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Marginal Gingiva Healthy

Pink, Melatonic, Flat, Firm, Shiny, Smooth

65

Marginal Gingiva Unhealthy

Erythemic, Cyanotic, Rolled, Festooned, Recessed, Clefting, Edematour, Stippled, Irregular, Fibrotic

66

Angiodema

Swollen on lower lip

67

Bells Palsy

Affects one side