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ORAL DIAGNOSIS M3

TECHNIQUES OF PALPATION

1. BIMANUAL PALPATION

• 2 hands, 1 hand to palpate and the other to

support

• Palpating floor of the mouth

i. One inside the mouth and one

outside supporting the jaw

2. BIDIGITAL PALPATION

• 2 fingers of 1 hand

• Palpating thinner tissues like lips, labial and

buccal vestibule, tongue

3. BILATERAL PALPATION

• fingers of both hands are used

• Best technique for palpating symmetricalstructures on both sides of the face

• EXAMPLES

i. R & L TMJ

ii. Parotid area

iii. Submandibular and sublingual area

iv. Cervical area of the neck

HOW TO CHECK THE TMJ

1. Check for the movement of TMJ

a. By asking the patient to open and close the

mouth and check for lateral deviations

2. Check the maximum extent of mouth opening

a. Extent of the interincisal distance

3. Do palpation in front of the ears just above the

condyles

a. Check for movements and clicking sounds

b. Check for tenderness when the patientopens and closes the mouth

c. Posterior part of the TMJ is located at the

External Auditory Meatus

PERCUSSION (sight and hearing)

• For localization of inflammation of Periodontal

membrane and 2° pulpitis

• Structures:

o Teeth – blunt end of the mouth mirror

o Facial Muscles - 2nd and 3rd finger is used

o  Jaw Bones - indirect percussion 

• Never used as a test for vitality

•

tooth with normal support = high pitch sound

• less dense support = lower pitch sound

• NOTE: Percussion or tapping over the facial nerve in

front of the ears causes twitching or spasm of the

facial muscles as in latent tetany = (+)

CHVOSTEK’S SIGN

• Motor movement of the eyes: III, IV, VI CN

o Strabismus – uncontrolled squinting of the

eyes

o Diplopia – double vision

o Ptosis – drooping of the eyelid

HOW TO EVALUATE MUSCLES OF MASTICATION

• MASSETER – one finger inside the mouth and one

finger outside

• TEMPORALIS – ask the patient to clench their teeth

• LATERAL & MEDIAL PTERYGOID – ask the patient

to do lateral excursions

CHORDA TYMPANI

• Gustatory sensation

• Branch of CN VII

5th CN – facial sensory

8th CN (vestibulocochlear)

• For hearing and balance

9th & 10th CN – Loss of gag reflex

11th CN (Spinal Accessory)

• No lateral movement of the head

• No shrugging

12th CN (hypogossal)

• No motor movement of tongue

• Cannot protrude tongue

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AUSCULTATION

• Refers to the act of listening to the sound produced

by various body structures

• Examples:

o Heart – LUBDUB SOUND

o Lungs – during breathing in and out

• Used in dentistry for:

o Examination of TMJ

o Diagnosis of fractured jaw

o BP measurement

PROBING

• Used for:

o Detection of carious lesion

o Determine depth of periodontal/crevicular

pocket

o Diagnostic aspiration or aspiration biopsy

OLFACTORY EXAMINATION

• Discretely done

• Not an SOP

EVALUATION OF FUNCTION

1. Pulp vitality testing using pulp vitalometer or thermal

test

2. Determination of occlusal relationship through the

production of diagnostic cast

GPA (GENERAL PATIENT APPRAISAL)

• Consist of the impressions concerning the patient’s

health status that can be gained by inspection from a

comfortable distance

1. Patient’s identifying/demographic features

a. Age

b. Gender

c. Race

2. Mental Orientation and emotional status

a. Psychic state of the patient

b. Usually assessed on patient’s awareness of

person, place and time

3. Body size (Habitus), stature (height) and 

bilateral symmetry (anatomic proportion)

BILATERAL SYMMETRY 

• Refers to the expectation that the midsagittal plane

bisects the body into 2 equal parts that normally

corresponds in form

ABNORMALITIES IN BODY SYMMETRY (ASYMMETRY)

A. Tissue Deficiency

• Physical injury

• degenerative disease

B. Tissue Enlargement

• Unilateral facial swelling

C. Abnormal tissue position

• Scoliosis or lateral spine curvature

CLASSIFICATION OF BODY BUILT (HABITUS)

1. Asthenic

• Slender and underweight

2. Sthenic

• Well proportioned, athletic build

3. Hypersthenic (Stocky build)

• Heavy bone/ muscular proportion

4. Pyknic

• heavy, soft and rounded build

• Abundance in body fat

STATURE or HEIGHT ABNORMALITIES

1. Large stature or GIGANTISM

a. ACROMEGALY – after puberty gigantism

2. Small stature or DWARFISM

a. CRETINISM – small stature with mental

retardation due to thyroid gland disorder

FACIAL FORM/HEAD SHAPE

1. NORMOCEPHALIC/ MESOCEPHALIC

2. BRACHYCEPHALIC – short round skull shape

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3. DOLICOCEPHALIC – long narrow head shape

-Rosette Go 081410

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