oral diagnosis m3
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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
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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