oral medicine lec3
TRANSCRIPT
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Examination of cranial nerves
.Abducent6. Trochlear ,4.Occulomotor ,3
Pupillory reflexes -------- both pupil on both sides
should be constructed
Diplopia ----------- patient see 1 object in 2 objects
Nystagms ---------- pendular movement of the eye or
rapid jerking
Ptosis -------- the patient can not elevate eyelid
completely.
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.Trigeminal nerve5
-sensory function : examined by light touch withcotton to the area
-motor function : by exam the muscle of mastication
- reflexes:
Cornal reflex :both eyes should be closed when
each corner is stimulate with a piece of cotton.
Jaw jerk : by applying a downward tap on the chin,
the tap produce a reflex contraction (( brisk
closure)).
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.Facial nerve7
Motor function:
# Ask the patient to wrinkled forehead.
# Ask the patient to rise eye brows.# Ask the patient to show his teeth.
# Ask the patient blow out his cheeks.
any involuntary movement like tics or spasm.Notice
of tongue.3/2: test the anteriorSensory function
. The Vestibulocochlear nerve8
- Examination is done by using of Tuning fork.- The normal patient should equally heard by both
ear.
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.Glossopharngael nerve9The patient loss of taste in the posterior third of the
tongue or by
palatal reflex---- when the soft palate is touch it
move upward.
. Vagus nerve10- The nasal quality of the voice-- Drooping of unilateral or bilateral of soft palate.
- Does the palate move when the patient says ((ah))for long times, and also tray to observe the palatal
movement in bilateral palsies here the palate will not
elevate. And in unilateral lesion the one side of the
palate remaining immobile.
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.The Spinal accessory nerve11
Here we examine the sternomastoid and the
trapezius muscle by :
-- ask the patient to press the chin downward
against the resistance of the examiner`s hand.
- ask the patient to turn against resistance.
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.Hypoglossal nerve12
-- Ask the patient to protrude the tongue andcarefully see the deviation if there is unilateral
weakness it deviated toward the paralysed side.
-- Ask the patient to move the tongue in- outdirection & from one side to other slowly and
rapidly.
- Ask the patient to press the cheek with the tonguewhile the examiner`s finger resist the movement by
pressure on the outside the cheek.
(any defect in the nerve lead to paralysis, tremor,
abnormalities in movement)
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TMJThe dentist should have a sound knowledge of the
function anatomy of TMJ and associated structure
prior to under taking the examination of the patient.
Inspection
Examination of the TMJ and masticatory muscleshould begin by observing the degree of symmetry
of the mandible and face, and by observing the path
of excursion of the mandible on opening and
closing. It is helpful to focus on specific landmark(such as the mesial incisal edge of mandibular
central incisor) whilst asking the patient to open and
close their mouth in this way any lateral deviation
will be noted.
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Palpation
In order to examine the joint by palpation the
examiner should be in front of the patient so that
movement of the mandible may be related to thosepalpated in the condylar heads.
A single finger is placed over each condylar head
while the mandibular movement are carried out.
Abnormal tenderness associated with the lateralaspect of joint detected by light pressure over the
condyle
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Intra Oral Examination
The TeethNumber of teeth, caries and fillings , loose teeth,
crowns, discoloration of teeth,.etc
The GumThe color and texture of the gum are noted, and the
standard of oral hygiene classified including thepresence of plaque and calculus , recession
,pocketing ,and hyperplastic of the gum is
measured, and the mobility of teeth assessed.
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The Palate
: ask the patient to tilt his headInspection of palate
Slightly backwards and to open his mouth to his
fullest extent. If the height is good the whole palate
can be observed.
- Ask the patient to say "Ah" loss of movement of
half of the soft palate suggest a lesion of the vagus
nerve or infiltrating neoplasm of the nasopharynx ,
while paralysis of the whole soft palate is found in
the bulbar form of poliomyelitis.
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The floor of Mouth
Ask the patient to put the tip of tongue on the roof of
the mouth and bend the head slightly backward and
examine the color, texture and presence of swelling
or ulceration.
Examination of Mucosa of cheek
Retract the angle of the mouth and the interior is
illuminated with a torch to examine the color, texture
and presence of swelling or ulceration.
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The Tongue
The Tongue will tell the dentist many things, not onlyby what we hear but by what we see first.
Color: because of it`s rich blood supply of the
capillary network closed to it`s surface make thecolor of tongue is dark red and normally it is
covered by slight grayish coating.
-- Excessive furring will be result from:1) Local infection either from the mouth or from
nose, throat, lung
2) Dehydration either from pyrexia, mouth breathing,
smoking.
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3) Discoloration of tongue can be occur due
to :
[a] food[b] iron containing medicine lead to black
color
[c] antibiotic change in oral flora --- candidainfection lead to white color
4) Dry tongue mostly occur due to renalfailure , dehydration ,intestinal obstruction,
xerostomia , mouth breather.
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The dentist have to inspect the dorsum of
the tongue for any swelling, ulcer , white
lesion & fissure.
-- In anemic patient : depapillated ,smooth
,sore and shiny.
-- In cynosis patient : the cynosis of tongue is
central in origin.
-- In Acromegaly and Mongolsim ----- large and
usually fissured in mongolism.
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Methods of examination of tongueof the tongue3/2(a)Examination of anterior
Ask the patient to put out his tongue and wrapping apiece of gauze around the tip of protruded tongue
and moved to left and right side to observed
lateral surface, to see any abnormalities present
such as large size than normal which may be dueto inflammation or muscular hypertrophy
(muscular macroglossiadiffuse benign
neoplasm).
Examination of ventral surface (under surface) of the
tongue done by asking the patient to rotate the
tongue upward toward the rest of his mouth.
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of the tongue3/1(b) Examination of posterior
Ask the patient to open the mouth widely and press
the left index finger firmly into the cheek i.e. it
intervenes between the teeth, then palpating the root
of the tongue , if patient have gag reflex use sprayanesthesia.
Palpation of posterior 1/3 of tongue should be
undertaken when the patient have :(1) discomfort at the back of the tongue
(2) slight dysphasia
(3) doubtful ankyloglossia
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(c) Neurological examination of the tongue(Examination of hypoglossal nerve )
Inability to protrude the tongue fully may be
due to ankyloglossia {in old and middle aged
patient suggest advanced neoplastic
infiltration of the lingual musculature , while
in young patient suggest congenital shortfrenum}
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Examination of salivary glandsThe dentist should know the following information
prior to examination of S.G1/ position of S.G and associated structure
2/ clinical features of S.G diseases
3/ investigations required for every symptoms.
Clinical examination;
During examination the dentist may notice:
1- asymmetry and detectable extra or intra oral
swelling2- sometimes large calculi may be palpable as
hardness
3- saliva should be carefully notice if it turbid or
mucopurulent
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4-pain and skin involve with a firm-rapidly growing
mass
5-facial nerve palsy is sinister sign when the parotid
mass is detected6- lymph node detected
7-hypersalivation: this may associated with certain
neurological disorder
8-dry mouth
The parotid gland
When dentist notice a swelling in site of parotid
gland he should examine it as following:
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Inspection
The characteristic of the general enlargement is a
swelling in front of the tragus extending downward
and slightly backward, and obliterating the normaldepression below and in front of the ear.
Palpation
Lay the pulp of finger over the main body of the
gland and a ascertain the consistency of the
swelling ( tender or not )
Palpate the superior 1/3 of the gland (if there is
fullness and if it continue with the main body of theparotid gland)
Lay the finger over the inferior 1/3 of the gland ( if
the whole parotid gland is enlarge there will be
fullness over the posterior-inferior part)
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of parotid glandorificetheExamination of
(stensen`s duct) which lies opposite the second
upper molar by:
retract the cheek with a spatula ,with a gentlepressure or massage to the parotid gland and see
the saliva if there is gush purulent saliva or drops of
thicker pus.
Submandibular S.GHere the dentist notice a swelling beneath and in front of
the angle of the jaw, or if the swelling occur only either
just before or during meals this may give an indication
that the submandibular S.G is involved.
Any swelling at this area should be differentiated from
other swelling in this region