Screening ExaminationScreening Examination

Early clinical experienceEarly clinical experience

Dent 1010Dent 1010

ObjectivesObjectives

To provide the rationale for the screening To provide the rationale for the screening examinationexamination

To prove an overview of the techniques for the To prove an overview of the techniques for the screening examinationscreening examination

To emphasize how important it is to provide a To emphasize how important it is to provide a full examination at every full examination and full examination at every full examination and whenever the patient returns for their regular whenever the patient returns for their regular “check-up”“check-up”

RationaleRationale

These are the steps to follow when planningThese are the steps to follow when planningpatient care: patient care: Data gathering including patient input. Data analysis/interpretation of the information Data analysis/interpretation of the information Formulation of the diagnosis and prognosis.Formulation of the diagnosis and prognosis. Development of the treatment plan Development of the treatment plan Communicating findings and presenting Communicating findings and presenting

rainbow of options rainbow of options to patient to patient

Data gatheringData gathering

Making sense of a whole lot of informationMaking sense of a whole lot of information

1.1. Looking for cancer, other growths, other Looking for cancer, other growths, other pathology that can be intercepted pathology that can be intercepted

2.2. Gathering as much information about the Gathering as much information about the patient as possible patient as possible

Methods of ExaminationMethods of Examination

Use sight, sound, smell, and touchUse sight, sound, smell, and touch ObservationObservation Palpation & Percussion Palpation & Percussion SmellSmell

ObservationObservation

Start as soon as the person answers the telephone Start as soon as the person answers the telephone – assess voice, hearing, memory, ‘busyness’, – assess voice, hearing, memory, ‘busyness’,

enthusiasmenthusiasm

Continue assessment when they are greeted in Continue assessment when they are greeted in the waiting roomthe waiting room

- gait, ease, appearance - gait, ease, appearance

Continue observation throughout appointmentsContinue observation throughout appointments

PalpationPalpation

Using the hands to examine to provide moreUsing the hands to examine to provide moreinformation about the salivary glands, lymphinformation about the salivary glands, lymphnodes, (thyroid gland, TMJ) by compressingnodes, (thyroid gland, TMJ) by compressingstructures against other fingers, hand, bone or otherstructures against other fingers, hand, bone or othertissuestissues- DigitalDigital- BidigitalBidigital- BimanualBimanual- BilateralBilateral

Correct techniqueCorrect technique

Just use fingertipsJust use fingertips Compress tissue about 10mm in a circular Compress tissue about 10mm in a circular

motion – use some pressuremotion – use some pressure When ready to move on, lift and move and When ready to move on, lift and move and

then circular motion in new areathen circular motion in new area

DigitalDigital

BidigitalBidigital

BimanualBimanual

Bilateral palpationBilateral palpation

PercussionPercussion

TappingTapping- In dentistry used mostly for teeth – best just In dentistry used mostly for teeth – best just

to use one finger or may use other end of to use one finger or may use other end of mirror handlemirror handle

Screening ExaminationScreening Examination

Important to develop a routineImportant to develop a routine

Start with observation at 12 o’clock positionStart with observation at 12 o’clock position Palpate temporalis – ask about pain or Palpate temporalis – ask about pain or

tendernesstenderness

Move to TMJMove to TMJ

Have patient open slowly, fully and watch as Have patient open slowly, fully and watch as they open – deviation? sounds? pain?they open – deviation? sounds? pain?

Watch as they slowly close Watch as they slowly close

Ask about history of any sinus painAsk about history of any sinus pain

Palpate both maxillary and frontal sinusesPalpate both maxillary and frontal sinuses

Move to angle of mandibleMove to angle of mandible

Palpate parotid gland (‘mumps’ gland while Palpate parotid gland (‘mumps’ gland while here)here)

Ask about tendernessAsk about tenderness

Move to submandibular salivary Move to submandibular salivary glandsglands

Palpate asking about tendernessPalpate asking about tenderness

Begin neck palpationBegin neck palpation

Remember correct palpation techniqueRemember correct palpation technique Constantly looking for any tenderness or Constantly looking for any tenderness or

change in consistencychange in consistency

Lymph nodesLymph nodes

Perioral examPerioral exam

AlaAla Nasiolabial foldNasiolabial fold PhiltrumPhiltrum Vermillion border Vermillion border Commissure of lipsCommissure of lips

Look for symmetry, scar tissue, swelling Look for symmetry, scar tissue, swelling

Intraoral soft tissueIntraoral soft tissue

Examine and palpate mucosal surface of lipsExamine and palpate mucosal surface of lips Check for scar tissue, bite marks, growthsCheck for scar tissue, bite marks, growths

Check cheeksCheck cheeks

Again, palpate for swelling – easiest bidigitalAgain, palpate for swelling – easiest bidigital

Move to floor of mouthMove to floor of mouth

Palpate in floor of mouth bidigitally to Palpate in floor of mouth bidigitally to examine the submandibular and sublingual examine the submandibular and sublingual salivary glandssalivary glands

Examination of the tongueExamination of the tongue

Using a gauze, have patient extend tongueUsing a gauze, have patient extend tongue Hold tongue and examine dorsal, ventral, and Hold tongue and examine dorsal, ventral, and

lateral surfaces and floor of mouth and throatlateral surfaces and floor of mouth and throat

Abnormal or Normal?

ThroatThroat

TeethTeeth

COUNT TEETHCOUNT TEETH Start with quadrant 1, go to 2, 3,and 4Start with quadrant 1, go to 2, 3,and 4 Check every surfaceCheck every surface

SummarySummary

Use sight, hearing, touch, and smell for Use sight, hearing, touch, and smell for examination purposesexamination purposes

The more information you gather, the better The more information you gather, the better the examination – the better you can diagnose, the examination – the better you can diagnose, predict outcome (prognosis) and the better the predict outcome (prognosis) and the better the treatment plantreatment plan