1. Examination of dental patient: subjective and objective, basic and extra methods. Medical document of therapeutic dentistry reception. Hospital chart as medical, legal and scientific document Therapeutic dentistry department

2. METHODS OF DENTAL PATIENT EXAMINATION
Taking a history (subjective examination), during which the patient provides doctor with all diagnostic information about itself.
Objective examination (visual examination, palpation, percussion, probing) using basic and extra (laboratory, instrumental) methods.

3. Subjective examination
Demographic details
Anamnesis
History of the present complaint
The family and social history
The medical history
The dental history

4. ►Put patients at their ease ►Start with an open question
Table. Essential principles of history-taking technique
►Introduce yourself and greet patient by name
►Put patients at their ease
►Start with an open question
►Avoid leading questions
►Avoid jargon
►Explain the need for specific questions
►Assess the patient’s mental state
►Assess the patient’s expectations from treatment

5. Table 1.4 Taking a pain history
Characteristic
Informative features
Type
Ache, tenderness, dull pain, throbbing, stabbing, electric shock. These terms are of limited and the constancy of pain is more useful.
Severity
Mild – managed with mild analgesics (e.g. aspirin / paracetamol)
Moderate – unresponsive to mild analgesics
Severe – disturbs sleep
Duration
Time since onset. Duration of pain or attacks.
Nature
Continuous, periodic or paroxysmal. If not continuous, is pain presence between attacks?
Initiating factors
Any potential initiating factors. Association with dental treatment or lack of it is especially important in eliminating dental cause.
Exacerbating and relieving factors
Record all and note especially hot and cold sensitivity or pain on eating which suggest a dental cause.
Localisation
The patient should map out the distribution of pain if possible. Is it well or poorly defined?
Referral
Try to determine whether the pain could be referred.

6. OBJECTIVE EXAMINATION
Clinical examination — extra-oral
Symmetry and Profile

7. Cutaneous Area
Cutaneous lesion of discoid lupus
Lupus erythematosus

8. Eyes Observe the eyes for any abnormalities
Yellow sclera is associated with jaundice and may indicate an undiagnosed case of hepatitis (A or B), other liver dysfunction or a blood disorder

9. Lymphatic nodes
The presence of neck masses is not an uncommon finding, especially in patients with oral infections or advanced malignancies. The anterior cervical chain is most commonly involved, although other regional lymph nodes may be enlarged as well. Lymphadenopathy secondary to infection generally is both mobile and tender, while metastatic lymphadenopathy is asymptomatic and fixed to the underlying structures; however, a significant amount of variation exists in both subjective and objective findings.

10. Palpation of Lymph Nodes
Occipital nodes.
.Palpate the occipital nodes about one inch above and below the hairline.
Bilateral palpation of the occipital nodes. Be sure to also observe the skin in this area.

11. Postauricular nodes. Pre-auricular nodes.
Auricular . Palpate the pre and post auricular nodes bilaterally using the pads of the index, middle and ring fingers.
Postauricular nodes.
Pre-auricular nodes.

12. Palpation of the anterior cervical nodes.
Cervical Chain. Palpate the nodes medial to the sternocleidomastoid muscle using a bidigital technique and the nodes posterior to the muscle with a bimanual technique.
Palpation of the anterior cervical nodes.
Palpation of the posterior cervical nodes

13. Bilateral palpation of the supraclavicular lymph nodes.
Supraclavicular. These nodes are examined using digital compressions just superior to the clavicle.
Bilateral palpation of the supraclavicular lymph nodes.

14. Submandibular lymphatic nodes.
Palpate the submandibular nodes by pulling or rolling the tissues under the chin up and over the inferior border of the mandible. Ask the patient to touch the roof of the mouth with the tongue, pressing firming against the roof will allow you to assess the muscles and any pathology associated with the submandibular lymph node areas.
Palpate the submandibular lymph nodes using a cupped hand as shown.

15. Submental lymphatic nodes.
Use digital palpation to determine the presence of an abnormal submental lymph node.
Digital palpation of the submental lymph nodes

16. Salivary glands
Palpation of parotid gland (superficial lobe)

17. Palpation of the submandibular glands.
Normally these glands should not be palpable. Induration and pain could be signs of infection, blockage, immune system disorder or a neoplastic process. In addition, non-tender parotid enlargement may occur with alcoholism, diabetes, Sjogren’s syndrome, eating disorders, HIV infection and various malignant/non-malignant states.

18. TMJ Palpate upon opening What is the maximum intermaxillary space?
Is the opening symmetrical?
Is there popping, clicking, grinding?
What do these sounds tell you about the anatomy of the joint?
When do sounds occur?
Use your stethoscope to listen to sounds

19. TMJ Proper positioning of the fingers on the TM joint.
Have the patient open and close slowly
Crepitation, clicking, and popping of the temporomandibular joints are most easily detected by placing the tips of the little fingers in the external auditory canals and having the patient perform a series of excursive mandibular movements

20. Lips
Bidigital palpation of the upper and lower labial mucosa

21. Exam: Lips-sun exposure

22. ORAL EXAMINATION examination of vestibule of oral cavity
examination of oral cavity itself

23. Examination of lips’ frenum: its attachment and level of attached gingiva

24. Maxillary labial vestibule showing frenulum
Mandibular labial vestibule
Vestibule of oral cavity—the region between the lips and cheeks and the teeth. The fold of tissue created by the vestibule between the lip and teeth is called the vestibular or mucolabial (mucobuccal) fold

25. Occlusion
Orthodontic classification
Interferences

26. Occlusion
Determination of occlusion

27. Gingiva Bidigital palpation of attached gingiva and muccolabial fold.
Normal condition of alveolar mucosa, gums tightly overlaps tooth’ neck

28. Gingiva
Note color, tone, texture, architecture & mucogingival relationships

29. Gingiva How would you describe the gingiva?
Marginal vs. generalized?
Erythematous vs. fibrous
Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant

30. Soft tissues
Orifice of Stenson duct
Linea alba on the buccal mucosa

31. Examination: Buccal Mucosa
Linea alba
Stenson’s duct

32. Examination: Buccal Mucosa
Lesions – white, red
Lichen Planus, Leukedema

33. Exam: Hard palate Minor salivary glands, attached gingiva
Note presence of tori: tx plan any pre-prosthetic surgery

34. Exam: Soft palate How does soft palate raise upon “aah”?
Vibrating line, tonsilar pillars, tonsils, oropharynx

35. Exam: Tongue Have the patient stick out their tongue
Wrap the tongue in a dry gauze and gently pull it from side to side to observe the lateral borders
Retract the tongue to view the inferior tissues

36. Exam: Tongue

37. Exam: Tongue
You may observe lingual varicosities

38. Exam: Tongue
You may observe geographic tongue (erythema migrans)

39. Exam: Tongue
You may observe drug reaction

40. Exam: Tongue
Observe signs of nutritional deficiencies, immune dysfunction

41. Exam: Tongue
You may observe oral cancer

42. Exam: Floor of mouth Visualize, palpate - bimanually Wharton’s duct
Must dry to observe
Does “lesion” wipe off?
Where are the two most
likely areas for oral cancer?
lateral border of the tongue
Floor of mouth

43. Palpation of the floor of the mouth

44. Exam: Floor of mouth

45. Exam: Floor of mouth
Squamous Cell Carcinoma

46. Exam: Floor of mouth
Squamous Cell Carcinoma

47. Exam: Leukoplakic area
Edentulous Mandibular Ridge

48. Systematic Oral Examination
Done at initial exam & at recalls unless patient history requires sooner
You must visualize all areas of the oral cavity
Oral cancer can occur in other places than the lateral borders of the tongue & the floor of the mouth
Be complete
Do good, do no harm, do justice, respect autonomy

49. Visualize all areas

50. Breath Oral odors can indicate: Infection: caries, periodontal dx
URT infections
Chronic G.I. disturbances
Lung abscess
Diabetic acidosis
Uremia, kidney problem
Liver failure: mousy, musty odor
Self-medication with alcohol

51. Thank you for attention!