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

Structures: o o o Teeth blunt end of the mouth mirror Facial Muscles - 2nd and 3rd finger is used 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 = (+) CHVOSTEKS SIGN Motor movement of the eyes: III, IV, VI CN o Strabismus uncontrolled squinting of the eyes Diplopia double vision Ptosis drooping of the eyelid

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 symmetrical structures on both sides of the face EXAMPLES i. ii. iii. iv. R & L TMJ Parotid area Submandibular and sublingual area Cervical area of the neck

o o

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

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

CHORDA TYMPANI Gustatory sensation Branch of CN VII

2.

Check the maximum extent of mouth opening a. Extent of the interincisal distance

5th CN facial sensory 8th CN (vestibulocochlear) For hearing and balance

3.

Do palpation in front of the ears just above the condyles a. b. Check for movements and clicking sounds

9th & 10th CN Loss of gag reflex 11th CN (Spinal Accessory) Check for tenderness when the patient opens and closes the mouth Posterior part of the TMJ is located at the External Auditory Meatus No lateral movement of the head No shrugging

c.

PERCUSSION (sight and hearing) For localization of inflammation of Periodontal membrane and 2 pulpitis

12th CN (hypogossal) No motor movement of tongue Cannot protrude tongue

AUSCULTATION Refers to the act of listening to the sound produced by various body structures Examples: o o Heart LUBDUB SOUND Lungs during breathing in and out

b.

Usually assessed on patients 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

Used in dentistry for: o o o Examination of TMJ Diagnosis of fractured jaw BP measurement

ABNORMALITIES IN BODY SYMMETRY (ASYMMETRY) A. Tissue Deficiency B. Physical injury degenerative disease

PROBING Used for: o o Detection of carious lesion Determine depth of periodontal/crevicular pocket Diagnostic aspiration or aspiration biopsy

Tissue Enlargement Unilateral facial swelling

C.

Abnormal tissue position Scoliosis or lateral spine curvature

CLASSIFICATION OF BODY BUILT (HABITUS) 1. Asthenic 2. Sthenic 3. Well proportioned, athletic build Slender and underweight

OLFACTORY EXAMINATION Discretely done Not an SOP

EVALUATION OF FUNCTION 1. Pulp vitality testing using pulp vitalometer or thermal test Determination of occlusal relationship through the production of diagnostic cast

Hypersthenic (Stocky build) Heavy bone/ muscular proportion

2.

4.

Pyknic heavy, soft and rounded build Abundance in body fat

GPA (GENERAL PATIENT APPRAISAL) Consist of the impressions concerning the patients health status that can be gained by inspection from a comfortable distance

STATURE or HEIGHT ABNORMALITIES 1. Large stature or GIGANTISM a. 2. ACROMEGALY after puberty gigantism

1.

Patients identifying/demographic features a. b. c. Age Gender Race

Small stature or DWARFISM a. CRETINISM small stature with mental retardation due to thyroid gland disorder

FACIAL FORM/HEAD SHAPE 1. NORMOCEPHALIC/ MESOCEPHALIC BRACHYCEPHALIC short round skull shape

2.

Mental Orientation and emotional status a. Psychic state of the patient

2.

3.

DOLICOCEPHALIC long narrow head shape

-Rosette Go 081410