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

 METHODS OF DENTAL
PATIENT EXAMINATION

Taking a history Objective examination

(subjective (visual examination,
examination), during palpation, percussion,
which the patient probing) using basic
provides doctor with all and extra (laboratory,
diagnostic information instrumental) methods.
about itself.
 Subjective examination
Demographic
details
Anamnesis History of
the present
complaint

The family and The medical

social history history

The dental
history
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 patients mental state
Assess the patients expectations from treatment
Table 1.4 Taking a pain history
Characteristic Informative features

Ache, tenderness, dull pain, throbbing, stabbing, electric shock.

Type These terms are of limited and the constancy of pain is more useful.

Mild managed with mild analgesics (e.g. aspirin / paracetamol)

Severity Moderate unresponsive to mild analgesics
Severe disturbs sleep
Duration Time since onset. Duration of pain or attacks.
Continuous, periodic or paroxysmal. If not continuous, is pain
Nature
presence between attacks?
Any potential initiating factors. Association with dental treatment or
Initiating factors lack of it is especially important in eliminating dental cause.

Record all and note especially hot and cold sensitivity or pain on
Exacerbating and eating which suggest a dental cause.
relieving factors

The patient should map out the distribution of pain if possible. Is it

Localisation
well or poorly defined?
Referral Try to determine whether the pain could be referred.
OBJECTIVE EXAMINATION
Clinical examination extra-oral
Symmetry and Profile
 Cutaneous Area
Cutaneous lesion of discoid lup

Lupus erythematosus
 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
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.
 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.
Auricular . Palpate the pre and post auricular nodes bilaterally
using the pads of the index, middle and ring fingers.

Postauricular nodes.

Pre-auricular 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
Supraclavicular. These nodes are examined using
digital compressions just superior to the clavicle.

Bilateral palpation of the supraclavicular

lymph nodes.
 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
Palpate the submandibular pathology associated with the
lymph nodes using a cupped submandibular lymph node
hand as shown. areas.
 Submental lymphatic nodes.
Use digital palpation to determine the presence of an
abnormal submental lymph node.

Digital palpation of the submental lymph nodes

 Salivary glands

Palpation of parotid gland

(superficial lobe)
 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, Sjogrens syndrome, eating disorders, HIV infection and various
malignant/non-malignant states.
 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

 TMJ
Proper positioning of the fingers on Have the patient open and close
the TM joint. 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
Lips
Bidigital palpation of the
upper and lower labial
mucosa
Exam: Lips-sun exposure
 ORAL EXAMINATION

examination of
vestibule of oral cavity
examination of oral
cavity itself
 Examination of lips frenum: its
attachment and level of attached gingiva
 Maxillary labial vestibule
showing frenulum

Mandibular labial
vestibule

Vestibule of oral cavitythe 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
Occlusion
Orthodontic
classification
Interferences
Occlusion

Determination of occlusion
 Gingiva
Bidigital palpation of attached
gingiva and muccolabial fold.

Normal condition of alveolar

mucosa, gums tightly overlaps
tooth neck
Gingiva
Note color, tone,
texture, architecture &
mucogingival
relationships
Gingiva
How would you describe the gingiva?
Marginal vs. generalized?
Erythematous vs. fibrous
Drug reactions: Anti-epileptic, calcium channel
blockers, immunosuppressant
 Soft tissues

Orifice of Stenson duct

Linea alba on the buccal

mucosa
Examination: Buccal Mucosa
Linea alba
Stensons duct
Examination: Buccal Mucosa
Lesions white, red
Lichen Planus, Leukedema
Exam: Hard palate

Minor salivary glands, attached gingiva

Note presence of tori: tx plan any pre-
prosthetic surgery
Exam: Soft palate

How does soft palate raise upon aah?

Vibrating line, tonsilar pillars, tonsils,
oropharynx
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
Exam: Tongue
Exam: Tongue
You may observe
lingual varicosities
Exam: Tongue
You may observe geographic tongue
(erythema migrans)
Exam: Tongue
You may observe drug reaction
Exam: Tongue
Observe signs of nutritional deficiencies,
immune dysfunction
Exam: Tongue
You may observe oral
cancer
Exam: Floor of mouth
Visualize, palpate - bimanually
Whartons 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
Palpation of the floor of the mouth
Exam: Floor of mouth
Exam: Floor of mouth
Squamous Cell Carcinoma
Exam: Floor of mouth
Squamous Cell Carcinoma
Exam: Leukoplakic area
Edentulous Mandibular Ridge
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
Visualize all areas
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