011 SOFT TISSUE EXAM
As any good relationship starts with a pt we have the oral exam. an intentional "non invasive" exam to screen for disease in the pt and build some rapport.
What we've been assigned to do in our 011 is basically:
- Intro and greeting
- History taking
- Soft tissue exam
- Plaque Free
- Hard tissue exam
- Radiographs and diagnosis/ Tx planning
SOFT TISSUE EXAM
extra oral
"Before i look inside your mouth i'm going to look and feel outside your mouth just as a routine screening to make sure everything is healthy"
soft tissue exam consists of bimanual palpation (for the most part) of the pts extraoral features. TMJ, Muscles of mastication, Lymph nodes (before ear? retroauricular, cervical, sub mental and sub md.
I found this videa useful: http://www.youtube.com/watch?v=yY9-7pOTROM . Target all the nodes and feel for gross swellings. I've never found any myself so i honestly have no idea what i'm looking for but oh wells.
I find it good positioning to stand behind the pt and palpate from there but they might find it more comforting to stand in front of them where they can see you. PPE for this includes mask, glasses and gloves are apparently optional but there are a lot of skin surface pathogens that could keep you awake at night if you don't glove up whenever you're in contact with the pt.
You should be able to feel TMJ clicking with the condyles heading back into the glenoid fossa at different times. always double check if the pt has felt clicking there, If they have but it isn't causing them any pain then just advise them about it but if they are experiencing TMD then you can refer to pros for a splint construction. Careful with TMD patients. Don't advise they chew gum after a meal (khan) as that can aggrivate their condition
While you're looking for lymphodenapathy, oberve the pts face and neck for any swellings, colour changes or assymmetry which could indicate pathology. from there. feel the muscles of mastication (only temporalis and masseter extra orally and ask if they have felt any muscle pain there.)
intra oral.
"okay now i'm going to look inside your mouth at the soft tissues and we'll move onto your teeth after this. It's just to be thorough with my examination"
use a mirror handle and the handle of another instrument to pull apart the cheeks and lips (or index fingers of both hands) and inspect the labial and buccal mucosainspect the buccal and labial gingiva and note any recession for later. you're looking for ulcerations, discolourations lumps and bumps or malformations. use a mouth mirror head and retract the tongue to check the labial gingiva on md and the palate (common is nicotinic stomaitis.) I havent done this before but look directly into the mouth from the front of the pt and check the fauces and palatine tonsils (enlargement of the tonsils indicates systemic disease) . tell the patient to stick their tongue to the roof of their mouth (don't say palate) and check underneath their tongue for abnormal lingual veins and englarged sublingual glands. I tend to want to leave all palpations to the end and make the procedure progessively more invasive as it allows them to become confident with you at first. run your finger along the lingual border of the md and feel for md torii, wrap the tip of the tongue in gauze and twist the tongue to both sides and inspect the sides of the tongue. be awayre that there is normal foliate papillae and compare both sides to judge pathology. IF YOU NOTICE ANYTHING ABNORMAL IN THE MOUTH THAT LOOKS SUSPICIOUS THEN REFER TO ORAL MED. ask pt questions i.e. have they noticed the lesion, does it hurt, how long has it been there? has it changed. DONT SAY LESION. say whiteness, patch, furriness etc
Next comes the PSR screening still under the soft tissue exam as it is technically probing the gingiva. probe at a 20-35 degree andgle to the tooth surface, not directly parallel. use light force and that involves holding the robe very loosely. if you're using a PSR probe... don't focus on the pocket depth. anything under 3.5mm you don't care about. insteal focus on feeling for calculus and watch for bop, furcation involveents and mobility. If your mind picks up that the gingiva is in or past the black then deffs mention it to your assistant or write it down. places to look out for are buccal of the upper 6s and lingual of the lowers. also pay closer attention to places with supragingival plaque.
What we've been assigned to do in our 011 is basically:
- Intro and greeting
- History taking
- Soft tissue exam
- Plaque Free
- Hard tissue exam
- Radiographs and diagnosis/ Tx planning
SOFT TISSUE EXAM
extra oral
"Before i look inside your mouth i'm going to look and feel outside your mouth just as a routine screening to make sure everything is healthy"
soft tissue exam consists of bimanual palpation (for the most part) of the pts extraoral features. TMJ, Muscles of mastication, Lymph nodes (before ear? retroauricular, cervical, sub mental and sub md.
I found this videa useful: http://www.youtube.com/watch?v=yY9-7pOTROM . Target all the nodes and feel for gross swellings. I've never found any myself so i honestly have no idea what i'm looking for but oh wells.
I find it good positioning to stand behind the pt and palpate from there but they might find it more comforting to stand in front of them where they can see you. PPE for this includes mask, glasses and gloves are apparently optional but there are a lot of skin surface pathogens that could keep you awake at night if you don't glove up whenever you're in contact with the pt.
You should be able to feel TMJ clicking with the condyles heading back into the glenoid fossa at different times. always double check if the pt has felt clicking there, If they have but it isn't causing them any pain then just advise them about it but if they are experiencing TMD then you can refer to pros for a splint construction. Careful with TMD patients. Don't advise they chew gum after a meal (khan) as that can aggrivate their condition
While you're looking for lymphodenapathy, oberve the pts face and neck for any swellings, colour changes or assymmetry which could indicate pathology. from there. feel the muscles of mastication (only temporalis and masseter extra orally and ask if they have felt any muscle pain there.)
intra oral.
"okay now i'm going to look inside your mouth at the soft tissues and we'll move onto your teeth after this. It's just to be thorough with my examination"
use a mirror handle and the handle of another instrument to pull apart the cheeks and lips (or index fingers of both hands) and inspect the labial and buccal mucosainspect the buccal and labial gingiva and note any recession for later. you're looking for ulcerations, discolourations lumps and bumps or malformations. use a mouth mirror head and retract the tongue to check the labial gingiva on md and the palate (common is nicotinic stomaitis.) I havent done this before but look directly into the mouth from the front of the pt and check the fauces and palatine tonsils (enlargement of the tonsils indicates systemic disease) . tell the patient to stick their tongue to the roof of their mouth (don't say palate) and check underneath their tongue for abnormal lingual veins and englarged sublingual glands. I tend to want to leave all palpations to the end and make the procedure progessively more invasive as it allows them to become confident with you at first. run your finger along the lingual border of the md and feel for md torii, wrap the tip of the tongue in gauze and twist the tongue to both sides and inspect the sides of the tongue. be awayre that there is normal foliate papillae and compare both sides to judge pathology. IF YOU NOTICE ANYTHING ABNORMAL IN THE MOUTH THAT LOOKS SUSPICIOUS THEN REFER TO ORAL MED. ask pt questions i.e. have they noticed the lesion, does it hurt, how long has it been there? has it changed. DONT SAY LESION. say whiteness, patch, furriness etc
Next comes the PSR screening still under the soft tissue exam as it is technically probing the gingiva. probe at a 20-35 degree andgle to the tooth surface, not directly parallel. use light force and that involves holding the robe very loosely. if you're using a PSR probe... don't focus on the pocket depth. anything under 3.5mm you don't care about. insteal focus on feeling for calculus and watch for bop, furcation involveents and mobility. If your mind picks up that the gingiva is in or past the black then deffs mention it to your assistant or write it down. places to look out for are buccal of the upper 6s and lingual of the lowers. also pay closer attention to places with supragingival plaque.
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