Diagnosis 3_Extraoral Examination

7/27/2019 Diagnosis 3_Extraoral Examination

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Dent 324; Extraoral Examination

Dr. Aceil Al-Khatib DDS,MS, Diplomat

ABOM


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Temperature,

Pulse,

Respiration, And blood pressure

All vital signs should be taken when the

patient is at rest; wait 30 minutes if thepatient has just eaten, drank a hot or cold

beverage, just smoked, or exercised.

Vital Signs


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Temperature

Normal range for temperature: (98.6=37)

Oral 97.6 99.6 (36.8-37.5C)

Rectal 98.6 100.6 (37.6 C)

Axillary 96.6

98.6 (36.4 C) Tympanic (ear) 99.5 ( 37.5)

In most adults, an oral temperature above 100F(37.8C) or a rectal or ear temperature above 101F (38.3C) is considered a fever. A child has a feverwhen his or her rectal temperature is 100.4F (38C) or higher


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Pulse

Cardiac rate, rhythm, and strength are

assessed by taking the pulse

Pulse is felt most plainly over these arteries:

Radial in the wrist, usually at the base of the

thumb

Carotid on each side of the neck Apical over heart with a stethoscope


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Use two fingers to feel the arteries. Do not use the

thumb to feel the pulse because there is a

pulse in it.

It is important to always take the pulse for 60 secondsto be able to feel an irregular pulse.


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Pulse

Bradycardia (100) occurs in anxious subjects

and in a variety of metabolic and cardiacdiseases.

Normal range =60 100 beats per minute(bpm)

Average resting heart rate = 72 bpm

Elite athlete resting heart rate = 40 to 50 bpm


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Assesses pressure within the arteries during

cardiac contraction (systole) and pressure

during cardiac pause (diastole)

To measure blood pressure, an inflatable

sphygmomanometer cuff is placed around the

upper arm.

The brachial artery is used for measuring

blood pressure.

Resting Blood Pressure


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Resting Blood Pressure

The brachial pulse ispalpated (the"antecubitalfossa").

The diaphragm is placed

over the brachial artery.

Systolic (top number)should be less than 130

Diastolic (bottomnumber) should be lessthan 85


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JNC Classification of blood pressure in adults

Classification BP (mm Hg)

Normalsystolic: less than 120

diastolic: less than 80

Pre-hypertension120-139 (systolic)

80-89 (diastolic)

Stage 1 hypertension

140-159 (systolic)

or90-99 (diastolic)

Stage 2 hypertensionequal or more than 160 (systolic)

equal or more than 100 (diastolic)

JNC: Joint National Committee on Prevention, Detection, Evaluation,

and treatment of high blood pressure


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Respiration Rate

Respirations may be counted by watching or

feeling ( with hand on the patients chest )the

number of times a persons chest rises and

falls in one minute.

One respiration is equal to the chest rising

(inhale) and falling (exhale) one time

The normal adult rate is 12-28 respirations per

minute (inhale + exhale =1 breath)


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Hyperpnea Vs Tachypnea

Hyperpnea : increased depth of respiration

(occurs in excersie, anemia, sepsis) when an

increase in body metabolic needs .

Tachypnea (increased shallow respirations),

may be encountered in anxious patients.


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Principles of Examination

Inspection

Palpation

Percussion Auscultation

Smelling


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Inspection


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Inspection

General appearance: Alert, distress, clean

State of nutrition: thin, temporal wasting

Symmetry: mild asymmetry is a variation of

normal Posture and gait : shuffle or foot drag

(Parkinsons) ,, limp.. lips and hands tremor

Speech: slurred (stroke), hoarse. Skin; Jaundice, lesions

Eyes: blue sclera, jaundice


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Sublingual icterus secondary to hepatitis C

(Jaundice( icterus)

Bleu sclera: osteogenesis imperfecta


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Extraoral Examination

Inspect the face, head, and neck.

Note any asymmetry ( mild asymmetry is a

variation of normal).

Inspect the skin and note any changes

Inspect the eyes, the ears and the hair


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Lymph Nodes Examination

Palpate lymph nodes to detect any enlargement:

Normal nodes if palpable are the size of a pea or lentil

Determine mobility and consistency of enlarged

nodes.

Recommended order of palpation:

the preauricular, submandibular, anterior cervical,

posterior auricular, and posterior cervical lymphnodes.


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Soft, tender, moveable

lymph node are more

likely associated with

an infection. Hard, nontender,

nonmoveable lymph

node may be morecharacteristic of a

neoplastic process

Lymph Nodes Examination


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The Temporomandibular Joint (TMJ)

The temporomandibular joint (TMJ) is

examined by palpation and auscultation

The interincisal maximal opening is measured

in millimeters (about 45 mm for females, 55

mm for males)

Record any deviation or pain on opening

Palpate the joint for tenderness


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The TMJ is examinedfrom preauricular andintra auricularapproach

The sound are usuallyrecorded andobserved by

stethoscopeauscultation orpalpation.


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The TMJ


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Muscles of Mastication


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Diagnosis 3_Extraoral Examination