Oral Medicine Lec3

7/27/2019 Oral Medicine Lec3

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Examination of cranial nerves

.Abducent6. Trochlear ,4.Occulomotor ,3

Pupillory reflexes -------- both pupil on both sides

should be constructed

Diplopia ----------- patient see 1 object in 2 objects

Nystagms ---------- pendular movement of the eye or

rapid jerking

Ptosis -------- the patient can not elevate eyelid

completely.


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.Trigeminal nerve5

-sensory function : examined by light touch withcotton to the area

-motor function : by exam the muscle of mastication

- reflexes:

Cornal reflex :both eyes should be closed when

each corner is stimulate with a piece of cotton.

Jaw jerk : by applying a downward tap on the chin,

the tap produce a reflex contraction (( brisk

closure)).


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.Facial nerve7

Motor function:

# Ask the patient to wrinkled forehead.

# Ask the patient to rise eye brows.# Ask the patient to show his teeth.

# Ask the patient blow out his cheeks.

any involuntary movement like tics or spasm.Notice

of tongue.3/2: test the anteriorSensory function

. The Vestibulocochlear nerve8

- Examination is done by using of Tuning fork.- The normal patient should equally heard by both

ear.


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.Glossopharngael nerve9The patient loss of taste in the posterior third of the

tongue or by

palatal reflex---- when the soft palate is touch it

move upward.

. Vagus nerve10- The nasal quality of the voice-- Drooping of unilateral or bilateral of soft palate.

- Does the palate move when the patient says ((ah))for long times, and also tray to observe the palatal

movement in bilateral palsies here the palate will not

elevate. And in unilateral lesion the one side of the

palate remaining immobile.


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.The Spinal accessory nerve11

Here we examine the sternomastoid and the

trapezius muscle by :

-- ask the patient to press the chin downward

against the resistance of the examiner`s hand.

- ask the patient to turn against resistance.


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.Hypoglossal nerve12

-- Ask the patient to protrude the tongue andcarefully see the deviation if there is unilateral

weakness it deviated toward the paralysed side.

-- Ask the patient to move the tongue in- outdirection & from one side to other slowly and

rapidly.

- Ask the patient to press the cheek with the tonguewhile the examiner`s finger resist the movement by

pressure on the outside the cheek.

(any defect in the nerve lead to paralysis, tremor,

abnormalities in movement)


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TMJThe dentist should have a sound knowledge of the

function anatomy of TMJ and associated structure

prior to under taking the examination of the patient.

Inspection

Examination of the TMJ and masticatory muscleshould begin by observing the degree of symmetry

of the mandible and face, and by observing the path

of excursion of the mandible on opening and

closing. It is helpful to focus on specific landmark(such as the mesial incisal edge of mandibular

central incisor) whilst asking the patient to open and

close their mouth in this way any lateral deviation

will be noted.


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Palpation

In order to examine the joint by palpation the

examiner should be in front of the patient so that

movement of the mandible may be related to thosepalpated in the condylar heads.

A single finger is placed over each condylar head

while the mandibular movement are carried out.

Abnormal tenderness associated with the lateralaspect of joint detected by light pressure over the

condyle


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Intra Oral Examination

The TeethNumber of teeth, caries and fillings , loose teeth,

crowns, discoloration of teeth,.etc

The GumThe color and texture of the gum are noted, and the

standard of oral hygiene classified including thepresence of plaque and calculus , recession

,pocketing ,and hyperplastic of the gum is

measured, and the mobility of teeth assessed.


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The Palate

: ask the patient to tilt his headInspection of palate

Slightly backwards and to open his mouth to his

fullest extent. If the height is good the whole palate

can be observed.

- Ask the patient to say "Ah" loss of movement of

half of the soft palate suggest a lesion of the vagus

nerve or infiltrating neoplasm of the nasopharynx ,

while paralysis of the whole soft palate is found in

the bulbar form of poliomyelitis.


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The floor of Mouth

Ask the patient to put the tip of tongue on the roof of

the mouth and bend the head slightly backward and

examine the color, texture and presence of swelling

or ulceration.

Examination of Mucosa of cheek

Retract the angle of the mouth and the interior is

illuminated with a torch to examine the color, texture

and presence of swelling or ulceration.


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The Tongue

The Tongue will tell the dentist many things, not onlyby what we hear but by what we see first.

Color: because of it`s rich blood supply of the

capillary network closed to it`s surface make thecolor of tongue is dark red and normally it is

covered by slight grayish coating.

-- Excessive furring will be result from:1) Local infection either from the mouth or from

nose, throat, lung

2) Dehydration either from pyrexia, mouth breathing,

smoking.


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3) Discoloration of tongue can be occur due

to :

[a] food[b] iron containing medicine lead to black

color

[c] antibiotic change in oral flora --- candidainfection lead to white color

4) Dry tongue mostly occur due to renalfailure , dehydration ,intestinal obstruction,

xerostomia , mouth breather.


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The dentist have to inspect the dorsum of

the tongue for any swelling, ulcer , white

lesion & fissure.

-- In anemic patient : depapillated ,smooth

,sore and shiny.

-- In cynosis patient : the cynosis of tongue is

central in origin.

-- In Acromegaly and Mongolsim ----- large and

usually fissured in mongolism.


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Methods of examination of tongueof the tongue3/2(a)Examination of anterior

Ask the patient to put out his tongue and wrapping apiece of gauze around the tip of protruded tongue

and moved to left and right side to observed

lateral surface, to see any abnormalities present

such as large size than normal which may be dueto inflammation or muscular hypertrophy

(muscular macroglossiadiffuse benign

neoplasm).

Examination of ventral surface (under surface) of the

tongue done by asking the patient to rotate the

tongue upward toward the rest of his mouth.


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of the tongue3/1(b) Examination of posterior

Ask the patient to open the mouth widely and press

the left index finger firmly into the cheek i.e. it

intervenes between the teeth, then palpating the root

of the tongue , if patient have gag reflex use sprayanesthesia.

Palpation of posterior 1/3 of tongue should be

undertaken when the patient have :(1) discomfort at the back of the tongue

(2) slight dysphasia

(3) doubtful ankyloglossia


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(c) Neurological examination of the tongue(Examination of hypoglossal nerve )

Inability to protrude the tongue fully may be

due to ankyloglossia {in old and middle aged

patient suggest advanced neoplastic

infiltration of the lingual musculature , while

in young patient suggest congenital shortfrenum}


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Examination of salivary glandsThe dentist should know the following information

prior to examination of S.G1/ position of S.G and associated structure

2/ clinical features of S.G diseases

3/ investigations required for every symptoms.

Clinical examination;

During examination the dentist may notice:

1- asymmetry and detectable extra or intra oral

swelling2- sometimes large calculi may be palpable as

hardness

3- saliva should be carefully notice if it turbid or

mucopurulent


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4-pain and skin involve with a firm-rapidly growing

mass

5-facial nerve palsy is sinister sign when the parotid

mass is detected6- lymph node detected

7-hypersalivation: this may associated with certain

neurological disorder

8-dry mouth

The parotid gland

When dentist notice a swelling in site of parotid

gland he should examine it as following:


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Inspection

The characteristic of the general enlargement is a

swelling in front of the tragus extending downward

and slightly backward, and obliterating the normaldepression below and in front of the ear.

Palpation

Lay the pulp of finger over the main body of the

gland and a ascertain the consistency of the

swelling ( tender or not )

Palpate the superior 1/3 of the gland (if there is

fullness and if it continue with the main body of theparotid gland)

Lay the finger over the inferior 1/3 of the gland ( if

the whole parotid gland is enlarge there will be

fullness over the posterior-inferior part)


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of parotid glandorificetheExamination of

(stensen`s duct) which lies opposite the second

upper molar by:

retract the cheek with a spatula ,with a gentlepressure or massage to the parotid gland and see

the saliva if there is gush purulent saliva or drops of

thicker pus.

Submandibular S.GHere the dentist notice a swelling beneath and in front of

the angle of the jaw, or if the swelling occur only either

just before or during meals this may give an indication

that the submandibular S.G is involved.

Any swelling at this area should be differentiated from

other swelling in this region

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Oral Medicine Lec3