Oral Medicine and Pathology at a Glance

Pedro Diz Dios, Crispian Scully, Oslei Paes de Almeida, José V. Bagán, Adalberto Mosqueda Taylor

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119121367
• Edition: 2
• Topic: Medizin
• Subtopic: Mundhygiene & Zahnchirurgie

Oral Medicine and Pathology at a Glance, 2 nd Edition offers a comprehensive overview of essential aspects of oral medicine and pathology, with an emphasis on oral health care provision in general practice.

• Updated new edition, covering the most important conditions and commonly encountered oral pathologies and their clinical management
• Presented in the popular, highly-illustrated At a Glance style with clinical photographs throughout
• Written by an international author team
• Includes a companion website with self-assessment MCQs, further reading and downloadable images

1
Examination of extraoral tissues

This book does not include the basics of history taking, only specific relevant points in the text. Bear in mind that the history gives the diagnosis in about 80% of cases.

Following the history, during which the clinician will note the patient’s conscious level, any anxiety, appearance, communication, posture, breathing, movements, behavior, sweating, weight loss or wasting (Figure 1.1), physical examination is indicated. This necessitates touching the patient; therefore, informed consent and confidentiality are required, a chaperone available, and religious and cultural aspects should be borne in mind (see Scully and Wilson).

Figure 1.1 Cerebral palsy head.

Relevant medical problems may even be manifest in the fully clothed patient – where changes affect the head and neck, cranial nerves, or limbs. Therefore, while there is no rigid system for examination, the clinician should ensure that these areas are checked.

Head and neck

Pupil size should be noted (e.g. dilated in anxiety or cocaine abuse, constricted in heroin abuse).

Facial color should be noted:

• pallor (e.g. anemia)
• rashes (e.g. viral infections, lupus) (Figure 1.2)
• erythema (e.g. anxiety, alcoholism, polycythemia)

Figure 1.2 Hereditary hemorrhagic telangiectasia.

Swellings, sinuses or fistulas should be noted (Figure 1.3).

Figure 1.3 Cutaneous odontogenic fistula.

Facial symmetry is examined for evidence of enlarged masseter muscles (masseteric hypertrophy) suggestive of clenching or bruxism.

Neck swellings should be elicited, followed by careful palpation of lymph nodes (and salivary and thyroid glands), searching for swelling and/or tenderness, by observing the patient from in front, noting any obvious asymmetry or swelling (Figure 1.4a and b), then standing behind the seated patient to palpate the nodes. Systematically, each region needs to be examined lightly with the pulps of the fingers, trying to roll the nodes against harder underlying structures.

Figure 1.4a Lipoma.

Figure 1.4b Scan of lipoma (arrow on lesion).

Some information can be gained by the texture and nature of the lymphadenopathy; nodes that are tender may be inflammatory (lymphadenitis), while those that are increasing in size and are hard, or fixed to adjacent tissues, may be malignant.

Cranial nerves

The cranial nerves should be examined, in particular facial movement and corneal reflex should be tested and facial sensation determined (Table 1.1). Movement of the mouth as the patient speaks is important, especially when they allow ...