Sei sulla pagina 1di 38

METHODS OF PHYSICAL

EXAMINATION
PHYSICAL EXAMINATION METHODS CAN BE DESCRIBED BY THE PRIMARY
SENSE ON WHICH THE TECHNIQUE RELIES
I. Visual Examination
Inspection - passive visual examination by the clinician while
the patient is in the resting state
Visualization - more active process; observation after
altering the patient’s resting status
- opening the mouth, extending the tongue, removing the
saliva
- recognize normal variations of color, pattern, contour,
symmetry, size, texture, and location of superficial structures,
proportions of the body and functional movements
Transillumination - a
visual diagnostic
method that relies on
the passage of light
through relatively
thin, translucent
tissues
II. Examination by Palpation
relies on the sense of touch
termed as the “third eye”
examines structures deep under the surface
and perceive characteristics such as
compressibility, tenderness, and anatomic
relationships not visually apparent
PALPATION TECHNIQUES:
1. Bimanual palpation - both
hands; one hand to manipulate
the tissue while the other supports
the structures from the opposite
side
- provides appreciation of deep
structure by trapping the tissues of
interest between hands
2. Bidigital palpation
- two fingers for thinner
tissues such as lips
3. Bilateral palpation
(compression)
- simultaneous
manipulation of
symmetrical structures to
appreciate the difference
between one side from the
other
response of tissues to pressure can
suggest the composition of the structures
muscles, glandular tissue, and bone all
have a characteristic resistance to applied
pressure
Features obtained by palpation:

• surface temperature • consistency


• anatomic regions and planes • fluctuance and emptiability
• mobility • pain and tenderness
• extent and borders of the • unilateral / bilateral
mass
• solitary / multiple
• thickness of overlying tissues • size and shape
PERCEPTIONS GAINED BY PALPATION AND
THE IMPLICATIONS RELATIVE TO TISSUE
COMPOSITION ARE REFLECTED BY THE FF:

• Bony hard • Doughy


• Indurated • Spongy
• Firm • Pitting
• Compressible • Collapsing
Bony Hard
rigid or unyielding sensation of bone
tissue and implies that the structure is
calcified
Firm
masses yield more to pressure than do
indurated tissues, however, minimal shape
alteration occurs in contrast to compressible
tissues
Indurated
hardness but without the rigid sensation
associated with calcification
Compressible
pressure significantly alters the shape of
the structure

Doughy
structure deforms with a degree of
resistance suggesting semi-solid contents,
then returns slowly to its original shape
Spongy
structure offers minimal resistance to pressure and
quickly regains the original contour after pressure is
released

Pitting
structure offers minimal or moderate resistance and
then slowly regains the original contour after pressure
is released
Collapsing
easily compressible enlargement that
remains deformed after the release of
pressure
implies that the contents of structure have
been displaced
III. Examination by Auscultation
diagnostic process of
listening to the sounds
made by various body
structures
vascular vibration can
produce a murmur or
blowing sound (bruit)
IV. Examination by Sense of Smell
occasionally contributes diagnostic information
aroma of alcohol; fruity scent of acetone is
associated with uncontrolled diabetes
bacterial infections are characterized by foul or
putrid odor
professional decorum requires that clinician pursue
“olfactory examination” discretely
V. Examination by Probing
Probing - use of a
periodontal probe to
identify or
determine the
extent of a narrow
tract or cavity
Aspiration - sharp
probing with a
needle to enter or
withdraw material
from a tissue
structure using
negative pressure
VI. Evaluation of Function
permits organization of some apparently
unrelated symptoms
decrease the possibility of overlooking
important symptoms by including areas of the
body giving the examiner logical sequence
for complete review of patient’s history
APPLICATION OF
PHYSICAL EXAMINATION
TECHNIQUES TO
DENTISTRY
Visual examination
patient positioning and direction of intraoral light source
affects the ability of the dentist
removal of materials such as food debris and appliances
is essential
presence of saliva can obscure subtle features of many
mucosal lesions
transillumination can reveal proximal caries of anterior
teeth
Palpation and Percussion
used to localize tenderness and pain
identify and quantify tooth mobility

Probing
most effective method of detecting lesions
accomplished with a dental probe or explorer
Examination of Gingival and
Periodontal Tissues
crevicular pocket depth relative to gingival
margin with periodontal probe indicates the
severity of chronic inflammatory damage to
dental supportive tissues
Evaluation of Function
most frequent dental adaptation of
functional evaluation is referred to as pulp
testing
determination of occlusal relationship
ADJUNCTIVE DIAGNOSTIC
METHOD
ROUTINE SUPPLEMENTS / DIAGNOSTIC AIDS
1. Radiographic examination
2. Cast analysis
3. Clinical laboratory tests
4. Pathological exams
EXTRAORAL PHYSICAL
EXAMINATION
General Patient Assessment consists of the
impression concerning the patient’s health
status that can be gained by inspection from a
comfortable distance
Includes observation of the patient’s
identifying features, mental orientation,
emotional status, body size, anatomic
proportions, facial form, posture movement,
speech and determination of vital signs
Patient Identification
consist of observation of patient’s apparent
age, gender and race
Mental orientation & Emotional
status
Mental orientation is assessed on the
basis of patient’s awareness of person,
place, and time
Emotional status may be described by
words such as alert, anxious, fearful,
suspicious, confrontational, distressed and
apathetic
Stature, Habitus, Symmetry
describes the absolute size and relative
proportions of body parts
STATURE
- patient’s height
HABITUS - patient’s body built
Classification:
a. asthenic - slender and underweight
b. sthenic - well proportioned and athletic with
typical bone and muscular development
c. hypersthenic - heavy-boned and thick
muscular proportions; stocky
d. pyknic - heavy; soft and rounded (body fats)
e. cachexia - abnormally decreased tissue mass
f. obesity - inordinately great fat tissue mass
SYMMETRY
- determine if
symmetry is a
consequence of tissue
deficiency, tissue
enlargement, or
abnormal tissue
position
Head and Facial Form
to evaluate briefly abnormalities of the
head that maybe related to patient’s well
being
review of skull including facies
Posture
unusual standing or sitting posture may
indicate pain
common cause is recent injuries
Vital Signs
Temperature = 37C or 95F
Pulse rate = 60-80 beats/min.
Blood pressure = 120/80 mmHg
Respiratory rate = 16-20/min