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WHY????
Many diseases (systemic or local) have signs

that appear on the face, head & neck or intraorally.


create a differential diagnosis in cases of abnormalities and make treatment recommendations based on accurate assessment of the signs & symptoms of disease
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Making a complete examination can help you

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Scope of examination
Diseases of the head & neck Diseases of the supporting hard & soft tissues Diseases of the lips, tongue, salivary glands, oral mucosa Diseases of the oral tissues which are a component of systemic disease
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AGE
AGE Congenital Vitamin deficiency and malnutrition Carcinoma of buccal mucosa, lips, tongue
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OCCUPATION
OCCUPATION
COUNTRY MANS LIP

RESIDENCE
Australia Caucasians Negroes

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SYMPTOMS

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SWELLING / ULCER
Mode of onset Duration
Progress

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PAIN
PAINLESS LESIONS Leukoplakia, mucous retention cysts, early carcinomas.
PAINFUL LESIONS Apthous ulcers, dental ulcers, abscess. Localized / radiating to ear
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SIALORIA
Excessive Salivation Painful lesions Mass lesions irritation Inability/difficulty to swallow due to ankyloglossia
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HISTORY
Ankyloglossia Tongue Tie Dysarthria

Hoarseness of voice
Cough with expectoration
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HISTORY
Trismus Ear pain Eye pain Dysphagia Hearing loss History of leukoplakia / erythroplakia

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MOKING PIRIT EPSIS UPERFICIAL GLOSSITIS YPHILIS PICES HARP TOOTH


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PERSONAL HISTORY
SMOKING
Type Pack Years Mode Of Smoking

ALCOHOL INTAKE TOBACCO CHEWING


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GENERAL EXAMINATION
Build and Nourishment Pallor

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INSPECTION
REQUIREMENTS

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LIPS
Exterior surface of lips Cleft lip Pigmentation Swelling / ulcer
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LIPS
Evert the lip and examine the tissue. Observe frenulum attachment.

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LIPS
Clear mucous filled pockets may be seen on the inner side of the lip (mucocele). This is a frequent, nonpathologic entity which represents a blocked minor salivary gland
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GUMS
To examine the gums lip must be everted fully. Healthy gums are bright pink in colour.

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GINGIVA GUMS
Note color, tone, texture, architecture & mucogingival relationships

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GINGIVA

GUMS

How would you describe the gingiva?


Marginal vs. generalized? Erythematous vs. fibrous

Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant

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GUMS
Cancrum oris is infective ulceration affecting alveolous and progresses to produce orocutaneous fistula.

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BUCCAL MUCOSA
Observe color, character of the mucosa Stensons duct

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BUCCAL MUCOSA
LEUKOPLAKIA / ERYTHROPLAKIA

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BUCCAL MUCOSA

Lesions white, red Lichen Planus, Submucous fibrosis

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PALATE
Congenital cleft Perforation Ulceration swelling

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TONGUE
VOLUME Macroglossia

COLOUR White Red glazed tongue Blue black


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TONGUE
ULCER Tuberculous tip and lateral borders

Gummatous dorsum
Carcinomatous anywhere Dental lateral borders and ventral surface
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TONGUE
Lingual thyroid swelling at foramen caecum

Mobility of tongue Ankyloglossia

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TONGUE
The tongue and the floor of the mouth are the most common places for oral cancer to occur. It can occur other places; so visualize all areas You may observe:
Circumvallate papillae, epiglottis

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TONGUE
Wrap the tongue in a dry gauze and gently pull it from side to side to observe the lateral borders

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TONGUE
You may observe lingual varicosities

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Exam: Tongue TONGUE


geographic tongue (erythema migrans)

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Exam: Tongue TONGUE


You may observe drug reaction

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TONGUE
Observe signs of nutritional deficiencies, immune dysfunction

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TONGUE
Ulceration, proliferative growth

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FLOOR OF MOUTH
Frenulum Ranula Sublingual dermoid

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PALPATION

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LIP
Any lesion of lip should be palpated
Benign neoplasms are firm & lobulated Carcinoma hard

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Apthous ulcers small discrete shallow tender ulcers with a rim of inflammation

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LIP
Hunterian chancre - in primary syphilis is rubbery hard

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LIP
Carcinoma of lip hard in consistency restricted mobility fixity
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TONGUE
Method of palpation

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TONGUE
Dental ulcers are very tender with no induration of edge / base. Carcinomatous ulcers show induration of base and edge.

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PALATE
Hard irregular swelling on hard palate with normal appearing overlying mucosa minor salivary gland tumor Malignant lesions of hard palate are hard fixed ulcerative or proliferative lesions

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ALVEOLUS AND GINGIVA

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ALVEOLUS AND GINGIVA


GINGIVITIS GINGIVAL HYPERTROPHY EPULIS ALVEOLAR CARCINOMA
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FLOOR OF MOUTH
UNIDIGITAL PALPATION BIDIGITAL PALPATION RANULA

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RANULA

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BUCCAL MUCOSA

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MANDIBLE
Bidigital palpation of mandible Temporo mandibular joint Movements at TMJ

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PALPATION OF LYMPH NODES

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DIFFERENTIAL DIAGNOSIS OF ULCERS ONN TONGUE


Apthous ulcers Dental ulcers Carcinomatous Syphilis Tuberculous

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INVESTIGATIONS
HAEMOGRAM WEDGE BIOPSY FROM EDGE OF ULCER FNAC OF LYMPH NODES CECT OF NECK ORTHOPANTOMOGRAM

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ORTHOPANTOMOGRAM

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