Extra-oral
Examination
Dental
Physical
Examination
Extra-oral
Intra-oral
General Patient Assessment
Extra-oral Examination
Intra-oral Examination
General Patient Assessment
1- Patients Identifying Features (Demographic)
2- Mental Orientation & Emotional Status
3- Habitus, Stature & Bilateral symmetry
4- Head & Facial Form
5- Posture
6- Gait
7- Abnormal Movement
8- Speech
9- Arms & Hands
10- Vital Signs
General Patient Assessment
1- Patients Identifying Features
- Demographic features which can alert the
clinician to the possibility of certain health
problems:
- Age
- Gender
- Race
General Patient Assessment
2- Mental Orientation & Emotional Status
* Mental Orientation
- Awareness of person, time & place
* Emotional Status
- Alert
- Anxious
- Fearful
- Suspicious
- Confrontational
- Distressed
- Apathetic
General Patient Assessment
3- Habitus, Stature and Bilateral Symmetry
* Habitus:
- Asthenic: Slender, underweight.
- Sthenic: Well proportioned.
- Hypersthenic: Heavy proportions.
- Pyknic: Heavy, rounded.
- Cachexia: Abnormal decreased tissue mass.
- Obesity: Great fat tissue mass.
General Patient Assessment
3- Habitus, Stature and Bilateral Symmetry
*Stature: Comparing the proportions of body parts.
- Body ratio: is the upper skeletal segment/ lower
segment (Symphysis pupis as dividing point).
- Stautre-to-span ratio: is height / distance from
fingertip to fingertip (arms extended).
- Dwarfism
- Gigantism
General Patient Assessment
3- Habitus, Stature and Bilateral Symmetry
*Bilateral Symmetry: The clinician should determine if
asymmetry is a consequence of:
- Tissue deficiency: Injury, degenerative diseases.
- Tissue enlargement: Infection.
- Abnormal tissue position: Congenital malformation
General Patient Assessment
4- Head & Facial Form
- General appraisal applied (Size, Shape and Symmetry).
* Skull Shapes:
- Normocephalic: Typical
- Brachycephalic: Short, rounded
- Dolichocephalic: Long, narrow.
General Patient Assessment
4- Head & Facial Form
* Facial Forms:
- Normal (Class I): Maxilla & Mandible slightly protruded.
(Flat appearance)
- Retrognatheic (Class II): Prominent maxilla & retruded
mandible (Convex appearance)
- Prognatheic (Class III): Protruded mandible & normal
maxilla. ( Concave appearance)
General Patient Assessment
General Patient Assessment
5- Posture
- Unusual standing or sitting posture may indicate
a medical problem.
- Recent injury
- History of injury
- Inflammatory disease
- Slumping forward or fully reclining feels uncomfortable
General Patient Assessment
6- Gait
Gait: Is the manner of walking
- Most of gait abnormalities relate to neuromuscular
disability due to:
- Injury
- Stroke
- Degenerative neuromuscular diseases
General Patient Assessment
7- Abnormal Movement
- Repetitive or uncontrolled tremors and other abnormal
movements can suggest a variety of neurologic disorders.
General Patient Assessment
7- Abnormal Movement
Tremors:
- The resting tremors of Parkinson’s disease.
- Essential tremors.
- The intentional tremor of Multiple Sclerosis
General Patient Assessment
7- Abnormal Movement
Movements
- Choreic movemnets
- Athetoid movemnets
- Tardive dyskinesia
General Patient Assessment
8- Speech
* Normal speech implies:
- Healthy neuromuscular function of related involved organs.
- Normal cortical function
- Coherent mental status
- Ability to hear
General Patient Assessment
8- Speech
* Obvious speech abnormalities
- Dysarthria: Slurring of speech (non-specific indication of
neuromuscular deficiency or intoxication).
- Aphasia: Inability to accomplish proper verbal expression
(partial or total and implies neuromuscular or cortical
defects).
General Patient Assessment
9- Arms and Hands
* Three specific features should be observed:
1- Examine the skin of the arm (lesions).
2- Relative size and appearance of the hands (developmental
syndromes, inflammatory diseases).
3- Appearance of the fingernails (systemic diseases).
General Patient Assessment
9- Arms and Hands
Fingernails:
*Generalized Clubbing
- Advanced cardiovascular & cardiopulmonary dysfunction.
* Dull Color & spoon shaped(Koilonychia)
- Iron deficincy anemia or cardiopulmonary disease
* Chalky white or unusual dark pink color
- Advanced hepatic or renal failure.
* Bluish discoloration of nail bed.
- An early sign of cyanosis.
* Pitted or linear malformations.
- Recent sever illness.
* Absence or severe malformations
- Genetic defects.
General Patient Assessment
Nail Clubbing
Koilonychia
General Patient Assessment
Pitted Nail
Severe Disease
General Patient Assessment
10- Vital Signs
General Patient Assessment
10- Vital Signs
Pulse
• Recorded by palpation of radial artery at
dorsal of wrist by index or middle finger.
(72/min)
General Patient Assessment
10- Vital Signs
Respiratory rate
• Upon supine position, observe / inspect the
movement of chest (rise & fall of chest) per
minutes (12-14 / min)
General Patient Assessment
10- Vital Signs
Temperature
• Place the tip of thermometer under the tongue
(37 Centigrade or 98.6 Fahrenheit
General Patient Assessment
10- Vital Signs
Blood Pressure
• Recorded by palpation on radial pulse (systolic) with sphygnomonometer
& auscultation method with the help of sphygmomonometer & Stethoscope
at brachial artery at anterior cubital fossa of dorsal to elbow joint (systolic
100-140 / diastolic 60-90 in mmHg)
General Patient Assessment
Extra-oral Examination
Intra-oral Examination
Extra-oral Examination
1- Facial Form & Symmetry
2- Skin
3- Ear, Nose and Eyes
4- Parotid Gland & Facial Tissues
5- Neck
6- TMJ
7- Cranial Nerves Evaluation
Extra-oral Examination
* Extra-oral Examination is a detailed anatomic &
functional evaluation of the patient that can be
performed with the mouth closed & without the use of
complex technical devices.
Extra-oral Examination
1- Facial Forms & Symmetry
* Facial form :
- Is examined by inspection & palpation.
- Examination from Frontal, Submental, Lateral & Supraorbital
perspectives.
Extra-oral Examination
1- Facial Forms & Symmetry
* Symmetry :
- The frontal perspective: Examination of position contour of the
orbits, pupil alignment & midline location of the nose.
-Symmetry & contour of the zygomatic arches, ears, mandible & the
resting position of the mouth should be examined.
Extra-oral Examination
1- Facial Forms & Symmetry
•Symmetry : cont’d
-The submental perspective: clinician in frontal position & the
patient hyperextend.
- This accentuates the anatomic triangles of the neck, shape of the
mandible & the preauricular prominence of the parotid glands.
Extra-oral Examination
1- Facial Forms & Symmetry
•Symmetry : cont’d
-The lateral perspective: reveals the profile contour of the facial
bones.
- This can demonstrate disproportional development of the
mandible, maxilla, zygomatic arches, frontal bones & abnormal ear
position.
Extra-oral Examination
1- Facial Forms & Symmetry
•Symmetry : cont’d
-The supraorbital perspective: is achieved by looking down the
patient’s face from above and behind the head.
- Effective position from which to observe deviation of the
mandible during opening.
Extra-oral Examination
2- Skin
-The skin of the face & the neck can be inspected concurrently
with the examination of facial form.
- Attention to any unusual variations in :
 Integrity
 Pigmentation
 Texture
 Abnormal elevation & depression
Extra-oral Examination
2- Skin
- Inspection & palpation of any lesion rely on:
• Location
• Size
• Surface texture
• Compressibility
• Tenderness
• Delineation of borders
• Alteration of surface contour
• Color of the lesion
• Consistency of the lesion
Extra-oral Examination
3- Eyes, Ears & Nose
EYES
-Abnormalities of the eyes can suggest:
 Developmental
 Inflammatory disease
 Manifestations of systemic disease
 Cranial nerve dysfunction
- Such conditions may produce related oral manifestations
Extra-oral Examination
3- Eyes, Ears & Nose
EARS
Most conditions affecting the ears either inflammatory
or developmental.
Extra-oral Examination
3- Eyes, Ears & Nose
EARS cont’d
* Developmental:
 Congenital defects or malformation
 Developmental pits
 Tissue tags near tragus
* Inflammatory:
 Symptoms similar to those of TMD & inflammatory
dental conditions
Extra-oral Examination
3- Eyes, Ears & Nose
Nose
The dentists examination of the nose is usually limited to
superficial inspection of the surface of the nose and the
nares.
Extra-oral Examination
4- Parotid Gland & Facial Tissues
Parotid Glands
-The principle method of identifying subtle enlargements of the
parotid gland is by Palpation.
 Bidigital or Bimanual palpation for Submandibular &
Sublingual glands.
 Extraoral & Intraoral palpation are involved
Extra-oral Examination
4- Parotid Gland & Facial Tissues
Facial Tissues
-Bilateral palpation allows to compare the relative thickness &
compressibility of the soft tissues.
- Some variations in different anatomic regions reflects a different
proportion of muscles, gland and other soft tissue components.
Extra-oral Examination
5- Neck
-The neck is most effectively examined from behind & patient
reclined with tilted head.
- Lateral of the neck is divided into 2 triangles:
 Anterior: bounded by inferior border of the mandible & the
anterior border of the sternocleidomastoid muscles.
 Posterior: bounded by Trapizius muscle, clavicle & posterior
border of sternocleidomastoid muscle.
Extra-oral Examination
Extra-oral Examination
5- Neck
- Midline of the Neck:
 Landmarks include:
- Hyoid Bone
- Thyroid Cartilage
- Cricoid Cartilage
- Trachea.
Extra-oral Examination
Extra-oral Examination
5- Neck
*Lymph Nodes:
- Any lymph node enlargement (lymphadenopathy) should be
assessed for:
 Compressibility
 Tenderness to pressure
 Mobility
Extra-oral Examination
Extra-oral Examination
6- Temporomandibular Joint
* Routine assessment of jaw function consists of :
 Palpation of the TMJ
 Determination of maximal opening (Limitation)
 Observation of lateral deviation
 Pain or Tenderness of TMJ during palpation.
Extra-oral Examination
Extra-oral Examination
6- Temporomandibular Joint
•The movement of both joints is normally synchronized.
• A pop, click (hear & feel), crepitus (hear) or “jump”
during opening suggests dysfunction.
Extra-oral Examination
7- Cranial Nerves Evaluation
* Formal Clinical Evaluation of the function of the cranial nerve is
seldom performed during routine dental examination:
• Evidence of CN deficiency needs to evaluate the CNS.
• Dental examination informally tests most of the CN.
Extra-oral Examination
7- Cranial Nerves Evaluation
1. I - Olfactory
2. II - Optic
3. III - Oculomotor
4. IV - Trochlear
5. V - Trigeminal
6. VI - Abducens
7. VII - Facial
8. VIII - Auditory
9. IX - Glossopharyngeal
10. X - Vagus
11. XI - Accessory
12. XII - Hypoglassal
Extra-oral Examination