Dent 324; Extraoral Examination

Dr. Aceil Al-Khatib DDS,MS, Diplomat ABOM

Vital Signs
Temperature, Pulse, Respiration, And blood pressure All vital signs should be taken when the patient is at rest; wait 30 minutes if the patient has just eaten, drank a hot or cold beverage, just smoked, or exercised.

Temperature
Normal range for temperature: (98.6=37)
Oral 97.6 99.6 (36.8-37.5C) Rectal 98.6 100.6 (37.6 C) Axillary 96.6 98.6 (36.4 C) Tympanic (ear) 99.5 ( 37.5)

In most adults, an oral temperature above 100 F (37.8 C) or a rectal or ear temperature above 101 F (38.3 C) is considered a fever. A child has a fever when his or her rectal temperature is 100.4 F (38 C) or higher

Pulse
Cardiac rate, rhythm, and strength are assessed by taking the pulse Pulse is felt most plainly over these arteries: Radial in the wrist, usually at the base of the thumb Carotid on each side of the neck Apical over heart with a stethoscope

Use two fingers to feel the arteries. Do not use the thumb to feel the pulse because there is a pulse in it. It is important to always take the pulse for 60 seconds to be able to feel an irregular pulse.

Pulse
Bradycardia (<60 )occurs in dedicated athletes and some disease. Tachycardia ( >100) occurs in anxious subjects and in a variety of metabolic and cardiac diseases. Normal range =60 100 beats per minute (bpm)
Average resting heart rate = 72 bpm Elite athlete resting heart rate = 40 to 50 bpm

Resting Blood Pressure

Assesses pressure within the arteries during cardiac contraction (systole) and pressure during cardiac pause (diastole) To measure blood pressure, an inflatable sphygmomanometer cuff is placed around the upper arm. The brachial artery is used for measuring blood pressure.

Resting Blood Pressure

The brachial pulse is palpated (the"antecubital fossa"). The diaphragm is placed over the brachial artery. Systolic (top number) should be less than 130 Diastolic (bottom number) should be less than 85

JNC Classification of blood pressure in adults

Classification Normal Pre-hypertension BP (mm Hg) systolic: less than 120 diastolic: less than 80

120-139 (systolic) 80-89 (diastolic)

140-159 (systolic) or 90-99 (diastolic)

Stage 1 hypertension

Stage 2 hypertension

equal or more than 160 (systolic) equal or more than 100 (diastolic)

JNC: Joint National Committee on Prevention, Detection, Evaluation, and treatment of high blood pressure

Respiration Rate
Respirations may be counted by watching or feeling ( with hand on the patients chest )the number of times a persons chest rises and falls in one minute. One respiration is equal to the chest rising (inhale) and falling (exhale) one time The normal adult rate is 12-28 respirations per minute (inhale + exhale =1 breath)

Hyperpnea Vs Tachypnea
Hyperpnea : increased depth of respiration (occurs in excersie, anemia, sepsis) when an increase in body metabolic needs .
Tachypnea (increased shallow respirations), may be encountered in anxious patients.

Principles of Examination
Inspection Palpation Percussion Auscultation Smelling

Inspection

Inspection
General appearance: Alert, distress, clean State of nutrition: thin, temporal wasting Symmetry: mild asymmetry is a variation of normal Posture and gait : shuffle or foot drag (Parkinsons) ,, limp.. lips and hands tremor Speech: slurred (stroke), hoarse. Skin; Jaundice, lesions Eyes: blue sclera, jaundice

Bleu sclera: osteogenesis imperfecta

Sublingual icterus secondary to hepatitis C

(Jaundice( icterus)

Extraoral Examination
Inspect the face, head, and neck. Note any asymmetry ( mild asymmetry is a variation of normal). Inspect the skin and note any changes Inspect the eyes, the ears and the hair

Lymph Nodes Examination

Palpate lymph nodes to detect any enlargement:
Normal nodes if palpable are the size of a pea or lentil

Determine mobility and consistency of enlarged nodes. Recommended order of palpation:

the preauricular, submandibular, anterior cervical, posterior auricular, and posterior cervical lymph nodes.

Lymph Nodes Examination

Soft, tender, moveable lymph node are more likely associated with an infection. Hard, nontender, nonmoveable lymph node may be more characteristic of a neoplastic process

The Temporomandibular Joint (TMJ)

The temporomandibular joint (TMJ) is examined by palpation and auscultation The interincisal maximal opening is measured in millimeters (about 45 mm for females, 55 mm for males) Record any deviation or pain on opening Palpate the joint for tenderness

 The TMJ is examined from preauricular and intra auricular approach The sound are usually recorded and observed by stethoscope auscultation or palpation.

The TMJ

Muscles of Mastication

Muscles of Mastication

Muscles of Mastication

Muscles of Mastication