(BQ) Part 2 book “History taking and clinical examination in dentistry“ has contents: Intraoral examination, establishing the diagnosis, investigations, final diagnosis, formulating a comprehensive treatment plan, levels of prevention.
C H A P T E R 11 Intraoral Examination SOFT TISSUE EXAMINATION Examination of Lips and Labial Mucosa Logically, the intraoral examination begins with the examination of the lips The exposed red portion of the lips, or the vermillion border, forms a transition between the external skin and the moist mucous membrane of the oral mucosa Because the overlying epithelium is thin, a normal lip shows the characteristic reddish color Several folds and sulci over the epithelium of the lip may crease the skin The thick, pink labial mucosa that line the internal surfaces of the lips may appear mildly lumpy or nodular on visual inspection This is due to the presence of accessory salivary glands found just beneath the mucosal surface Both the upper and lower lips have a flap of tissue called a frenum or frenulum, which attaches to the midline mucosa of the maxillary and mandibular alveolar processes The clinical features of normal lips and labial mucosa are: •• Reddish color over the area •• Folds and sulci over the surface of lips •• Absence of any plaque or patchy area •• Absence of any erosive areas The lips and the labial mucosa are examined by the observation of the patient at rest The lips are normally in contact or slightly apart The lip line, the level of the edge of the lip should be noted, both at rest and when the patient smiles Any abnormalities should be carefully noted and recorded A careful evaluation of the lip by bidigital palpation is done 166 History Taking and Clinical Examination in Dentistry using the index finger and the thumb to gently squeeze the lip mass Any abnormalities to sight or feel are carefully recorded The lips are thus recorded for: •• Competency •• Color •• Texture •• Fissuring •• Shape •• Presence of any lump or hard tissue Some of the common conditions that manifest as lip abnormalities are: Lip pits and commissural pits: These are congenital defects of lip and labial mucosa that result in unilateral or bilateral depression or pit that may occur on the lip region or on the commissures (angles of mouth) Cleft lip: These are one of the most common developmental malformations The incidence of cleft lip varies from 1:500 to 1:2500 in Asians It presents a unilateral or bilateral deficiency over the lip area, extending up to the nasal area Cleft lip is most common in upper lip Cleft lip is also commonly associated with cleft palate (Figs 11.1A and B) A B Figs 11.1A and B: (A) Bilateral cleft lip; (B) Unilateral cleft lip Intraoral Examination 167 Angular cheilitis: Inflammatory lesion at the labial commissure, or corner of the mouth, and often occurs bilaterally The condition manifests as deep cracks or splits Angioedema: Diffuse edematous swelling occurring as a result of allergic reactions Spreads to other tissues very rapidly and should be treated instantly Examination of Buccal Mucosa Buccal mucosa is the internal lining of the cheek region The mucous membrane often varies considerably in thickness from one area to another but it is generally thick and pink like the labial mucosa with which it is continuous Occasionally, there is seen a white line running anteroposteriorly at the occlusal level, termed as linea alba This line is produced by continuous pressing of buccal mucosa by the teeth due to the action of buccinators Also, a frequent observation of small yellow nodules is seen at the posterior parts of buccal mucosa These are actually the ectopic sebaceous glands, termed as Fordyce’s granules Check for the openings of Stensen’s ducts and establish their patency by first drying the mucosa with gauze and then observing the character and extent of salivary flow from duct openings, with and without milking of the gland Palpate muscles of mastication Clinically, a normal buccal mucosa presents: •• Pink to slight reddish surface •• Occasionally, linea alba may be present •• Occasional occurrence of Fordyce’s granules The buccal mucosa can be best visualized when the patient partially opens the mouth A mouth mirror or clinician’s finger can be used to retract the cheek to expose all the areas Gauze should be used to dry the surface of buccal mucosa when required Any abnormal finding should be carefully noted and recorded 168 History Taking and Clinical Examination in Dentistry Some of the common conditions in buccal mucosa that manifest as abnormalities are: •• White lesions of oral cavity: Such as hyperkeratosis, leukoplakia, actinic keratosis, candidiasis, chewer’s mucosa, white sponge nevus, lichen planus, etc •• Red lesions of oral cavity: Hemangiomas, varix, erythroplakia, ecchymosis, etc •• Ulcerative lesions of oral cavity: Trauma, apthous stomatitis, herpangina, Behcet’s syndrome, etc Examination of the Floor of Mouth The floor of the mouth is a narrow, horse-shoe shaped depression lying between the base of the tongue and alveolar processes of the mandible There is present in the midline a lingual frenulum, connecting the inferior surface of the tongue with the floor of the mouth Clinically, a normal floor of mouth presents: •• Shiny pink surface •• Presence of normal lingual frenal attachments •• Absence of any patchy or ulcerated lesion The best view of the floor of the mouth is seen by asking the patient to raise the tongue to the roof of the mouth and then using a mouth mirror to further retract the tongue away from the medial sides of the mandible The mucosa is gently dried with gauze Palpation is done by gently pressing the floor of the mouth by index finger of one hand and the opposite hand palpating from outside of the jaw extraorally, gently pressing up Some of the common conditions of floor of mouth that manifest as abnormalities are: •• Mandibular tori: A physiologic enlargement of alveolar process on the lingual surface that can be seen while examining the floor of the mouth Intraoral Examination 169 •• Ranula: A traumatic swelling that occurs on the floor of mouth as a result of calculi in the duct of salivary gland or obstruction of minor salivary glands on the surface Maxillary and Mandibular Mucobuccal Folds Observe color, texture, any swellings and any fistulae Palpate for swellings and tenderness over the roots of the teeth and for tenderness of the buccinator insertion by pressing laterally with a finger inserted over the roots of the upper molar teeth Examination of the Tongue The dorsum of a healthy tongue is covered by a mucous membrane, which is rough due to the presence of thousands of papillae projecting onto the surface There are three types of papillae present on the surface: Filiform papillae: These are the most numerous type of papillae with small, spike-like projections covering most of the surface of tongue These papilla not contain taste buds and are responsible for surface roughness Fungiform papillae: These are the second most numerous papillae containing taste buds, having mushroom-shaped projections, most commonly on the lateral borders and on the tip of tongue Circumvallate papillae: These are to 14 in number, distinctively present slightly anterior to the sulcus terminalis (a V-shaped groove on the posterior part of tongue), running parallel to it Each circumvallate papilla is surrounded by a trough or crypt, into which numerous taste buds open A normal tongue presents the following characteristics: •• A moist, reddish mucosa over the dorsal surface •• Roughness over the dorsal surface indicating the presence of papilla •• Absence of any plaque or ulcer 170 History Taking and Clinical Examination in Dentistry The dorsal and lateral surfaces of the tongue are best examined by asking the patient to open his mouth wide and the tongue thrust forward Wrap a piece of gauze around the tip of the protruding tongue to steady it, and lightly press a mirror against the uvula to observe the base of the tongue and vallate papillae; note any ulcers or significant swellings Holding the tongue with the gauze, gently guide the tongue to the right and retract the left cheek to observe the foliate papillae and the entire lateral border of the tongue for ulcers, keratotic areas, and red patches Repeat for the opposite side and then have the patient touch the tip of the tongue to the palate to display the ventral surface of the tongue and floor of the mouth All surfaces of the tongue should be carefully inspected and palpated by running a finger firmly over the surfaces Care must be taken not to stimulate the patient’s gag reflex by touching the soft palate Some of the conditions of tongue that manifest as abnormalities are: •• Aglossia: Absence of tongue •• Microglossia: Decrease in size of tongue •• Macroglossia: Increase in size of tongue •• Ankyloglossia: It also known as ‘tongue-tie’ A condition, where lingual frenum attaches overly to the bottom of the tongue and restricts its free movement (Fig 11.2) •• Sprue: A common condition seen in malabsorption syndrome where tongue becomes severely ulcerated and inflamed with a painful, burning sensation •• Iron deficiency anemia: Tongue presents depapillated areas with erosive lesions •• Fissured tongue •• Geographic tongue •• Ulcers •• Cleft tongue •• Black hairy tongue Intraoral Examination 171 Fig 11.2: Ankyloglossia Lingual varices Lingual thyroid nodule Squamous cell carcinoma Median rhomboid glossitis Bluish discoloration of tongue, i.e central cyanosis can occur in many of the cardiovascular and respiratory diseases • Painful/sore tongue can manifest as a result of local irritants, smoking, candidiasis, vitamin B12 and folic acid deficiency • Burning mouth syndrome which presents with burning tongue especially in post menopausal women having multifactorial etiological factors • • • • • /: / tt p h Frenum Attachments Frenal attachments are thin folds of mucous membrane with enclosed muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum 172 History Taking and Clinical Examination in Dentistry A B C D Figs 11.3A to D: Frenum attachments Depending upon the extension of attachment of fibers, frena have been classified as: Mucosal: When the frenal fibers are attached up to mucogingival junction (Fig 11.3A) Gingival: When fibers are inserted within attached gingiva (Fig 11.3B) Papillary: When fibers are extending into inter dental papilla (Fig 11.3C); and Papilla penetrating: When the frenal fibers cross the alveolar process and extend up to palatine papilla (Fig 11.3D) Tonsils and Oropharynx Note the color, size, and any surface abnormalities of tonsils and ulcers, tonsilloliths, and inspissated secretion in tonsillar crypts Palpate the tonsils for discharge or tenderness and note restriction of the oropharyngeal airway Examine the faucial pillars for bilateral symmetry, nodules, red and white Intraoral Examination 173 patches, lymphoid aggregates, and deformities Examine the postpharyngeal wall for swellings, nodular lymphoid hyperplasia, hyperplastic adenoids, postnasal discharge, and heavy mucous secretions Examination of the Hard and Soft Palate The hard palate forms two-third of the palatal region, lying between the alveolar processes of the maxilla and palatine bones The soft palate is just the posterior one-third of the palatal region, and is formed by a group of small palatal muscles covered by a mucous membrane The hard palate consists of an incisive papilla, a soft tissue portion overlying the incisive canal, a median palatine raphe, which can be distinguished by a shallow depression or a low ridge extending to the soft palate and palatine rugae, which are dense ridges of mucosa present on anterior hard palate The soft palate consists of a soft tissue projection in the midline termed as the uvula The hard and soft palates can be best visualized when the patient’s head is tilted back as the patient lies in a supine position with the mouth wide open A mouth mirror may be used for additional help In addition, the patient is asked to say ‘ahhh’ as the examiner gently depresses the tongue, visualizes the soft palate function There are different shapes of hard palate like (Figs 11.4A to C): • U-shaped • V-shaped • Flat The soft palate can be classified into three types, namely (Fig 11.5): • Class I: Soft palate is horizontal and demonstrates little muscular movement • Class II: Soft palate makes a 45 degree angle to hard palate 174 History Taking and Clinical Examination in Dentistry A B C Figs11.4A to C: Different shapes of hard palate (A) U-shaped (B) V-shaped (C) Flat •• Class III: Soft palate makes a 70 degree angle to hard palate •• Class III: Soft palate is commonly associated with a V-shaped palatal vault and class I,II with flat palatal vault Some of the common conditions of palate that manifest as abnormalities are: •• Cleft palate: A common developmental anomaly resulting in incomplete fusion of the two lateral processes creating a gap in the palatal shelf Cleft palate may be complete (involving the hard and soft palate) or incomplete (involving only the hard palate or only the soft palate) (Fig 11.6) •• Torus palatinus: A slow growing, physiologic, bony protuberance occurring in the midline area of the palate Appendices 341 Stain 1: A soiled or discolored spot; a spot of color in contrast to the surrounding area 2: A preparation used in staining 3: In dentistry, the discoloration of a tooth surface or surfaces as a result of ingested materials, bacterial action, tobacco, and/or other substances Stippling The pitted, orange-peel appearance frequently seen in attached gingiva Stomatitis Inflammation of the soft tissues of the oral cavity Supernumerary A genetic occurrence in which there are more teeth teeth than the usual number These teeth can be malformed or erupt in abnormal position Symptom Subjective evidence of disease or physical disturbance; something that indicates the presence of a bodily disorder Symptomatic apical periodontitis Inflammation, usually of the apical periodontium, producing clinical symptoms including a painful response to biting and/or percussion or palpation It may or may not be associated with an apical radiolucent area Symptomatic irreversible pulpitis A clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing Additional descriptors: Lingering thermal pain, spontaneous pain, referred pain Transudate Any fluid substance that has passed through a membrane or tissue surface; sometimes associated with inflammation Traumatogenic An occluding of the teeth that is capable of occlusion producing injury to oral structures Wires Also known as arch wires, they are held in the brackets using small elastic o-rings or stainless steel wire ligatures Wires are used to move the teeth Index Page numbers followed by f refer to figure and t refer to table A Aberrant salivary gland duct 161 Abfraction 38, 39f, 223f, 328 Ablation 328 Abrasion 38, 200, 221f, 328 Abscess 29, 48, 140, 185, 328 Accessory ducts 161 Acinic cell tumor 162 Acquired defects 55 Addison’s disease 51 Adenoameloblastoma 14 Adenocarcinoma 162 Adenomatoid odontogenic tumors 55 Adhesion 328 Adnexal skin tumor 29, 31 Adrenal insufficiency 69 Aglossia 170 Agranulocytosis 32 Albinism 134 Alcohol consumption 107 Alkaptonuria 54 Allergic reactions 32 Allergies 34, 69 Alveolar bone, osteomyelitis of 47 Alzheimer’s disease 68 Amalgam 264, 329 Ameloblastic fibro-odontoma 15 Amelogenesis imperfecta 54, 198, 199, 215, 217 American Society of Anesthesiologists 71 Amiodarone 52 Amyloidosis 43, 45 Analgesia 329 Anaphylactic shock 329 Anaphylaxis 329 Anemia 32, 56, 67, 68, 78 Anesthesia 329 Angioedema 167 Angular cheilitis 167 Ankyloglossia 12, 170, 171f, 329 Anodontia 199, 200 Anorexia 43 nervosa 15 Antalgic gait 118 Anticoagulants 68, 329 Anxiety 45, 68 Apexification 329 Apexogenesis 329 Aphthous stomatitis, recurrent 35 Apical abscess acute 328 chronic 332 Apical periodontitis 330 Aplasia 161 Aphthae chancre 34 Arch 192, 329 length deficiency and skeletal pattern 56 Arthritis 78 344 History Taking and Clinical Examination in Dentistry Aspiration 117 Aspirin 69, 79 Asthma 69, 78, 133 Ataxic gait 118 Atrophy 330 Attachment loss and gingival recession 187 Attrition 12, 15, 200, 222f, 227, 330 Atypical facial pain 28, 330 Auscultation 117 Automatic blood pressure device 126f equipment 125 Automatic pulse meter 127f Avulsion 330 gums, history of 40 recurrent 41 Bleomycin 52 Blood disease 78 dyscrasias 32 pressure 118, 121 urea nitrogen test 247 Bluish discoloration of tongue 171 Body mass index, calculation of 118, 136 surface area 13 temperature 130 Bone disease 48 grafts 261 B Bottle feeding 95 Bacterial infection 32 Brachial and radial arteries of Bacterial parotitis 162 arm, anatomy of 129f Barbiturates 79 Bracket 331 Basal cell Bradypnea 133 adenoma 15 Brain 28 carcinoma 29, 31, 15 Branchial cleft cysts 29 Basophils 243 Breastfeeding, duration of 90 Behỗets Breath, shortness of 78 disease 72 Fibromatosis, gingival 55 syndrome 32 Bronchiectasis 48 Bell’s palsy 43, 139 Bronchitis 48, 69, 133 Benzoyl argininenaphthylamide test (BANA) Brown heme-associated lesions 51 50 Brown melanotic lesions 51 Bilateral cleft lip 166f Bruxism 82, 222, 104, 224f, 331 Biopsy 240, 331 Bruxomania 331 Black hairy tongue 170 Buccal mucosa Bleaching 331 carcinoma of 15 Bleeding examination of 167 chronic 41 Bulimia 43 disorder 67-69, 78 Index 345 Bullous pemphegoid 34 Busulfan 52 C Cancer 28, 69, 78, 134 fear of 45 Candida albicans 43, 241 Carotenemia 51 Carcinoma 331 adenoid cystic 162 in situ 15 Cardiorespiratory disorders 67 Caries acute 194 chronic 194 classification of 194 recurrent 194 Carotid artery 128 body tumor 29 Cavernous sinus thrombosis 331 Celiac disease 56, 68 Cellulitis 29, 332 Cephalic index 138 Cerebral palsy 56 Cerebrovascular accident 68 Cervical abrasion 39f Charged couple device 238 Chemotherapy 34, 78 Chest disease 69 Chicken pox 216 Child sucking thumb 83f Chipping 227 Chlorhexidine 332 Chloroquine 52 Chlorpromazine 52 Chondrosarcoma 15 Christmas disease 41 Circumvallate papillae 169 Clear cell carcinoma 162 Cleft lip 12, 166 palate 12, 174, 175f tongue 170 Cleido-cranial dysostosis 215 Clofazimine 52 Cluster headache 28 Codeine 79 Cold tests 241 Combined periodontal/ endodontic lesions 185, 186 Compartment nodes, anterior 148 Competent lips 144 Complete blood count 242 Composite resin 264 Computed tomography 162, 238 Condensing osteitis 333 Congenital erythropoietic porphyria 54 Congenital hyperbilirubinemia 54 Congenital syphilis 216 Congestive heart failure 68 Cotton test 103 Cough 78 Cracked tooth 333 syndrome 28, 40 Cranial arteritis 28 Crohn’s disease 32, 68 Cross bite 333 Cyanosis 51, 118, 135 Cyclophosphamide 52 Cystic fibrosis 43 Cysts 29, 31, 47 346 History Taking and Clinical Examination in Dentistry D Dane system 192 De Lange’s syndromes 107 Deciduous teeth ankylosis of 55 apical periodontitis of 55 Deep bite 333 Dehydration 43 Delayed tooth eruption 21, 55, 57 Dens evaginatus 199, 210, 210f in dente 199, 208 invaginatus 208, 209f Dental caries 40, 55, 193 assessment 193 charting 272f fluorosis 225 prophylaxis, frequency of 61 Dentinal dysplasia 215, 218 hypersensitivity 36, 333 etiology of 37 Dentinogenesis imperfecta 54, 198, 215, 218 Dentoalveolar structure 87 Dentures, artificial 48 Depression 45 Developmental cysts 31 Diabetes 43, 68, 78 acetone odor of 48 mellitus 45, 248 Diabetic coma 133 Diastema 333 Diastolic pressure 122 Digit sucking, diagnosis of 85 Digital thermometer 131f Dilated composite odontome 208 Discolored teeth 53 Dolichocephalic skeletal pattern 101f Doxorubicin 52 Doxycycline 69 Drug-induced aspirin burn 32 Dry mouth 21, 42, 45 nasal mucosa 48 socket 48 Ducts, atresia of 161 Dunlop’s beta hypothesis 91 Dysosteosclerosis 56 E Eating disorders 69 Ectopic eruption 56 Edema 118, 135, 184, 333 Electronic battery-powered devices 125 Emphysema 333 Enamel hypoplasia 54, 198, 199f, 224, 226f pearl 55, 200, 213, 214f Enameloma 213 Endemic fluorosis 216 Endocarditis, categories of 68 Endocrine disease 68 disorders 56, 67 End-stage renal disease 43 Eosinophils 243 Epidermolysis bullosa 34 dystrophica 215 Epilepsy 78 Index 347 Erosion 15, 38, 200 Erythema 184, 334 multiforme 34 Erythrocyte sedimentation rate 243 Everted lips, evaluation of 144 Ewings sarcoma 15 Exanthematous disease 216 Exfoliation 334 Exogenous 50 Exostosis 334 Extrinsic discoloration 54 Extrusion 334 Exudates 334 F Face, shape of 139, 140t Facial arthromyalgia 28 divergence 141, 142f fractures 140 hemiatrophy 12 hemihypertrophy 12 index 139 space infection 334 swellings 140 symmetry 139 Fasting plasma glucose 248, 249 Fetor oris 334 Fibroma 29, 31 Fibromatosis 31 Filiform papillae 169 Fine needle aspiration cytology (FNAC) 239 Finger sucking 81 Fissured tongue 12, 170 Fistula 334 Fits and faints 67 Fixed appliances 93 Fixed bridges 62 Fixed intraoral antithumb sucking appliances 93 Floor of mouth, examination of 168 Fluorosis 54, 199, 335 Folic acid deficiency 32 Fordyce’s granules 143 Fractures 227, 335 Fremitus 227 Frenum attachments 171 Fried’s rule 13 Frostbite 134 Fungiform papillae 169 Furcation 335 assessment 188 Fusion 199, 205 G Gait 118 Gastroesophageal reflux disease 45 Gastrointestinal disorders 67 disturbances 216 Gemination 199, 206 Genetic disorders 56 Genitourinary system 69 Geographic tongue 45, 170 Ghost teeth 219 Giant cell granuloma, peripheral 29 Gingiva 87, 102, 335 Gingival recession and attachment loss, causes of 38t Gingivitis 184 348 History Taking and Clinical Examination in Dentistry Glass ionomer 264 Glaucoma 78 Glomerular filtration rate 247 Glossopharyngeal neuralgia 28 Glysylated hemoglobin 249 Goiter 29 Graft-versus-host disease 43 Granular cell tumor 29, 31 Granulomas 31 Granulomatous diseases 43 GV Black’s classification 195 H Habit breaking appliance 99f Habit crib appliance 92f Halitosis 47, 335 Hard and soft palate, examination of 173 tissue examination 191 Hawley’s retainer 91 Hay fever animals 79 HBA1C test 249 Head and neck, lymph nodes of 145f shape 138 types of 138t Headache 78, 134 Healing oral wounds 48 Heart disease 68, 134 valves, artificial 78 Heat test 242 Hemangioma 162 Hematoma 335 Hemifacial hypertrophy/ hypotrophy 139 Hemiplegic gait 119 Hemochromatosis 51 Hemoglobin 243 Hemophilia 12, 15, 41 Hemorrhagic disorders 41 Hepatitis 68, 78 viruses A 77 Hereditary hemorrhagic telangiectasia 51 opalescent dentin 218 Herpangina 34 Herpes simplex virus 34, 77 Herpes zoster virus 34 Herpetic gingivostomatitis 185, 186 High blood pressure 78 HIV 32 and AIDS 69, 78 infection 43, 56 oral melanosis 51 Hodgkin’s disease 15, 152 Human immunodeficiency virus 45, 77 Hydrodynamic theory 37 Hydroxychloroquine 52 Hypercementosis 200, 213 Hyperplasia, gingival 55 Hyperpnea 133 Hypersensitivity 21 Hypertension 68, 122 angina 68 Hyperthyroidism 69 Hypertonic orbicularis oris 95 Hypertrophy 335 Hyperventilation 133 Hypofunction 47 Hypoglycemia 134 Index 349 Hypoparathyroidism 56 Hypopituitarism 56, 134 Hypoplasia 161, 215 causes of 215 Hypoprothrombinemia 41 Hyposalivation 48 Hyposensitive palate 95 Hypotension 122 Hypothyroidism 56, 69, 134 I Ichthyosis 56 Icterus 118, 136 Idiopathic disorders 43 Idiopathic orofacial pain 28 Impacted tooth 335 Inadequate attached gingiva 38 Incisors, flaring of 102f Infantile scurvy 216 tetany 216 Infection 32, 45, 67, 215, 336 Inflammation acute 328 chronic 332 Internal derangements 28 Internal jugular chain 149 examination of 151f Internalized discoloration 55 International classification of diseases (ICD) system 231 Intrinsic discoloration 54 Iodine 69 Iron 32 deficiency anemia 14, 170 Irregular teeth 21 Irreversible pulpitis, asymptomatic 330 J Jaundice 51, 67, 68 Jaw cysts 29 deviation, causes of 154 fractures of 154 infection of 154 pain 78 Joint artificial 78 noise 60 prosthesis, artificial 69 sounds 155 Juvenile diabetes mellitus 71 periodontitis 12, 14 K Kaposi’s sarcoma 51 Keratoacanthoma 15, 31 Ketoconazole 52 Kidney disease 67, 78 dysfunction, uremic breath of 48 function tests 247 L Late stage liver disease 43 Lateral pterygoid muscles, palpation of 157f Lead poisoning 135 Lesch-Nyhan syndrome 107 Leukemia 32, 41, 69, 134 Leukoplakia 15, 336 Lichen planus 34, 45, 336 Lingual thyroid nodule 171 350 History Taking and Clinical Examination in Dentistry Lip 86, 143 and labial mucosa, examination of 165 biting 82, 106 competency/posture 144 habits 144 pits and commissural pits 166 sucking 82 Lipoma 31 Liposarcoma 15 Lipstick sign 44 Lisping distortions 95 Liver disease 68, 78 function tests 244 Loose teeth 21, 46 Lower jugular nodes 147 Lupus erythematosus 34 Luxation 336 Lymph nodes 145 classification of 147 examination of 148, 179 Lymphadenopathy 29 Lymphatic drainage of face, area of 152 Lymphocytes 243 Lymphoepithelial cysts 29 Lymphoid aggregates 29 Lymphoma 29, 31, 162 M Macrodontia 199, 204, 204f Macroglossia 95, 170 Magnetic resonance imaging 163, 238 Malnutrition 43, 162 Malocclusion 96, 196, 336 correction of 99, 104 Mandibular tori 168 Masseter muscles bimanual palpation of 157f palpation of 157f Masseteric hypertrophy 29 Mastication, muscles of 156 Mastoid nodes 149 Materia alba 337 Matrix, mineralization of 199 Maxillary and mandibular mucobuccal folds 169 central incisor 202f lateral incisor, dens evaginatus on 210f sinusitis 28 Maximum interincisal opening 154 Mean corpuscular hemoglobin 243 volume 243 Measles 216 Mechanotherapy 93, 97 Medial pterygoid muscle, palpation of 157f Median rhomboid glossitis 12, 171 Melanoma 29, 31 Melanoplakia 51 Melanotic macule 51 Mercury thermometer 131f Mesenchymal neoplasm 29 Mesenchymal tumor 29, 31 Mesiodens 201 Mesomorph 119 Metastatic carcinoma 29 Microdontia 199, 205, 205f Microglossia 170 Middle jugular nodes 147 Index 351 Migraine attack 134 Mikulicz’s disease 161 Milk extrinsic sugars 109 Minocycline 52 Missing teeth 21 Mixed tumor, malignant 162 MMP 60 Mobility test 190 Moderate motor disability 95 Monocytes 243 Mouth breathing 82, 94, 337 burning sensation of 45 guard 337 Mucocele 29, 31, 162, 337 Mucoepidermoid carcinoma 162 Mucosal disorders 45 Mucositis 337 Mucous membrane pemphigoid 34 Multiple myeloma 15, 42 sclerosis 69 Muscle of mastication, examination of 157f pain 59 Muscular hypertrophy and hypotrophy 154 Myasthenia gravis 14 Myoepithelioma 162 Myofacial pain 28 Myositis 337 N Naber’s probe 189f Nail biting 82, 106 Nasoalveolar cyst 14 Nasopharynx 28 Neck nodes, examination of 146f Neuropathic pain 27, 27t Neutrophils 242 Nodes location of 146 number of 146 Nonodontogenic tumors 55 Nonsteroidal anti-inflammatory drugs (NSAIDs) 71 Nuclear bone scans 238 O Obstructive breathing 133 pulmonary disease, chronic 69, 133 Occlusal therapy 262 trauma 38 treatments 260 Odontoblastic transduction theory 36 Odontodysplasia 215, 219 Odontogenesis imperfecta 219 Odontogenic tumor 29, 55 Odontomas 55 Open bite 337 Optic neuritis 28 Oral candidiasis 32 cavity, pigmented lesions of 53 clefts 56 contraceptives 52 glucose tolerance test 249 352 History Taking and Clinical Examination in Dentistry hygiene instruction 255 lichen planus 15 malodor 47 mucosal pigmentation 50 pigmented lesions, classification of 50 screen 104f ulcers 34t diagnosis of 33 malignant 35t Organoleptic scoring scale 49 Orofacial pain, classification of 28t soft tissues swelling 29t Orthognathic surgery 263 Ossifying fibroma 14, 29 Osteoarthritis 69 Osteocartilaginous choristoma 29 Osteogenesis imperfecta 215 Osteomyelitis 48 Osteonecrosis 48 Osteoporosis 134, 338 Paget’s disease 139 Pain 21, 23, 60, 227, 338 analysis of 24 duration of 24, 26 nature of 24, 26 progression of 24, 26 radiation of 24, 26 site of 25 types of 24, 25 P Pallor 118, 134 Palpation 117, 154, 177, 179, 338 Panic attack 134 Papillary cystadenoma lymphomatosum 162 Papillomavirus 77 Paraneoplastic pemphigus 34 Paresthesia 21, 338 Parkinson’s disease 69, 118 Parotid gland 163 diseases 15 duct 164 Parotid nodes 149 Parulis 29, 31 Pemphigous vulgaris 34 Penicillin 69, 79 Percussion test 195 Pericoronal abscess 185, 186 Pericoronitis 48, 185, 186 Periodontal abscess 185 disease 38 examination 180 pocket assessment 186 surgery 38, 261 therapy 260, 261 Periodontitis 12, 338 acute 185 chronic 48, 184 Periodontium 338 Peutz-Jegher’s syndrome 51 Pheochromocytoma 135 Pigmentation 338 Pit and fissure caries 195 sealants 264 Platelet 243, 244 disorders 41 Pleomorphic adenoma 14, 162 Pneumonia 48 Polymerase chain reaction 50 Poor oral hygiene 38, 48 Postauricular nodes, examination of 150f Index 353 Postherpetic neuralgia 28 Post-rubella purpura 42 Preauricular nodes 149 examination of 150f Prenatal syphilis 216 Preorthodontic trainer 98f, 103 Primary tooth, premature loss of 55 Pseudohypoparathyroidism 56 Psychogenic disorders 45 Psychological nipple, use of 90 Psychosocial stress 45 Pulp amputation 339 necrosis 339 stones 12 vitality testing 241 Pulpal hemorrhagic products 54 pathology 40 Pulpotomy 339 Pulse 118, 127 pressure 122 Pyogenic granuloma 29 Pyorrhea 339 Q Quad helix 93, 93f Quinacrine 52 Quinidine 52 R Radial artery 127 Radiograph bitewing 233, 234, 234f digital 236 interproximal 234 intraoral 233 occlusal 233, 234, 235f panoramic 236, 237f Radiotherapy 34 Ramsay Hunt syndrome 28 Ranula 29, 31, 162, 169, 340 Rapid deep breathing 133 Rapid shallow breathing 133 Recent myocardial infarction 68 Red blood cell count 243 Regional odontodysplasia 56 Reiter’s syndrome 32 Removable appliance therapy 98 Renal disease 69, 247 failure 56 Replacing missing teeth 268 Resorption 340 Respiration 118, 132 types of 133 Respiratory tract, infection of 48 Restricted jaw motion 60 Retained infantile swallow 94 Reversible pulpitis 340 Rheumatic fever 68, 78 Rheumatoid arthritis 69 Root resorption 12, 54 surface caries 195 S Salivary adenocarcinomas 31 adenomas 31 gland 158, 159f disease 28, 45 hypofunction 45 tumor 29 354 History Taking and Clinical Examination in Dentistry disorders of 161 neoplasm 29 tumor 29 Sarcoidosis 43, 45 Sarcomas 31 Scalene nodes 149 Scar tissue 55 Scarlet fever 12, 78, 216 Schizophrenia 69 Schonlein-Henoch purpura 41 Scleroderma 139 Scurvy 135 Seborrheic keratosis 29, 31 Segmental odontomaxillary dysplasia 56 Seizure disorders 68 Sexually transmitted disease 69 Shooting pain 26 Sialadenitis 29 Sialendoscopy 163 Sialocysts 31 Sialography 161 Sialolithiasis 29, 161 Sialorrhea 162 Sibilant distortions 95 Sickle cell anemia 14 Sinus tract 340 Sjögren’s disease 45 syndrome 14, 43, 45, 161 Skin rash 78 Sleep deprivation 135 Slow breathing 133 Smiles, types of 268f Smoker’s breath 48 melanosis 51 palate 176, 176f Smooth surface caries 195 Soft palate, types of 175f Soft tissue examination 165 Space infection 29 Spastic gait 119 Sphygmomanometer 122f, 124f Squamous cell carcinoma 29, 31, 32, 34, 162, 171 adenoid cystic 15 Stabbing pain 26 Stenson’s duct 164 Stethoscope, parts of 123f Stevens-Johnson syndrome 32 Stippling 341 Stomatitis 45, 341 nicotina palati 15 Streptococcus mutans 44 Submandibular gland 164 nodes 148 Sub-mandibular nodes, examination of 149f Submental nodes 148 examination of 148f Sucking reflex 83 Superficial temporal artery 128 Supernumerary teeth 55, 199, 201, 202f, 341 Supraclavicular chain, examination of 151f Sweet score, interpretation of 109 Swelling 21, 27, 78 examination of 176 progress of 28 recurrence of 28, 30 shape of 176 site of 28, 176 Syncope 68 Synodontia 205 Index 355 Syphilis 32 Systemic lupus erythematosis 69 T Tachypnea 133 Talon cusp 199, 210, 211f Teeth, concrescence of 208f Temporomandibular disorders 21, 59 joint 59, 153 anatomy of 153f pain 28 Teratoma 12 Tetracycline 52 staining 54 TFO, etiology of 228 Thermal sensitivities 28 Thermoplastic thumb post 91, 92f Throbbing pain 25 Thrombocytopenic purpura 41 Thumb and digit sucking 82 finger sucking 95 Thumb sucking 81 control of 89 development of 85 Thyroglossal cysts 29 Thyroid 68 disease 14, 43 function test 246, 246t neoplasm 29 TMJ arthralgia 60 Tongue 86 blade sign 44 diagnosis of 96 etiology of 94 treatment of 97 examination of 169 Tonsil stones 48 Tonsillitis 48, 78, 95 Tooth discoloration, classification of 54 eruption 55 fracture 228, 228f migration 227 wear and gingival recession 55 Toothbrush abrasion 38 Torus palatinus 174 Translucency 177 Transverse cervical nodes 149 Trauma 34, 215 acute 38 chronic 38 Traumatic ulcer 32, 35 Traumatogenic occlusion 341 Trigeminal neuralgia 28 Trophic disturbances 216 Tuberculosis 32, 34, 43, 78, 135 Tumor of jaw 47 Turner’s hypoplasia 215, 216 tooth 216 Two digit system 191 U Ulcer, examination of 178 Ulceration in oral cavity 48 Ulcerative colitis 32 Ulcers 31, 32f, 45, 170 aphthous 15, 52 Universal system 192 Unstable angina pectoris 68 356 History Taking and Clinical Examination in Dentistry Upper arch 273f model of 210f Upper jugular nodes 147 respiratory tract infection 94 Urinary tract disease 69 V Vague pain 25 Vascular disease, peripheral 134 Verrucous carcinoma 15 Viral parotitis 162 Visceral larva migrans 135 Vital signs 118, 121 Vitamin B12 32, 45 C deficiency 41, 216 D deficiency 134 D resistant rickets 56 K deficiency 41 W Warthin’s tumor 162 Wasting diseases of teeth 220 Water test 103 Weight gain 134 White blood cell counts 242 William’s periodontal probe 187 X Xerostomia 42, 43, 48, 162 causes of 42 Y Young’s rule 13 Z Zidovudine 52 Zsigmondy and palmer system 192 ... tooth in the quadrant 1 92 History Taking and Clinical Examination in Dentistry •• •• •• Permanent teeth: 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33... teeth: 10 11 12 13 14 15 16 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 Dane system: For permanent teeth: 8+ 7+ 6+ 5+ 4+ 3+ 2+ 1+ +1 +2 +3 +4 +5 +6 +7 +8 8– 7– 6– 5– 4– 3– 2 1– –1 2 –3 –4 –5... but it can only be 1 82 History Taking and Clinical Examination in Dentistry determined by probing In a fully erupted tooth in an adult, the apparent position of gingival margin is normally at the