Patients Evaluation 1

1
Patients Evaluation 1 11 ( OMFS/ SYS )

• Introduction History , clinical exam.
  ,then diagnosis treatment plan.
• You need written record to assess
  progress of treatment ,
• for medico- legal importance, and for
  other practitioners to see the patient.
• - In hospitals specialist
  clinics this is a routine work.
• - History at the first visit is
  important , then , less in straightforward
• dental conditions.
• - With experience , only important
  facts need be noted.
• History
• - establish a relationship with the
  patient, attitude. Seat comfortably,
  addressed by his name proper title. Records in
  details.
• - anxious or relaxed. Some will
  verbose, reticent.
• - avoid leading question.
• - arrange the facts in inverse
  chronological order( recent events first).
• History recorded under the following headings

2

• a- patient referred by.
• b- complains of (CO)---- his own words
  ----symptoms he wants to cure ---not his views on
  the diagnosis.
• c- history of the present complaint (HPC) pain
  , swelling,discharge,remissions
• treatment received
• d- previous dental history (PDH) regular
  patient, pay attention to his teeth,
• difficulty in extractions or anaesthesia,
  bleeding-----.
• e- relevant medical history (RMH) the
  conditions that affect the diagnosis or
• treatment.
• f- family history (FH) mainly in O.S. ,
  haemophilia---anodontia.
• g- social history (SH)
• - occupation
• - social habits
  -----smoking,drinking,exercise.
• - home relation---alone,tr
  avel,or has somebody to look after him.

3

• Principles of examination
• Medical or dental is the same (
  inspectionpalpation- percussionauscultation).
• Inspection - observe signs of or
  psychological disease (in the gait).
• - eyes first then hands.
• -locate the anatomical
  landmarks by tips of hands notice
• any asymmetry
  ----swelling (fluctuation, bimanual palpation)
• record positive or
  negative findings.

4

• Systematic procedure for exam. of the mouth -
• extra-oral exam. inspection palpation of
  the face (asymmetry, facial
• paralysis, eyes
  movement, pupils reaction, and difficulty
• in breathing.
• a- T.M.J. open closed---range of
  opening ---tenderness---clicking
• crepitus.
• b- maxillary sinus swelling, tenderness,
  redness, nasal discharge, O.A.F-
• c- lymph nodes tenderness, cosistency
  degree of mobility.
• d- the lips fissure at the angle of the
  mouth or ulceration.
  intra-oral exam.
• a- m.m. colour, texture, swelling or
  ulceration. Compare both sides by
• palpation.
• b- the tongue movements , intrinsic
  extrinsic (limitation is an
  important clinical sign in inflammation early
• neoplasia).
  Check dorsum ----pull the tongue using
• dental
  napkin---for fissure, ulcers,etc.
• c- the tonsils depress the tongue with
  a spatula ask the patient to
• say AH.
  

5

• Cont. intra-oral exam.
• d- The pharynx depress the tongue pass
  the uvula , mirror to show the
• oro-and naso-pharynx.
• e- the salivary glands
• f- the periodontal tissues standard of
  oral hygiene calculus, plaque, color ,
  texture of the gingivae, hyperplasia mobility
  of the teeth.
• g- the teeth caries, fillings, loose teeth
  before G.A.
• h- edentulous ridges form , R.Rs. , bony
  soft tissues abnormalities.
• check
  denture!!.
• i- the occlusion occlusal function ,
  bridges , crowns , dentures assessed.
• 
  

6

• Special lesions
• This is the complaint of , the
  patient ( swelling , ulcer , fistulae ).
• Record down the site, size, shape, colour,
  margins, multiple or single.
• Tenderness, fluctuant or solid.
• Solid swelling hard ---- bone
• firm ----
  muscle
• soft ----
  relaxed muscle
• very soft ---- fat
• pulsatile swelling check whether it is
  true or transmitted from an
• underlying artery.

7

• Special investigation -
• History clinical exam.
  completed----consider your findings for
  provisional or differential diagnosis. Special
  investigation are not needed for
• every patient.
• local dental investigation -
• a- performed in the
  surgery
• - percussion
  to the teeth
• - vitality
  tests on the teeth ------- thermal or
  electrical.
• -
  radiography
• - diagnostic
  injection of local anesthesia facial pain.
• - study
  models for occlusion.
• -
  photography as a comparative record.
• b- requiring special
  facilities
• -
  bacteriological ------- C. S.
• - aspiration
  of cystic cavities
• - biopsy of
  tissue

8

• General investigation
• a- performed in the surgery
• - temperature,
  pulse rate blood pressure , respiration rate
• b- requiring special facilities
  
• - urinalysis
• - blood
  examination
• - chest
  radiographs
• -
  electrocardiograph
• - tests for
  allergy
• The surgeon must understand the clinical
  significance of the results.

9

• Diagnosis
• after completing the
  investigation , the surgeon should be able
• to make the final diagnosis which is
  like a computer exercise
• in which all the information are
  sorted analyzed in the surgeon
• mind.
• sometimes it is difficult to
  reach a diagnosis due to lack of
• information or knowledge. It is wise
  to seek another opinion ,
• or consult textbooks or papers.
• Treatment plan
• - Is divided into -
  pre-operative
• -
  operative
• -
  post-operative care
• Bear in mind that the ultimate aim is
  to cure the patient with the least
• risk minimal inconvenience to him.