SIGNIFICANCE OF HISTORY AND EXAM RISK FACTORS Accelerate dz SYMPTOMS Indicate Dz - Severity SIGNS Reveal asymptomatic dz’s

Signs HISTORY EXAM ASYMTOMATIC PROBLEMS Risk Factors Symptoms Cardiac arrhythmia Hypertension Oral cancer What are the symptoms of hypertension What are the symptoms of cancer PAIN FUNCTION Signs

STANDARD PATIENT ASSESSMENT EXAM VS (Vital Signs) E/O (Extraoral) I/O (Intraoral) Tests (Vitality/Mobility) HISTORY CC (Chief Complaint) HPI (History of present Illness) PDHx (Past Dental History) PMHx (Past Medical History) ROS (Review of System) SHx (Social History) FHx (Family History) Meds (Medications) All (Allergies) RADIOLOGY Ass/Dx (Assessment / Diagnosis) History from CC to periphery Exam: from periphery to CC Plan Reassessment

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.

STANDARD PATIENT ASSESSMENT EXAM VS (Vital Signs) E/O (Extraoral) I/O (Intraoral) Tests (Vitality/Mobility) HISTORY CC (Chief Complaint) HPI (History of present Illness) PDHx (Past Dental History) PMHx (Past Medical History) ROS (Review of System) SHx (Social History) FHx (Family History) Meds (Medications) All (Allergies) RADIOLOGY Ass/Dx (Assessment / Diagnosis) History from CC to periphery Exam: from periphery to CC Plan Reassessment

VITAL SIGNS: Pulse: 68 reg. BP: 130/85 RAS (right arm sitting)

STANDARD PATIENT ASSESSMENT EXAM VS (Vital Signs) E/O (Extraoral) I/O (Intraoral) Tests (Vitality/Mobility) HISTORY CC (Chief Complaint) HPI (History of present Illness) PDHx (Past Dental History) PMHx (Past Medical History) ROS (Review of System) SHx (Social History) FHx (Family History) Meds (Medications) All (Allergies) RADIOLOGY Ass/Dx (Assessment / Diagnosis) History from CC to periphery Exam: from periphery to CC Plan Reassessment

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.

DISASTERS CANCER Risk factors SILENTLY accelerate disease

RISK FACTORS FOR SCC

4 RF Dz 3 RF 2 RF 1 RF RISK FACTORS (RF)

systemic T regional N M The concept of local INFECTION TUMOR PAIN chronic pain can originate in the CNS chronic pain can affect the mood systemic

INFECTION NEOPLASM OTHERS CERVICAL LYMPH NODE ENLARGEMENT bacterial leukemia connective tissue diseases (e.g. lupus erythematosus) sarcoidosis bacterial viral (local / systemic) fungal postinfect. fibrosed node < 40 yrs: lymphoma > 40 yrs: metastatic SCC

Diagnostic approach for Head and Neck Tumors 1) Rule out lymphadenopathy caused by infection bacterial (odontogenic, tonsils) viral (respiratory epithelium) 2) Search for oral squamous cell carcinoma 3) Follow up in 2 weeks: if still present, refer to ENT specialist for evaluation Asymmetric enlargement of one or more cervical lymph nodes in an adult over 40 is almost always cancerous and usually is due to metastasis from a primary lesion in the mouth or pharynx.

Importance of early diagnosis of squamous cell carcinoma 40% stage I & II 60% stage III & IV 80-90% cure 2/3 recurrence < 2 yrs < 1/3 survive 3 yrs. Second primary tumor in successfully treated patients within 5-7 years: up to 40% !!! Follow-up important!!!

therefore……. ...know the H&N anatomy!!! ...performing a H&N exam for EVERY dental check-up!!! ...following up on suspicious signs!!!

Differential diagnosis of lateral tumors of the neck Salivary gland (sublingual / submandibular / parotis) Lymph node Soft tissue tumor (Lipoma, Fibroma) Neurofibroma Esophageal diverticulum Laryngocele Branchial cyst Carotid aneurysm Hyoid bone Transverse process of cervical spine

Differential diagnosis of midline tumors of the neck Thyroid Dermoid cyst Sebaceous cyst Thyroglossal duct Lymphnode

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.

Redness Heat Swelling Pain Dysfunction CARDINAL FEATURES OF INFLAMMATION Redness Heat Swelling Pain Dysfunction

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.

DESCRIPTION OF MASSES / LYMPHNODES Location Size (< 1cm >) Tenderness Consistency Mobility

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.

COMPETENCY EXAM PHYSICAL EXAMINATION You are required to demonstrate the following diagnostic procedures: - Take vital signs and document findings in the proper write-up Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids). Perform a neurologic exam of cranial nerves Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles) Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present) Perform examination of salivary gland function Know the cardinal features of inflammation Know how to describe a lesion or a node/lump/mass.