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

2. 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

3. 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

4. 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.

5. 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

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

7. 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

8. 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.

9. DISASTERS
CANCER
Risk factors SILENTLY accelerate disease

10. RISK FACTORS FOR SCC

11. 4 RF Dz
3 RF
2 RF
1 RF
RISK FACTORS (RF)

12. 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

13. 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

14. 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.

15. 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!!!

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

17. 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

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

19. 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.

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

21. 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.

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

23. 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.

24. 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.