Blok 14 Oral Biomedis Drg.

Goeno

Physical Examination
Perlu diperhatikan saat melakukan anamnesis:
 Memulai wawancara dg pasien
 Sikap menghadapi pasien
 Mengajukan pertanyaan kepada pasien
 Mencatat hasil wawancara
Sambung rasa & komunikasi yang baik antara dokter dg pasien
 Saling percaya
 Saling menghargai
 Emphati

284 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Melkersson-rosenthal syndrome:
1. Fissured tongue
2. Cheilitis granulomatosa
3. Facial Paralysis

3. Facial paralysis

Physical examination
 General observation
 Extraoral examination (eo)
 Intraoral examination (io)

 Normal
 Variasi normal
 Abnormal
Apa yang akan ditemukan?

General Observation
 Gait & posture
 Hemiplegi
 Parkinson
 Degenerative joints
 Dress & grooming

285 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno
 Agility & energy
 Breathing
 Odor
 Vital signs

Posture in dental chair

 Pregnacy
 Congestive heart failure
 Arthritis
 HNP

Vital signs
 Temperature
 Respiration
 Pulse
 Blood pressure

Extraoral examination
 Head, face and neck
 Eyes
 Lips
 Lymph nodes
 Salivary glands
 Masticatory muscle

Pemeriksaan kepala dan leher

 Facial form : symmetry, swelling, imperfection
 Around the eyes: sclera, color of the conjunctiva
 Perioral: color, shape, pigmentation, fissure, cracks, ulceration
 Skin surface: reddening, blistering, telangiectasis, vascular abnormality, pigmentation,
skin surface
 Testing motor function
 Functional test: mandibular and condylar mobility, masticatory musculature, occlusion,
articulation

286 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Asesmen fungsi
 Fungsi kel. Ludah
 Kelenjar air mata (schimer tear test)
 Fungsi syaraf kranial:
V
 VII
 IX
 XII

Asesmen fungsi pengecapan

Vital signs
 A stethoscope
 A blood pressure cuff
 A watch displaying seconds
 A thermometer

General considerations

287 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno
 The patient should not have had alcohol, tobacco caffeine, or performed vigorous exercise
within 30 minutes of the exam.
 Ideally the patient should be sitting with feet on the floor and their back supported. The
examination room should be quiet and the patient comfortable.
 History of hypertension, slow or rapid pulse, and current medications should always be
obtained

Temperature
 Oral with a glass, paper, or electronic Thermometer (normal 98.6f/37c)
 Axillary with a glass or electronic thermometer (normal 97.6f/36.3c)
 Rectal or "core" with a glass or electronic Thermometer (normal 99.6f/37.7c)
 Aural (the ear) with an electronic thermometer (normal 99.6f/37.7c)

Respiration
 Best done immediately after taking the patient's pulse. Do not announce that you are
measuring respirations.
 Count breaths for 15 seconds and multiply this number by 4 to yield the breaths per
minute.
 In adults, normal resting respiratory rate is between 14-20 breaths/minute.

Pulse
Note whether the pulse is regular or irregular:
 Count the pulse for 15 seconds and multiply by 4.
 Count for a full minute if the pulse is irregular.
 Record the rate and rhythm.

Blood pressure
 Position the patient's arm so the anticubital fold is level with the heart. Support the
patient's arm with your arm or a bedside table.
 Center the bladder of the cuff over the brachial artery approximately 2 cm above the
antecubi tal fold.
 Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough
estimate of the systolic pressure.
 Place the stetescope over the brachial artery.

288 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno
 Inflate the cuff to 30 mmhg above the estimated systolic pressure.
 Release the pressure slowly, no greater than 5 mmhg per second.
 The level at which you consistently hear beats is the systolic pressure. Continue to lower
the pressure until the sounds muffle and disappear. This is the diastolic pressure.
 Record the blood pressure as systolic over diastolic ("120/70" for example).

Questions must be answered are:

 Is the abnormality itself important?
 How well he will tolerated dental procedures ?
 Is the finding suggestive of systemic problem ?
 If so, what the best to do to the patient ?

Pemeriksaan oral
 Mata
 Hidung
 Rahang
 Bentuk muka
 Kelenjar ludah
 TMJ
 Kelenjar limfe

 Anomali
 Asimetri
 Pembengkakan
 Ekspresi wajah
The anterior cervical chain of lymph nodes

Parotid masses(especially in superficial lobe)

289 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno
Crepitation, clicking, and popping of the TMJ?

Perioral and intraoral

● Bibir – terbuka / tertutup
● Vermillion border
● Sulkus nasolabialis
● Labial commisure
● Warna; tekstur, abnormalitas

Vermilions border of the lips (smooth and pliable)

Angioedema (angioneurotic edema)

Mukosa labial - vestibulum

● Mukosa labial
● Sulkus – vestibulum
● Frenulum
● Warna, tekstur, struktur
● Kondisi abnormal

290 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Labial mucosa (pinpoint mucosal secretions)

Mukosa pipi
● Comisura labialis
● Liea alba
● Muara kel,parotis
● Fordyce’s granule

291 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Fordyce’s granule

Morsicatio buccarum (cheek-biting)

White sponge nevus

292 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Asymptomatic, bilateral, soft, white and “spongy” plaques

Gingiva

Fistula / gum-boil

293 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno
Gigi mati – abses periapikal – fistula

Peripheral giant cell granuloma

Pyogenic granuloma

Phenytoin

Cyclosporin

294 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Palatum
 Bentuk
● Papila insisiva
● palatum durum
● palatum molle
● uvula
● ‘AH’ line

Melanoma

Lidah
● Bentuk lidah
● Permukaan dorsal
● Permukaan lateral
● Permukaan ventral
● Papilla lidah
● Abnormalitas

295 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Lidah
Erythematous candidosis (after antibiotics)

Hairy leukoplakia

Carcinoma?

Dasar mulut
 Lining mucosa
 Frenulum
 Muara kelenjar ludah
 Pembuluh darah

296 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Leukoplakia dasar mulut

The ostia of the wharton ducts

Lingual frenum (overattachement?)

297 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Pemeriksaan gigi

Localized environmental enamel Hypoplasia (turner’s tooth)

Parulis (gumboil)

298 | P a g e
 Blok 14 Oral Biomedis Drg.
Goeno

Tes diagnostik
 Routine ‘dental’ test:
Vitality test
 Routine ‘medical’ test
Vital signs
 Additional test:
Rontgen, aspirasi, biopsy
Blood etc.

299 | P a g e