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Extraoral Exam

Endo Diagnosis

Overview

Function

Regardless of the patient’s chief complaint, perform a brief comprehensive extraoral exam.

Armamentarium 

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Video

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Procedure

Regardless of the patient’s chief complaint, perform a brief comprehensive extraoral exam.


First, take the patient’s vital signs. Record the patient’s temperature, respiratory rate, blood pressure, and pulse. Be cognizant of any abnormalities that the patient may have.tretch the dam away from the gingiva to remove.

Assess the patient’s overall appearance. Do they appear well or unwell? Are there signs of fatigue or malaise? Are there any indications of head trauma?

  • If a patient presents to a dental setting following a traumatic incident, it is important to make sure that they have received medical clearance if there are signs of shock, obvious injury, or neurological deficits. In particular, following an injury to the head or neck, it may appropriate to refer a patient to an emergency room physician so that they can receive any necessary care

  • If you suspect head trauma, you can help the patient get transported to the nearest emergency room. It may be helpful to perform a brief neurological exam to assess the severity of the situation

Examine your patient’s head and neck. In particular, look for signs of facial swelling (edema), redness (erythema), extraoral sinus tracts, and lymphadenopathy. Consider whether the patient’s appearance is generally symmetrical or if there is any asymmetry.

  • When assessing the patient’s appearance it can be helpful to look at a reference photograph. Explain this to your patient and ask to see a photo ID (such as a driver’s license), which will allow you to determine the degree of swelling or discoloration

To further assess any edema or lymphadenopathy, gently palpate along the submental, submandibular, and cervical lymph node chains. Note any tenderness the patient reports or any swelling or hardening of the nodes.

If there is a swollen area you can place the back of your gloved hand against the area. Is the swelling firm, suggesting a cellulitis, or is it soft and fluctuant?

  • Generally, a fluctuant swelling is more consistent with a more localized infection, possibly of endodontic origin, and a cellulitis is an infection which has progressed and will require antibiotic therapy.

Record any significant findings from your extraoral exam in your record keeping table. 

References:

Torabinejad M, Fouad A, Shabahang S. Endodontics: Principles and Practice. 6th ed. London, United Kingdom: Elsevier, 2020.

Blicher B, Pryles RL, Lin J. Endodontics Review: A Study Guide. Hanover Park, IL: Quintessence Publishing Co, Inc, 2019.