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Fimbriated fold of tongue

From Wikipedia, the free encyclopedia

Fimbriated fold of tongue
The mouth cavity. The apex of the tongue is turned upward, and on the right side a superficial dissection of its under surface has been made. (Plica fimbriata labeled at upper right.)
Prominent fringed fimbriated folds.
Details
Identifiers
Latinplica fimbriata
Anatomical terminology

The fimbriated fold of tongue, also plica fimbriata, is a slight fold of the mucous membrane on the underside of the tongue which runs laterally on either side of the frenulum. The free edge of the fimbriated fold occasionally exhibits a series of fringe-like processes. (Fimbria is Latin for fringe).

Some people have small (<1 cm) horn-like triangular flaps of "skin" (mucosa) under their tongue. They are on each side of the frenulum (the piece of tissue connecting the bottom of the tongue to the inside of the mouth) under the tongue and run parallel next to the two distinct veins. They typically appear in pairs and may even be up to 4 or more sets, but for even those who have them only two closer to the tip are distinctly visible while the others are very minor or just small bumps. These are the "fringe-like processes" part of the "fimbriated fold".

They are normal residual tissue not completely reabsorbed by the body during the development and growth of the tongue.

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  • Examination of the Mouth

Transcription

Welcome to the University of Michigan Dentistry Podcast Series promoting oral health care worldwide. The examination of the mouth is one of the procedures that is used in the total evaluation of the patient, it is called sometimes the "object examination" because it is the means of gathering objective diagnostic information. It is correlated with the history which is the subject of examination, information that the patient can tell us and the history is obtained in advance of examination of the mouth. In addition to that, dental radiographs are used during the course of the examination for reference to confirm findings that are detected during the course of the examination procedure. This is a typical record that we use to record the findings from the history and from the examination and from additional procedures that may be done. It is supplemented by Polaroid color pictures which have been used in recent years in lieu of a dental chart. You'll find that the Polaroid pictures are much less time consuming and of course far more accurate in recording the situation in the patient's mouth. The instruments that are used during the course of examination are simple and a minimum of material is required. We have a mirror, the probes, the periodontal probe, the cow horn probe, finger cots are used to make the examination procedure more comfortable for the patient because during the process of probing inside the mouth with the fingers it's better if you don't have hang nails exposed for the discomfort of the patient. The gauze squares are used for drying off the surface of the tissue, for grasping the tongue, and for drying off the openings or the ductal openings for the salivary glands. It's important to have the patient in a comfortable position both for the patient and for the examiner. Good lighting is extremely important. And of course a situation which permits maximum exposure of all the tissues to be examined is extremely important. The initial phase of the examination is the general appraisal of the patient's health. This begins upon the first meeting with the patient. It also continues during the history taking procedure. And following the history taking procedures it goes to a more detailed examination of the patient's exposed skin surfaces, for example the facial skin, the distribution of hair, the facial profile, the symmetry of the face, the contour of the head, and the contours in the neck, pulsations in the neck are all important parts of the general evaluation of the patient's health. We would like to go some examples now which demonstrate some findings in the general appraisal of the patient. This individual demonstrates prominence of the eyeballs and because of the position of the upper lid well above the iris. This is a natural position under the circumstances of general illness that this individual has. As we go down and look at the neck area, it's obvious that there is enlargement here which is related to the thyroid gland. Prominence of the eyes and the prominence of the thyroid gland in the neck are related. Ordinarily the upper lid courses over the upper third of the iris. These two individuals side-by-side demonstrate very well the presence of jaundice in the individual on the right. This is an indication of liver disease or retention of the break down products of red blood cells that are not processed properly because of the liver problem. This is important to note because of its relationship to the blood clotting mechanism and to the use of certain drugs. Some of the pigments are transitory in character that we see in the skin and some are permanent. But it's important to detect them when they occur and determine the basis for them. This is the hands of a young person with congenital heart disease. It could well be the hands of an individual with lung cancer or other chronic pulmonary problem. This is a condition known as clubbing and it's demonstrated by the club character of the end of the fingers, the round contour of the nails. It is also evident that there is a bluish color in the nail bed here which indicates that this person has too much reduced hemoglobin in the circulating blood. It's important to note this because certain conditions relate to the treatment of these individuals. Comparison of the nail bed, between a normal, hopefully the examiner, and the patient will help to detect the presence of anemia. The cardiovascular bed is close to the surface in the nail bed area. It helps the examiner detect the presence of pallor. Comparing the palms of the same two individuals, it's apparent that the creases in the palm of the person on the right retain their pink color as the hand is outstretched while those on the individual on the left do not demonstrate a pink color. Here again the vascular bed is close to the surface and indicates a lack of hemoglobin in the individual on the left. Returning to our patient let's look for some of the conditions that were demonstrated on the slides. First of all, let's look at the patient's eyelids as they course across the iris. You'll notice that the upper one-third or one-fourth of her iris is covered by the upper lid. As we look down into the neck region, we are not able to detect any significant lack of symmetry from one side to the other. The sternocleidomastoid muscles are evident. The supersterno notch is clearly visible here. And there is no abnormal swelling or altered contour in the neck region. As we go to the hands, the nails are normal in contour there is no evidence of clubbing. As we compare the color of nail beds with mine, we see there is a good comparison between the two beds. As we look at the palm of the hand, the hand outstretched, the palm or creases retain their pink color in both hers and mine. The examiner's hemoglobin level at this point is 15.8 grams which is well within the normal range. Now as we continue in the examination. We go to the more detailed examination of lymph nodes in the neck region. There are various groupings of nodes that we will examine. As you can see the pointer is indicating the submental group of nodes, the submandibular group of nodes, the parotid group of nodes, and above those the preauricular nodes. Going down into the neck area below the sternocleidomastoid muscle or under the sternocleidomastoid muscle which you see outlined by the dotted lines are the deep cervical nodes or the jugular chain. During the examination for lymph nodes certain criteria should be kept in mind. They're listed here. We're concerned about the size of the lymph node under examination. Its shape. Ordinarily, most palpable nodes that are normal in character will be about the size of a kidney bean and similarly shaped. They will have a somewhat rubbery or soft consistency and they will be freely mobile, they will have good mobility. Most lymph nodes are found singly or in groups but they are always separated and identifiable as single entities. When they are multiple and coalesced this is suggestive of a disease process. Tender lymph nodes of course indicate that some inflammatory process has invaded the lymph node and is producing the tenderness. Now let's examine the patient for lymph nodes. We'll start in the submental area and in the process of examination we're trying to trap lymph nodes under against underlying tissue, muscular tissue, connective tissue or bone. Submental area and the submandibular area produce no detectable nodes on examination. Into the parotid area we're unable to detect any evidence of prominent lymph nodes. Keep in mind that at the same time we examine this area that the parotid gland is found here and should not be palpable under normal circumstances. We come down into the jugular chain and notice the outline of the sternocleidomastoid muscle here. We have the patient bend forward and relax. It's a simple process to place the fingers below the anterior or inside of the anterior edge of the muscle attempting to pick up nodes that are prominent. Now we're ready to go to the more detailed examination of the mouth. And in doing so, let's first stop and discuss the methods we're going to use in the examination procedure. We've already used these methods we're about to discuss to some extent. We have used the process of inspection but now we're going to use it in more detail in the inter-oral examination. In the inspection of the inter-oral tissue we're going to be concerned with these characteristics: the size, the shape or contour, the color of the tissue under examination. We're going to be concerned about the anatomic relationship of various parts to their surrounding structures. We're going to look at the integrity of the covering tissue; the epithelium over the surface should be in tact under normal circumstances. The degree of keratinization will vary in different parts of the mouth. In most areas we will not able to detect keratinization clinically and therefore the finding of keratinization is an important one. Fortunately, most of the parts in the oral cavity are duplicated bilaterally so this permits us to examine the symmetry of bilateral parts. Palpation is another method of evaluating tissue that cannot be inspected, that is tissue that is deep to the surface. We under these circumstances must evaluate tissue by using the sense of touch and in so doing we check tissue for its consistency. Is it soft, firm, hard, or nodular? And is this characteristic of the normal tissue under examination? Is there any evidence of tenderness displayed by the patient during the course of the examination procedure? If we find the mass, it's important to determine whether it is mobile or whether it is fixed to the surrounding tissue. Again we have the opportunity for the bilateral comparison of parts since most parts are duplicated bilaterally. And of course during the palpation procedure we want to be able to identify anatomic landmarks that are invisible by this method. The detailed examination of the mouth begins at the outer portion of the lip. We inspect the lip for its normal appearance. In a woman patient it's not unusual to find that lipstick is still adherent to the surface of the lip and therefore masks some of the changes or lack of changes that we would like to identify. Since there are no significant problems in most women we do not consider this to be a serious factor in the completion of this portion of the examination. As we examine the lip we look for the line of demarcation between the vermillion portion and the skin. Also we are interested in finding that there are folds running at right angles more or less to the junction between the vermillion and skin. We should palpate at the same time we inspect to be sure that the lip is supple. Then finally we are concerned about the possibility of keratinization on the surface. The vermillion portion of the lip should have a translucent pink color. At the same time we examine the lower lip, we proceed on to the upper lip stretching it out, looking for the line of demarcation again and any changes in the vermillion itself or in the adjacent skin. Our patient has normal appearing lips. So let's turn to some slides to demonstrate some changes that we need to identify. Important changes in the lips are more likely to be seen in men. This person shows a change in the vermillion portion where it is noted that there are opaque areas demonstrated here and here by the pointer. The loss of the deep creases which ordinarily run at right angles to the junction of the vermillion and the lip and a thinning of the surface tissue or epithelium covering the lip and a loss of the sharp line of demarcation of the skin between the lip and the vermillion. This next example shows similar changes. The opacity of the vermillion portion of the lip, the loss of definition between the vermillion and the skin and the pointer focuses on an area of increased keratinization which is in fact a small cancer lesion. This next example is in a younger person than the previous two examples. We see less change in the normal portion of the lip. However, over in the, near the left corner of the mouth are significant changes, a depressed area of a scaly patch which is also a cancerous lesion. The examination of the upper lip is also important but does not produce nearly as much pathological findings as the lower but occasionally in an area such as this basil cell cancer is detected. Following the external examination of the lips, the lower lip is reflected to expose the lower labial mucosa and because our patient told me during our history taking procedure that she smokes two packages of cigarettes a day we're able to relate an increase of redness at this point on her lip to that smoking habit. We look at the topography of the labial mucosa. We notice that are very tiny elevations which represent the ductal openings of small nests of salivary glands within the lower lip. These continue on over to the angle of the mouth. Also the salivary glands result in small undulations in the surface of the lip. We then reflect the upper lip and examine that carefully. At the same time we're looking at the labial mucosa and its characteristics, surface characteristics we want to look at the frenum or the attachment of the mucosa to the gingival surface both in the upper and lower arches and in both cases the base of the frenum is well away from the gingival margin. The next procedure is the palpation of the lower lip to determine the consistency and the presence or absence of small areas of firmness or induration which might be associated with the accessory salivary gland tissue. We can illustrate by looking at an artist's drawing of this area, the contents of the lower lip in particular. In the central portion of the lip is a mass of muscle tissue. Then adjacent to that are layers of connective tissue and then of course the external portion or epithelium. A more detailed view of this same area of the lip shows that there are nests of salivary gland tissue underlying the surface depicted here in green and surrounded by connective tissue adjacent to those are, or is the epithilial surface and the undulations that are seen in the epithilial surface are related to the underlying salivary gland beds. This example shows an individual who has a cheek chewing habit. Notice the roughness of the surface that is created by nibbling away at the surface, picking up little shaggy tips of epithelium such as demonstrated here and tearing them off with the teeth to produce the eroded area or reddish areas that are being pointed out. This person shows an excessive amount of keratinization in the lower labial mucosa and the muco-buccal fold as a result of a snuff chewing habit. The labial frenum and its attachment in relationship to the gingival margin was mentioned during our examination of the patient and this example shows an unfavorable relationship producing gingival irritation and recession. The examination continues into the area of the buccal-mucosa the superior and inferior muco-buccal fold. Just tip down a little. In the lower fornix we're concerned about the position of the labial frenum and about the character of the tissue in the muco-buccal fold area. Try to follow this back posteriorly as far as possible until we get to the retromolar pad area. Now just turn to the left a little. Continuing on past the retromolar pad area up to the superior muco-buccal fold, we can tilt the mirror to see the area that is blocked out by the tuberosity behind the upper second molar tooth. Visualizing no significant change there we continue into the superior muco-buccal fold. Just tip your head a little upward now. And on up to the area and overlapping the area that was examined previously. Now we look at the buccal-mucosa in its entirety. Just turn to the right a little. Then we see here a familiar landmark, the parotid papilla. We can see that the nest of labial salivary glands ends at about the end of my finger with the finger caught on it you can see the slight elevation in contour above the surface. Next we continue our examination with the palpation of the cheek region. It's made up, you'll recall, mainly of muscular tissue, the buccal fat pad, and the Stensen duct which is the duct of course for the parotid gland. Back into the retromolar area, the area of the pterygoid mandibular region. The other side of the mouth is examined similarly. These are Fordyce spots, a finding in about 80-90% of the patients who are examined. They are ectopic sebaceous glands and have an orange-yellow color when the lip or the cheek is stretched out they are slightly elevated above the surface. They are seen in a varying degree of concentration from one individual to another. They have no real significance. Another common finding in the clinical examination is the presence of the linea alba or white line opposite the plane of occlusion of the teeth. This hyperkeratotic, elevated line is the result of impingement on the buccal mucosa of the buccal cuspids of the teeth in a variety of situations. We continue with the inspection of the palate. The landmarks that are familiar in the palatal area, in its anterior portion, are the rugae and between the central incisor teeth the incisive papilla which you see elevated in the center of the mirror. The rugae are the elevated, tortuous lines that are seen across the anterior portion of the palate. They have a slight increase, degree of keratinization associated with cigarette smoking. As we continue further back, into the palatal area, we see that there is no abnormality present. There is a uniform degree of keratinization which is somewhat increased. Now we continue our examination on in to the soft palate region and depressing the tongue at about the apex of the, or rather the crest or the curve of the tongue. It's not too uncomfortable for the patient. Just tip your head forward a little bit now. And say 'Ahhh'. Patient: Ahhhhh. Dentist: We can see the elevation of the soft palate. There is no deviation from the midline. Also at the same time we can see the posterior wall of the pharynx. Say 'ah' one more time for me. Patient: Ahhh. Dentist: Very good. Now let's look at a cutaway drawing of the palate. The rugae are visible on the surface in the upper portion. But the important tissue to be concerned with here below the surface is the salivary gland tissue or the palatine gland tissue. As you can see there are continuous nests of glands from the anterior third of the palate back into the soft palate region and down toward the retromolar area. These tend to impart a bluish color to the posterior two-thirds of the palate, the hard palate, and are misleading to some extent because of the color change they create. The commonest change that is seen in the palate is the result of smoking. In this instance there is a generalized keratinization of the hard palate in a pipe smoker's mouth. Specific changes in the accessory salivary gland ducts take place as are demonstrated here. Several of these are elevated above the surface. The duct itself is red in the central portions surrounded by elevated the periphery of keratotic tissue. Through visualization of the posterior wall of the pharynx, the soft palate, and uvula is important. On the posterior wall of the pharynx there is frequently visible elevated lymphoid tissue and little ovoid orange colored shapes such as are seen here. On the tip of the uvula in this individual a benign epithelial neoplasm called a papilloma. Before leaving the palatial area it's important to palpate the entire hard palate and soft palate. We're concerned in the hard palate for the continuity of the underlying bone or elevations above the surface. As we get back into the soft palate area it's important to elevate it with mild pressure from the tip of the finger in an attempt to detect any underlying areas of modularity. We proceed with the examination of the tongue by having our patient open as wide as she can, extending the tongue straight forward, and grasping the apex gently with cotton gauze to stabilize it, being careful not to trap the lingual frenum on the lower incisor teeth. With the tongue projected and grasped, it's possible to rotate it from side to side to expose the lateral surfaces. You go on over to the other side in the same manner rotating it in the opposite direction and exposing the tongue all the way back to its junction with the soft palate and pharynx. Looking at the dorsum of the tongue in our patient we can point out here a characteristic that is seen quite frequently in individuals who smoke. Notice an increase in length in the filiform papillae creating somewhat of a brownish or tan coat on the posterior third of the dorsum. As we turn now to the artist's rendition of the tongue. We can identify the areas of the papillae by the colors here. The yellow colored area which is in an inverted 'V' shape is the zone of the circumvallate papillae and just anterior to that in the blue zone is the area containing filiform and fungiform papillae. Laterally on both sides in the green areas are the foliate papillae which are important because they contain lymphoid tissue of in varying degrees which may be difficult to distinguish from disease process. In the more posterior area of the pointer at this time we see the lymphoid tissue or the area of the tongue containing lingual tonsils. Now as we go to a magnified picture of the dorsum of the tongue in the circumvallate papillae area. We can identify the circumvallate papillae by the outer ring and an inner area separating it from the outer ring by a zone of invagination and adjacent to that the filiform papillae are seen as the sharp projections above the surface and the mushroom dome-shaped papillae amidst the filiform papillae are the fungiform papillae. These areas of the tongue where the papillae are partially absent is rather, or is evidence of a rather common finding known as geographic tongue or migratory glossitis. It is characterized by a rather sharp line of demarcation around the zone of the exclamation of papillae. It's a benign process. There's no concern to the patient. To the examiner who is uninitiated in the procedure sometimes the appearance of circumvallate papillae as the tongue is projected is a bit unsettling. However if the anatomy of the area is recalled it's obvious what these elevations are. This is an example of an individual who has a systemic disease which is producing a change in the tongue color as well as papillation of the tongue or the loss of the papillae, rather, generally. This lateral view of the tongue in the area of foliate papillae demonstrates well the inclusion of lymphoid tissue in this zone and more posterior to that is a triangular elevated area of white tissue, hyper-keratinization which has malignant potential and must be investigated further than just examination. We move from the examination of the tongue to the floor of the mouth. And in the anterior portion of the floor of the mouth we recognize, seen in the mirror the lingual caruncles at the base of the lingual frenum and the sublingual fold coursing laterally and posteriorly on both sides. We move the tongue medially to inspect as best we can the lateral-lingual space. This area has come up during the examination of the tongue so we have seen most of it prior to this portion of the examination. Again we look into the lateral-lingual space and – just turn to the right now – and into the medial aspect of the mandible and the lateral aspect of the tongue. While we're talking about the tongue there's one area that we didn't point out earlier. Just project out your tongue and tip it up for me. That is the fimbriated fold that appears along the lateral edge of the tongue on the ventral surface. These are little projections such as the ones you can see here that should not be confused with a papilloma which you saw earlier on the uvula. Continuing then with the examination of the floor of the mouth because there are significant contents which we can palpate we begin by first of all palpating the lingual aspect of the mandible, running the finger from side to side to determine whether there are elevations above the surface. Then we trap the tissue between an inter-oral finger and an exter-oral hand to palpate for the major salivary glands that are found in this area. While doing this we are able to detect the presence of lymph nodes much more readily because the depression on the floor of the mouth makes them more prominent. I think if we just concentrate on the exter-oral hand we can see a lymph node right between the fore finger and the middle finger being flipped over the base of the mandible. Now let's look at a cutaway of this area. Just to recall to mind what we're palpating for in this area. The major salivary gland that is palpable here as the submandibular gland which you see positioned between the exter-oral finger and the inter-oral finger. The sublingual gland is found anterior to the submandibular gland but in general is not palpable as an isolated mass. The next step is to check the secretions of the salivary glands. This is accomplished by first of all drying off the ductal opening of the two orifices of Wharton's duct in the anterior floor of the mouth and producing light upward pressure to stimulate the salivary flow or really to empty the ducts that contain saliva. Let's do that again so that we can concentrate on the appearance of saliva from the ducts as we apply the pressure. We have now watched the area there we can see the appearance of saliva very readily. Now, we proceed to the parotid orifices; remember the parotid papilla was seen earlier in the examination of the buccal-mucosa. We dry that area thoroughly and with light pressure to the cheek we can stimulate the flow of saliva from that duct. Again since this is a duplicate procedure bilaterally we move to the left side, dry off the orifice of the duct, apply light pressure to the cheek with a stroke forward producing the flow of saliva from the duct. We're now ready to go to the examination of the gingival tissues. And the criteria that will be used for the examination of the gingiva will be color and the form of the gingiva, its relationship to the surface of the tooth, its density that is whether it's firm or soft, or showing evidence of inflammatory change. The attachment of the epithelium in the gingival sulcus to the tooth surface in relationship to the cementoenamel junction referred to as the epithelial attachment and finally the gingival sulcus depth which will be determined by the insertion of a measuring probe into the gingival sulcus. Let's look at what is considered to be normal gingival tissues and describe the criteria of color and form. This is an example of healthy gingiva. The general characteristic that is noticeable at once is the uniform pale pink color. There is no differentiation in color from the gingival margin to the attached portion of the gingival tissues. The gingival margin itself is closely adapted to the surface of the tooth and ends in a knife edge on the surface of the tooth. The gingival margin is all coronal to the cementoenamel junction. In interdental papillae fill in the interproximal spaces to the contact point and are rather sharp but still do not overfill the interproximal space. Now let's apply the criteria for examination of gingiva to our patient. Just close a little bit. The color is uniform in general. There is a mild tinge of bluish change which may not be entirely visible on the color television. There is a noticeable change in the contour of the gingiva. The gingival margins are somewhat rounded in their relationship to the crown of the tooth. The interdental papillae do not fill the interproximal space rather they underfill. The probe I have in my hand is used for the measurement of the gingival sulcus and I think you can see it has markings on it. Let's look at an artist's drawing of the probe and the proper positioning of the probe in the gingival sulcus. You'll notice that the working end of the probe has three marks on it. These are set at three, six, and eight millimeters from the tip. The insertion of the probe should be done in as far as possible in the long axis of the tooth, parallel to the long axis of the tooth so that the measurement is accurate. If there is deviation from this parallel position then the measurement will not be an accurate one of the true depth of the pocket. Now we will go to the patient and insert the probe to demonstrate the positioning for the examination procedure. Now in this procedure the interproximal areas are measured both buccally and lingually. And the buccal-lingual areas are measured as well. It's possible to move around the entire tooth without removing the probe entirely from the gingival sulcus. I think you can see that the tip of the probe is entering the gingival sulcus to a depth of about three millimeters. Let's go to the lingual aspect of these same teeth and insert the probe here and we can see that on insertion in this area we go to a point that is above the three millimeter mark. Notice the mark that is showing as the probe is totally inserted just above the surface is the six millimeter mark. This would indicate then that a pocket six millimeters in depth is present in this area. We would continue our probing around the teeth, lingual aspect, and into the interproximal area. Probing of the gingival sulcus should be done in a sequential manner beginning with tooth number one, working around to tooth number 16, dropping down into mandibular arch and probing from tooth 17 around to 32. This is done so that any recordings can be done or made in numerical order. Now we'll proceed to the examination of the teeth of our patient. One of the initial procedures that's carried out is the percussion of the teeth. Percussion of the teeth is done with the probe that we just finished using for examination of the gingival sulcus depth. And we use it to tap vertically on the teeth. There are certain responses that we are concerned with in this procedure. Our chart shows that we are concerned about the sound produced. This tells us something about the supporting structure of the tooth and the relationship of the tooth to the surrounding bone. The resistance of the stroke or the resistance of the tooth to the stroke of the probe again tells us something about the supporting tissues surrounding around the tooth. The response of the patient, that is, whether there is altered sensation or pain as a result of the percussion also tells us about the state of the periodontal membrane and the surrounding supporting structures. Let's go back and see if we can demonstrate some of these situations on our patient. We'll begin percussing on tooth number three. Continuing to number four. I think there is a detectable difference in the sound that is produced in the percussion process on these two teeth. The percussion of the teeth then is related to the mobility of the teeth. When we check mobility of the teeth we place a finger on the tooth adjacent to the one under examination as a point of reference. Then we try to move the tooth being examined in a buccal-lingual direction so that we can detect any movement with the finger that is palpating the tooth. After the completion of these two procedures we continue on to the inspection and exploration of the teeth themselves. We're concerned in our inspection of the teeth with the amount of stain, with the cervical area, that is whether there is evidence of erosion or abrasion on tooth number three. It's obvious that there's a definite notch at the cervical portion. This is also evident on tooth number four. You see that the probe enters into this notched area very readily. These two teeth have been restored probably for the reason that we've just demonstrated not necessarily decay but destruction of the tooth by either the abrasion or erosive process that has caused the notching. Continuing the examination of the teeth we're concerned about carious lesions and the condition of existing restoration. And we probe thoroughly the margins of all of the teeth. This examination procedure is best done when the teeth have been cleaned recently following a prophylaxis that is, and when the teeth are completely dried. We're also concerned in the examination of the teeth with the appearance of the occlusal surfaces and our patient demonstrates a significant amount of occlusal wear. This is where there probably is an excess of that that would ordinarily be found through a normal functional process. If we can get this highlighted in the examination light we can see definite deficits reflected on the surface of the teeth. Looking at them in profile we can see the cuspal inclinations are somewhat worn down more so than we expect to see ordinarily. Again the examination of the teeth is done in a sequential manner and the criterion for this examination is applied continuously throughout the arch. Once again the sequence begins with tooth number one and finishes with tooth number 32. Upon completion of the examination of the teeth, we go then to the examination of the occlusion or the occlusal function of our patient. This is done by first of all determining the relationship of the maxillary arch to the mandibular arch and the intercuspation of the teeth. Now just close and bite on your back teeth. Now just turn your head to the right. We can see that in this area we have a mild class II relationship or retrognathic relationship placing the mandibular first molar somewhat posterior to the usual position in relation to the maxillary first molar. As we examine the overjet and overbite we see that there is not occlusal contact when the teeth are in centric position. Now we proceed to the functional evaluation and we ask our patient to relax as we move the lower jaw into contact with the upper jaw keeping a constant firm but gentle pressure posteriorly and upward as the teeth come into contact. Now just touch very lightly. Now squeeze. We find there is a discrepancy between the initial contact when the jaws are in centric relation and then compared to the position of the jaws when the teeth are brought into full occlusal contact. We then check lateral excursions by asking our patient to close and to slide the lower jaw toward the right shoulder observing the cuspal relationships during this maneuver. Now back. On your back teeth. Bite and slide your lower jaw. Keep your teeth right together all the time. Very slowly now. Back again on the back teeth and keep your teeth together all the time. Just slide right out there. Fine. Now just bite on your back teeth again. Now slide straight forward keeping your teeth in contact all the time. And back. Good. Another important point to check particularly in the patient we have today is the space that is left by the extraction of two mandibular teeth and the relationship of the maxillary teeth to this space. Just turn to the left now and bite right together. We can see that there has been some excessive eruption of the maxillary teeth so that they are now in a position that is impinging to some extent on the space left by the extracted teeth. They are below the occlusal plane and must be dealt with in rebuilding the inclusion of the lower arch. After the evaluation of the occlusion, we then complete the examination procedure by the evaluation of the temporomandibular joint. We ask the patient to open as wide as she can. We look to see if there are deviations from the midline in the course of opening. Just bite together now. And with your teeth halfway open, move your lower jaw from side to side. We palpate the joint area for irregularities during the excursions of the mandible laterally without the teeth in contact. Now bite on your back teeth. And slide, just grind your teeth from side to side. A little more each way. We palpate the temporomandibular joint area as the patient slides from side to side with the teeth in contact. This helps us to distinguish whether irregularities in the movement of the joint are related to the occlusal surfaces of the teeth or whether those irregularities are intrinsic to the joint itself. During the course of the examination we followed a definite sequence. The purpose of this sequence is to avoid the omission of important details during the examination. You have been listening to a presentation from the University of Michigan's School of Dentistry which is dedicated to supporting open learning and open educational resources. This recording is licensed under the creative comments. It may be reused and redistributed for nonprofit use. Please attribute materials to the University of Michigan's School of Dentistry and redistribute under this same license. For more information on how this and other University of Michigan School of Dentistry recordings may be used visit www.dent.umich.edu/license.

See also

References

Public domain This article incorporates text in the public domain from page 1125 of the 20th edition of Gray's Anatomy (1918)

External links


This page was last edited on 5 March 2024, at 15:56
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