Before performing an oral examination,
review the patients medical and dental history.
Note any history of allergies, heart disease, and
hepatitis. Note the medications the patient is
currently taking. Review and update the patients
NAVMED 6600/3, as needed.
When you examine the oral cavity, use a
thorough and systematic approach. Some
knowledge of the normal dental anatomy is
essential to recognize oral diseases. The starting
point of the examination is determined by the
individual performing it. However, the exami-
nation should include the entire orofacial region.
The following approach is merely a suggested
guideline. First, examine the patients tongue and
the floor of the mouth. Check for signs of
deviations in normal
anatomy and appearance, and lack of papillae on
the tongue. To properly visualize these areas,
grasp the tongue with a 2 x 2 or 4 x 4 gauze pad,
and move the tongue from side to side.
Next examine the buccal mucosa and vestibule
areas for signs of ulceration, swelling, or sinus
tracts. Examine the hard and soft palates,
gingivae, and alveolar mucosa. Record any
deviations from normal. Palpate the patients
submental, submaxillary, and tonsillar lymph
nodes, and record any palpable nodes and whether
they are tender, fixed, or mobile.
Using a mirror and an explorer, examine the
teeth for caries, chips or fractures, faulty
restorations, and other anomalies. Use the
mirror and a periodontal probe to check the
periodontium for depth of the periodontal sulcus
around the teeth. A depth in excess of 3 mm is
indicative of periodontal disease, especially if
bleeding accompanies gentle probing.
You must now evaluate the chief complaint
that brought the patient to seek treatment. If the
complaint is a fractured restoration, the exposed
dentin may be sensitive to thermal changes, or the
sharp edges may irritate the tongue. If the
problem is a painful carious lesion, determine the
status of the pulp. This is done by percussion in
which a painful response may indicate periapical
pathology. Sensitivity to heat or cold may indicate
pulpal changes, which may be the result of caries,
trauma, a new restoration, or a fractured tooth.
If pain persists after the stimulus is removed, the
pulpal tissue is probably seriously damaged and
undergoing degenerative changes.
If the chief complaint is a periodontal
evaluate the color, contour, and
uniformity of the gingivae. Hemorrhage upon
probing indicates periodontal disease. The pain
may be related to a pus-filled, fluctuant
periodontal abscess. The teeth may be mobile as
a result of advanced bone loss or trauma from
a recently placed high restoration.
Most emergency dental procedures may be
performed without the use of anesthetics.
Incising and draining a well-localized soft tissue
abscess with a single stab incision, opening the
pulp chamber of a painful nonvital tooth, or
placing a temporary filling in a carious tooth can
usually be performed without a local anesthetic.
Often it is disadvantageous to use an anesthetic.
For example, if an anesthetic is used when
excavating and filling a large carious lesion, you
must wait for the anesthesia to wear off before
determining whether or not the restoration has
eliminated the pain. Placing a temporary sedative
filling will usually bring relief without using
Placing a dressing on an exposed vital pulp
may require an anesthetic. However, in this case
profound anesthesia may not make this procedure
pain free. Extensive manipulation of painful
tissues, such as irrigation and debridement of an
will be more tolerable
when you administer an anesthetic. You, the
independent duty hospital corpsman, and the
patient must decide whether to use an anesthetic.
Pain is perceived differently by patients. One
patient may perceive pain as minimal, while
another will describe it as excruciating. Fear and
anxiety increases the patients perception of pain.
It is up to you to reassure the patient to help
alleviate this problem.
The problems involved in anesthetizing the
mandibular arch are different from those involved
in anesthetizing the maxillary arch. In the
maxillary arch, most teeth can be effectively
anesthetized by injecting 2 ml of anesthetic
solution in the loose tissue just above the tooth.
It is important to penetrate the loose oral mucosa
above the lighter pink attached gingiva that is
immediately adjacent to the teeth. The attached
gingiva and the similarly attached tissues of the
palate are denser, more difficult, and more
painful to penetrate. The needle should not
penetrate the mucosa more than 5 to 6 mm to
approximate the apex of the root of the tooth.
Make sure the needle point does not contact the