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医学知识双语阅读:口腔检查

2016-7-10 22:27| 发布者: admin| 查看: 70| 评论: 0

摘要: 医学知识双语阅读:口腔检查

医学知识双语阅读:口腔检查

  Source: http://www.zuinow.com/n4363859.html

Examination of the oral cavity is part of every general physical examination. Oral findings in many systemic diseases are unique, are sometimes pathognomonic, and may be the first sign of the disease. Early detection of oral cancer may be possible. 

  A dental history is obtained first. It may indicate a particular dental problem or neglect of dental care. A complaint of difficulty in chewing food suggests insufficient teeth for proper mastication, loose or painful teeth, poorly fitting dental appliances, or disorders of the temporomandibular joint or the masticatory muscles. Slight bleeding after brushing suggests mild gingivitis; frequent, spontaneous, or profuse bleeding may indicate a blood dyscrasia. Recurring oral infections may indicate diabetes mellitus (the most common cause), agranulocytosis, neutropenia, leukemia, immunoglobulin defects, or disorders of leukocyte function. Immunosuppressed persons may experience painful reactivation of oral herpes simplex or other infections, with pain, oral ulcerations, and consequent interference with food intake. 

  A thorough evaluation requires good illumination, a tongue blade, gloves, and a gauze pad. A dental or laryngeal mirror, if available, is helpful.    

  The examiner initially looks at the face for appreciable asymmetry, skin lesions, and other abnormalities, such as restricted movement during speech, as occurs in scleroderma or acromegaly. Numerous congenital syndromes produce characteristic facies. For example, a very thin upper lip suggests the fetal alcohol syndrome or Prader-Willi syndrome. Trauma in youth, particularly blunt trauma to the point of the chin, can damage growth centers in the condyles and lead to unilateral or bilateral impairment of mandibular growth. Idiopathic hypertrophy of one or both sides of the mandible or other parts of the face may distort the face, as may acromegaly or a salivary gland or jaw tumor. If the posterior teeth or dental prostheses are missing, the cheeks may be sunken, producing a prematurely aged or cachectic appearance. One or both cheeks may appear swollen due to cherubism, parotitis, Sjögren's syndrome, tumor, an excessively thick denture flange, or cellulitis from an abscessed tooth. Multiple basal cell carcinomas on the face may indicate the nevoid basal cell carcinoma syndrome, which alerts the examiner to look for multiple odontogenic keratocysts on x-rays. 

  The lips are palpated. With the patient's mouth open, the buccal mucosa and vestibules are examined using a tongue blade; then the hard and soft palates, uvula, and oropharynx are viewed. The patient is asked to extend the tongue as far as possible, exposing the dorsum, and to move the extended tongue as far as possible to each side, so that its posterolateral surfaces can be seen. If a patient does not extend the tongue far enough for the circumvallate papillae to be seen, the examiner uses a gauze pad to grasp the tip of the tongue and extend it to the desired position. The tongue is then raised to view the ventral surface and the floor of the mouth. The teeth and gingivae should be viewed. 

With gloved hand, the examiner palpates the vestibules and the area over the roots of the teeth with one finger and the cheek with two fingers. The index finger of the dominant hand is inserted inside the mouth, and the contents of the floor of the mouth are compressed gently between it and the fingers of the other hand. To make palpitation more comfortable, the examiner asks the patient to relax the mouth, keeping it open just wide enough to allow access. The cervical lymph nodes should also be palpated. 

The temporomandibular joint (TMJ) is assessed by looking for jaw deviation during opening and by palpating the head of the condyle, anterior to the ear. The examiner then places his little fingers intrameatally while the patient opens widely and closes three times. The patient should be able to comfortably open wide enough to fit three fingers between the incisors. Trismus, the inability to open the mouth, may indicate scleroderma, arthritis, ankylosis of the TMJ, dislocation of the temporomandibular disk, tetanus, or tonsillar abscess. Unusually wide opening suggests subluxation or type III Ehlers-Danlos syndrome. 

Malodor of exhaled breath may have many causes. Fetor oris originates in the mouth. Most commonly, it is caused by volatile sulfur compounds resulting from bacterial metabolism, particularly when oral hygiene is poor or xerostomia is present. Halitosis may follow eructation from the GI tract or may be caused by systemic metabolic conditions--eg, an acetone odor with diabetes mellitus, a mousy odor with liver failure, and a urinous odor with kidney failure. Halitosis may also originate from the nose, sinuses, nasopharynx, and lungs, particularly when infections or necrotic neoplasms are present. A patient whose breath frequently smells of mouthwash may be masking halitosis or may have parosmia (a perversion of the sense of smell, usually involving smelling unpleasant odors that do not exist). 

 

口腔检查是全身检查的一部分。在许多系统性疾病中,口腔表现是独特的,有时是病征性的,可以是疾病的首先征兆。口腔癌的早期发现是可能的。

首先采集口腔科病史,可提示一个特别的口腔问题或被忽略的口腔保健。主诉咀嚼食物困难提示能行使咀嚼功能的牙齿缺失或疼痛,或颞颌关节及咀嚼肌群功能紊乱。刷牙后轻度出血,提示轻度牙龈炎;经常的、自发的、大量出血,表示血液病。反复出现的口腔感染,可能存在糖尿病(此为最常见原因)、粒细胞缺乏症、中性粒细胞减少症、白血病、免疫球蛋白缺乏病或白细胞功能紊乱。免疫抑制者可经历口腔单纯疱疹的疼痛反应,并伴有口腔溃疡而导致妨碍摄食。

全面的评估需要良好的照明、压舌板、手套和纱布垫。口镜或咽喉镜有助于口腔检查。

检查者首先观察面部有无明显的不对称,皮肤病损和其他的不正常,如当说话时运动受限常出现于硬皮病或肢端肥大症。许多先天性综合征均产生特殊的面貌。例如,很薄的上唇提示胎儿酒精综合征或Prader-Willi综合征、青少年时期的创伤,特别是颊部的钝伤,能伤及髁状突的生长中心和导致下颌骨单侧或双侧生长发育受损。下颌一侧或双侧自发性肥大,或面部其他部分自发性肥大,如肢端肥大症或涎腺肿瘤或颌骨肿瘤均可破坏面部外貌。如果后牙或义齿缺失,颊部会凹陷而形成早老的或恶病质样的面貌.由于颌骨增大症,腮腺炎,SjÖgren综合征,肿瘤,过厚的义齿突缘,或牙槽脓肿引致的蜂窝织炎,均可使一侧或双侧颊部肿起。面部多发性基底细胞肉瘤可表现痣样基底细胞肉瘤综合征,这可使检查者留心地在X线片上寻找多发性牙源性角化囊肿。

对唇部作扪诊,同时令患者张口,用舌板检查颊粘膜和口腔前庭;然后巡检硬软腭,悬雍垂和口咽部.请患者尽快地伸出舌,暴露舌背,并且尽快地向每侧移动舌,这样就可看到舌的后侧表面。如果患者不能将舌伸出足够以使轮状乳头能被看见时,检查者可用纱布垫拉住舌尖,使其伸出到所需的体位。然后巡检舌腹部表面和口底,再检视牙齿和牙龈。

检查者用戴手套的手指对口腔前庭进行扪诊并用一个指头扪所有牙齿的根部,用两个指头核对。主检手的示指放入口内,另个手的几个手指置于口外相当部位,轻柔地触扪口底。为了使扪诊更舒适些,可请患者将口腔放松,维持一定的开口度以使手指能进入口腔。对颈部淋巴结也应作扪诊。

颞下颌关节(TMJ)的检查为当开口时在耳前方扪诊髁状突的头,检视颌骨的偏向。然后检查者将小指深入置于外耳道内,请患者张大口和闭口3次。患者能舒适地张大口,足以使上下切牙之间能放进三个手指。不能张口的牙关紧闭提示可能为硬皮病、关节炎、颞下颌关节强直、颞下颌关节盘脱位、破伤风或扁桃体脓肿。异常的大开口提示关节盘半脱位或Ehlers-Danlos综合征的(先天性遗传性综合征,特征为关节过度伸长,皮肤弹性脆弱等---译者注)

呼吸气味的恶臭可由许多原因引起。口臭起源于口腔。最多的原因是来自于细菌代谢产生的易挥发的硫化物,尤其是口腔卫生不良或口干症时。口臭也可随胃肠道的嗳气而来或由系统性代谢性疾病引起,也即丙酮味与糖尿病有关,鼠臭味与肝功能衰竭有关,尿味与肾功能衰竭有关。口臭也可起源于鼻部,上颌窦,鼻咽部和肺,尤其当这些部位有感染或坏死性肿瘤时。经常散发着漱口液气息的患者常感觉有潜在的口臭或可能是个嗅觉倒错者(嗅觉反常,常自己感到不适的臭味,而事实上此味是不存在的)


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