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Demo 3: Physical Examination: Extraoral Examination: Cranial Nerve (10min)

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Introduction to Dental Medicine

University of Pennsylvania

4.8 (380 ratings) | 15K Students Enrolled

The mouth is the window into human health. This course provides an overview of dental medicine to engage, educate, excite and assist you in improving the oral health of your patients and members of your community. We will review topics in dental medicine including scope of the field, what to expect in function, and some of the many ways that dysfunction may present for different patients. This will include discussions of mouth, jaw, and tooth anatomy, pathology, and treatment. We will talk about differences between patients and the unique roles that different members of the dental field may play in treatment depending on the patient and condition. This course starts from basic concepts and proceeds to review trends in current research and technology. We offer scientific background, some skills for patient evaluation and interview, and some suggestions for further learning for those interested in or involved in dental education.

Lehrplan anzeigen

Bewertungen

4.8 (380 ratings)

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ND

Nov 29, 2016

Great overview of issues encompassing the patient assessment and management in the general dental practice underpinned by theoretical basis of health and disease supported by the latest evidence .

MA

Aug 19, 2017

I am going to the Dentist School and I feel like this is a very beneficial course that introduced me perfectly to the dentistry sea.\n\nIt's really awesome.\n\nThank you Pennsylvania university!

Aus der Unterrichtseinheit

Week 3 - Comprehensive Evaluation of Dental Patient Needs

These modules will demonstrate the evaluation of extra- and intraoral structures. They also review the taking of a thorough medical history, with live patient demonstrations. This unit emphasizes the complex relationship between the systemic and oral health.

Lecture 1: First Dental Appointment (13min)13:17

Lecture 2: Dental Local Anesthesia (4min)4:41

Lecture 3: Comprehensive Patient Evaluation (14min)14:21

Demo 1: Physical Examination: Introduction (3min)3:14

Demo 2: Physical Examination: Extraoral Examination: Head, Neck and Face (4min)4:48

Demo 3: Physical Examination: Extraoral Examination: Cranial Nerve (10min)9:43

Demo 4: Physical Examination: Extraoral Examination: TMJ (5min)5:24

Demo 5: Physical Examination: Intraoral Examination (9min)8:34

Unterrichtet von

Dr. Uri Hangorsky
Associate Dean for Academic Affairs/ Director PASS
Dr. Thomas P. Sollecito
Professor and Chairman of Oral Medicine
Dr. Eric Stoopler
Associate Professor of Oral Medicine

Skript

[MUSIC]

The next part of the extraoral examination includes a cranial nerve examination.

We perform this examination if there is a patient that has

a significant facial pain component.

The gross cranial nerve exam is done with actual ease.

The most important part is to remember that there are 12 cranial nerves.

So, for olfaction, which is cranial nerve number one,

we'll just often ask the patient if they can smell a certain substance,

perhaps the hand sanitizer, or if there is

some type of solvent that has a very distinct odor.

Cranial nerve number two is the optic nerve, and again,

we often will perform this by asking the patient to

read something on the history that they have brought into the patient.

Part of the optic nerve is to also identify the fields of vision,

of which case you would ask the patient to look straight, and for

demonstration purposes, ask for

them to evaluate when they're able to see my fingers in their peripheral vision.

Tell me when you can see the fingers.

>> Now.

>> Beautiful.

And.

>> Now.

>> The cranial nerve number three is your ocular motor nerve,

and that nerve often is tested by asking a patient to follow

your finger as they hold their head steady.

As you're asking them to look at your finger in all of its movements,

you're also asking them.

You're also checking not only the third cranial nerve, but

also the fourth cranial nerve, and the sixth cranial nerve.

The fourth cranial nerve being the trochlear nerve, and the sixth cranial

nerve being the abducens nerve, which controls the lateral rectus muscle.

The lateral rectus allows for lateral visualization, and

the trochlear nerve allows for downward and inward movement of the eye.

As part of the gross cranial examination, often we will have either a pen light,

or if one is not handy, we'll ask the patient to look at the light, and

be able to determine whether or not the pupils are reacting to that light.

We'll often cover one, followed by covering the other, and

making sure that the light is in fact causing the pupil to constrict.

For cranial nerve number five, which is most important to the dentist,

we will perform this cranial nerve examination in

a little bit more detail than some of the others.

If we remember, cranial nerve number five is divided grossly into three segments.

V1 which is the upper portion of the head, V2 which is the mid portion of the face,

and V3 which is the lower portion of the face.

All of which go to midline.

Sorry about that.

So we would like to test cranial nerve number five to light touch

to be able to discriminate between a sharp point and a dull point,

as well as to be able to discriminate if something is cool, has a cool sensation.

So for these purposes, I'm going to use just a standard gauze.

And I'll ask the patient, as I

place a little bit of the wisp of the gauze in different segments of their face.

So I'll first ask them if they can feel this as light touch in all three segments.

And can you feel that?

>> Yes.

>> And then I'll ask them, does it feel equal on both sides?

>> Yep. >> In all three segments.

>> Yes.

>> Good.

As part of this examination, I'll also perform a corneal reflex.

I'll ask the patient to open up their eyes wide, and I'll just sort of brush,

very gently, the cotton in the corneal region, and you'll see a normal twitch.

In order to test sharp dull in a patient when we're in the dental office,

we've devised a cotton applicator, where we break the cotton applicator and

it is a sharp point on one end, and a dull point on the other.

Now we will ask the patient if they're able to discriminate sharp from dull.

Once again, we'll do that in all three segments of the face, and

we'll ask them if the sharpness on the one side feels equal or

roughly equal to the sharpness on the other side.

The last portion of the patient's examination, we'll be

able to discriminate if the patient can tell a cold sensation.

And for this, our dental mirrors are very good tools where we can ask the patient,

the metal, does that feel cool?

And does it feel equally cool on the other side?

Once again, we'll use that in three distinct areas.

This is a very gross cranial nerve examination.

However, if there are deficiencies in that nerve, further testing can be done.

So thus far, we've accomplished cranial nerves one through six.

For cranial nerve number seven, this is our facial nerve, and

this is the nerve that is associated when a patient has a Bell's palsy.

This is a relatively easy nerve to test

because we ask patients about facial expression.

Would you please smile?

And would you frown?

Wiggle your eyebrows up and down.

Can you blow up your cheeks?

And also, we'll ask them to close their eyes, to see if we can part their eyes,

just slightly.

Any facial weakness would be determined by this examination,

and would warrant additional evaluation.

Cranial nerve number eight is the vestibulocochlear nerve.

This actually is a nerve that has two purposes.

One is for hearing, the other is for balance.

I will not perform a standard balance examination, but it will be obvious,

in discussing with a patient if they're off balanced, or upon

the general survey of them walking in, if in fact the patient has balance issues.

A gross cranial nerve exam for

hearing is to ask the patient if you can hear equally in both ears.

Now mindful, this is not a very detailed examination.

For those purposes a Rene or

Webber examination is often performed to determine whether or

not there is a sense in neural hearing loss or conductive hearing loss.

For today's purposes however, we asked the patient if they could just hear us

whisping our fingers together equally on both sides.

Cranial nerve number number and cranial nerve number ten are associated with.

Well, cranial nerve number nine is associated with both motor and

sensory perceptions.

In fact, if the patient has some pain or even has a lesion

in the back of their tongue, they'll often feel pain into their ear.

And this is through cranial nerve number nine.

Cranial nerve number nine is also associated with the patients gag reflex.

As is cranial never number ten which is referred to as the vagus nerve.

So often when we inspect a patient, and

I'll show you this when we look intraorally in just a minute.

At the patient's back of their throat, we like to see the tonsils and

the back of the throat move up together evenly to make sure there

are no deficiencies in cranial nerves number nine or cranial nerve number ten.

Cranial nerve number 11 is the spinal accessory, and

we'll ask the patient to shrug their shoulders.

And we'll feel if there's good muscular tone in the patient's shrugging of

the shoulders, which is again, associated with the spinal accessory nerve.

Lastly is cranial nerve number 12 which is referred to as the hypoglossal nerve.

This is the nerve that produces motor to the tongue,

so often we'll ask the patient to stick out their tongue.

We'll ask to move their tongue right and left, and

be able to follow commands in doing so.

In patients that have a deficiency in the hypoglossal nerve,

when they protrude their tongue, their tongue may move to one side only.

Can you pretend to do that for us?

>> Sure.

>> Right. Which would suggest that one of the nerves

on the right side or the left side is working properly,

whereas the other side is not.

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