History and Physical for the Pediatric Dental Patient: Establishing a Systematic Approach for Procedural Sedation

Prologue: Conducting, Interpreting and Understanding the History and Physical: A Dentists Perspective
Contents
1: Conducting a History and Physical: “Succinct yet Exhaustive”
	References
2: Assessment of the Vital Signs
	2.1	 Development of the Lung
	2.2	 Sleep Disordered Breathing
	2.3	 Mechanism of Gas Exchange
	2.4	 Abnormal Vital Sign Readings
	References
3: Assessment of the Head and Neck
	3.1	 Extraoral Examination
	3.2	 Differential Considerations for Deviations: Child Abuse
	3.3	 Examination of the Neck
	3.4	 Obesity
	3.5	 Intraoral Examination
	3.6	 Tonsils
	3.7	 The Tongue
	Reference
4: The Eye Examination During a Dental Procedure
	4.1	 The Examination
		4.1.1	 Vision
		4.1.2	 Pupils
		4.1.3	 Lids, Lashes, and Orbit
		4.1.4	 Motility
	4.2	 Sclera and Conjunctiva
		4.2.1	 Cornea
		4.2.2	 Anterior Chamber
		4.2.3	 Red Reflex
		4.2.4	 Eye Reflexes
	4.3	 Ophthalmic and Systemic Considerations Prior to Dental Procedures
	4.4	 Dental Local Anesthesia and Potential Ophthalmic Complications
	4.5	 General Anesthetic Agents and Intraocular Pressure Changes
	4.6	 Potential Ophthalmic Complications from Dental Procedures
	References
5: Ear Exam for the Non-ENT
	5.1	 External Ear
		5.1.1	 Anatomy
		5.1.2	 Exam
		5.1.3	 Pathology
			5.1.3.1	 Otitis Externa
			5.1.3.2	 Cerumen Impaction
			5.1.3.3	 TMJ Dysfunction
			5.1.3.4	 Odontogenic Referred Pain
			5.1.3.5	 Microtia/Anotia/Ear Canal Stenosis/Atresia
			5.1.3.6	 Preauricular Anomalies
	5.2	 Tympanic Membrane/Middle Ear
		5.2.1	 Anatomy
		5.2.2	 Exam
		5.2.3	 Pathology
			5.2.3.1	 Otitis Media
			5.2.3.2	 Tympanic Membrane Perforation
			5.2.3.3	 Cholesteatoma
	5.3	 Inner Ear
		5.3.1	 Anatomy
		5.3.2	 Exam
		5.3.3	 Pathology
			5.3.3.1	 Vertigo
			5.3.3.2	 Sensorineural Hearing Loss
6: Assessment of the Lungs
	6.1	 Introduction
	6.2	 Differences Between the Pediatric and Adult Airway
	6.3	 Assessment of the Airway
	6.4	 Oral Cavity
	6.5	 Nasal Cavity
	6.6	 Epiglottis and Larynx
	6.7	 Vocal Cords and Trachea
	6.8	 Ribs and Lungs
	6.9	 Preoperative Airway Assessment
	6.10	 Airway Examination
	6.11	 Oropharyngeal and Nasopharyngeal Examination
	6.12	 Assessment of the Atlanto-Occipital Joint Mobility
	6.13	 Examination of the Chest and Lungs
		6.13.1	 Respiratory Rate
	6.14	 Chest and Lungs
	6.15	 Possible Complications
		6.15.1	 Cough
			6.15.1.1	 Congenital Syndromes
	6.16	 Conclusion
	References
7: Assessment of the Heart
	7.1	 Cardiac Anatomy
	7.2	 Cardiac Circulation
	7.3	 The Cardiac Cycle
	7.4	 The Cardiovascular Exam
		7.4.1	 General Appearance
		7.4.2	 Baseline Vital Signs and Palpation of Pulses
			7.4.2.1	 Blood Pressure
			7.4.2.2	 Heart Rate and Rhythm
			7.4.2.3	 Pulse Oximetry
		7.4.3	 Auscultation of Heart Sounds and Palpation of the Precordium
			7.4.3.1	 First Heart Sound (S1)
			7.4.3.2	 Second Heart Sound (S2)
			7.4.3.3	 Third and Fourth Heart Sounds (S3 and S4)
		7.4.4	 Classification of Heart Murmurs [16]
			7.4.4.1	 Murmur Areas [5, 7]
			7.4.4.2	 Systolic Murmurs
			7.4.4.3	 Diastolic Murmurs
			7.4.4.4	 Continuous Murmurs
			7.4.4.5	 Pericardial Friction Rub
			7.4.4.6	 Still’s Murmur
			7.4.4.7	 Pulmonary Flow Murmur
			7.4.4.8	 Venous Hum
		7.4.5	 Atrial Septal Defects
	7.5	 Integrating Examination Findings
		7.5.1	 Murmur Evaluation in the Pediatric Patient
	References
8: Assessment of the Gut
	8.1	 Introduction
	8.2	 Medical History
		8.2.1	 Family History and Past Medical History
		8.2.2	 History of Autoimmune Conditions
		8.2.3	 History of Malabsorption
		8.2.4	 History of Gastroesophageal Reflux Disease (GERD), Chest Pain and Eating Disorders
		8.2.5	 History of Liver Disease and GI Bleeding
		8.2.6	 History of Immunosuppression
	8.3	 Physical Examination
	8.4	 Gastrointestinal Tract Conditions that Manifest in the Oral Cavity
	References
9: Assessment of the Musculoskeletal System
	9.1	 Introduction
	9.2	 Family History or Previous Medical History
	9.3	 Examination
		9.3.1	 Skin
		9.3.2	 Neck
		9.3.3	 Shoulders and Elbows
		9.3.4	 Hands and Forearms
		9.3.5	 Knees and Legs
		9.3.6	 Feet
		9.3.7	 Spine
		9.3.8	 Gait
	9.4	 Orthopedic Findings/Diagnoses and How to Proceed
	Reference
10: Assessment of the Brain
	10.1	 Overview of Neurologic History and Physical
	10.2	 Mental Status
	10.3	 Cranial Nerves
	10.4	 Motor Evaluation
	10.5	 Sensory Examination
		10.5.1	 Reflexes
		10.5.2	 Common Neurological Conditions of Interest to the Dentist
	Further Reading
11: Assessment of the Teenager
	References
12: COVID-19 and Procedural Sedation
	References