It extraoral exploration. Once we have listened

 It is important to talk about the importance of clinical assessment at the oral level, especially in pediatric surgery because it will depend on the age of the patient and the confidence he has with the medical team, most children will have difficulty to be evaluated in the part oral because initially most children do not like to be examined by strangers even if it is their doctor or nurse.         When a patient enters the consultation and we are looking at the presence he has, we are already conducting a first extraoral exploration. Once we have listened to our patient in this case giving confidence to our pediatric patient, we must move on to his thorough exploration. We will start from the outside of the oral cavity and then analyze its interior with all its structures. A systematic approach must always be followed when exploring the patient. The order will be as follows: 1. Extraoral Exploration.2. Intraoral exploration.3. Dental Exploration.4. Periodontal exploration          Within the extraoral examination, we should evaluate symmetries and facial asymmetries in the mid sagital plane, superciliary plane, sub nasal plane and submental plane. We must not forget to examine the lymph nodes in search of adenopathies without forgetting that we must lose the consent of the parents who are accompanying the patient, educate them and explain them why we are doing every step in their children to complete the assessment. (Mayo Clinic, 2017)         The palpation should be done in a methodical way bimanually with the patient’s head relaxed by the back and front of the patient, but remember that being in the pediatric area everything depends on the age and the patient’s cooperation, and for that reason it is better that we can do it as a game to distract the patient.        If we are going to evaluate the TMJ scan, the palpation of the temporomandibular joint is performed bilaterally in maximum intercuspation with closed mouth with teeth in occlusion and during oral opening, this examination should be done to school children who can cooperate with the maneuver and always explaining the reason for the procedure.  We must document the pathological signs of the joint such as joint noises, or the presence of pain during the opening and closing movements. We must also assess the degree of oral opening.         The examination of the oral cavity should be performed in all patients in an orderly and complete, with good lighting, natural or artificial and having at hand gauze and low tongue, inspecting and palpating: lips, cheeks, hard and soft palate; gold pharynx, floor of mouth, tongue, gums and teeth, to assess their health status and see if there are primitive or secondary elemental lesions, which characterize the disease or condition suffered by the patient, interpret them and make the correct diagnosis. (Aapd, 2017)         A good exam of the mouth requires the examiner to use most of his senses. The inspection by direct or indirect vision must be done with good lighting, it is advisable to use a magnifying glass to increase the size of the anatomical structures and / or injuries. The palpation with the fingertips must be done with gloves, it can be digital or bidigital. Olfaction helps us in the diagnosis of some diseases that have a “sui generis” odor.          To prepare the child for this type of examination or any physical examination that is going to be performed, I must emphasize the age of the patient. It is not the same to examine a child about one year of age compared to a teenager who turns out to be easier in the latter. Distraction is one of the tools that the pediatrician or pediatric nurse will have, which is a stress-free environment to reduce discomfort to the child, in addition to being a room with room temperature and free of medical instruments that frighten the child especially injections or needles.         In the case that the child does not allow the examination we will not be able to traumatize it, for that reason, depending on the clinical case, we should talk with the parents and allow them to make a previous assessment at home by meeting with the doctor so that in the next appointment the patients They feel more comfortable because they know that it is part of the game previously made from their homes. This is highly valued especially in the dental evaluation where the children and only with the fact of hearing the noise of the dental machines will be uncomfortable, but if they know that it is a game they could be more relaxed and allow the evaluation by the dentist. Remember that these professionals have training in this type of patient where patience will be the secret of oral assessment. (Touschner, 2016)