during brushing and later loosening teeth), is usually detected by dental check- ups ( Pelton, Dunbar, McMillan, Moller & Wolff, 1969).
It is of interest to note that the hair is not typically kinky. Some African Americans have naturally straight, wavy, or loosely curly hair. Popular styles now include hair that is relaxed or worn in cornrows, especially among the females, although many males wear similar styles. Many males wear their hair natural, although the popularity of the Afro (full and rounded cut) has waned ( Greathouse & Miller, 1981).
In order to diagnose abnormal color changes in dark-skinned individuals, one must observe the body areas where melanin and carotene are least concentrated: the sclera, conjunctiva, nail beds, lips, palms, soles of feet, and mucous membranes of the mouth ( Sherman & Fields, 1982).
Pallor may appear as a yellowish-brown in brown-skinned individuals but will be indicated by an ashen-gray coloring in dark and black individuals.
Cyanosis, when present in dark-skinned persons, may be best seen in facial skin, around the mouth, the earlobes, and nail beds. Pressure to the nail beds and/or earlobes may be used to determine slow or normal return of color. Slow return of color is indicative of cyanosis ( Sherman & Fields, 1982).
Jaundice may be observed as a generalized yellowing of the sclera. The normal yellow pigmentation found in dark individuals tends to be concentrated in the inner and outer canthi of the eyes. In jaundice, the palate may also display a yellowish tint. Additional data, such as clay-colored stools and blood test results, may be needed to confirm the presence of jaundice in dark-skinned individuals ( Sherman & Fields, 1982).
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