Examination of the oral cavity

Examination of the oral cavity

1. Examination of the Oral Cavity

2. Fast review of Examination of the Oral Cavity
Complete examination of the oral cavity includes:
• Lips and Labial Mucosa
• Buccal Mucosa
• Mucobuccal Fold
• Hard Palate
• Soft Palate and Uvula
• Oropharynx & Nasopharynx
•Tongue
•Floor of Mouth
•Muscles of Mastication
•Periodontium
•Teeth

3. Oral Examination
•Many diseases (systemic or local) have signs
that appear on the face, head & neck or
intra-orally
•Making a complete examination can help you
create a differential diagnosis in cases of
abnormalities and make treatment
recommendations based on accurate
assessment of the signs & symptoms of
disease

4. Oral Examination
•Each disease process may have individual
manifestations in an individual patient
•And there may be individual host reaction to
the disease
•Careful assessment will guide the clinician to
accurate diagnosis

5. Scope of responsibility
•Diseases of the head & neck
•Diseases of the supporting hard & soft
tissues
•Diseases of the lips, tongue, salivary glands,
oral mucosa
•Diseases of the oral tissues which are a
component of systemic disease

6. Equipment
•Assure that you have all the supplies
necessary to complete an oral examination
–Mirror
–Tissue retractor (tongue blade)
–Dry gauze
•You must dry some of the tissues in order to
observe the any color changes

7. Exam of the Head & Neck; Oral Cavity
•Be systematic
•Consistently complete the exam in the same
order

8. Extra-oral examination
•Observe: color of skin
•Examination area of head & neck
•Determine: gross functioning of cranial
nerves
–Normal vs. abnormal
•Paralysis
–Stroke, trauma, Bell’s Palsy

9. Examination of Lips and Labial Mucosa

10. Exam: Lips
•Observe the color & its consistency-intra-
orally and externally
•Is the vermillion border distinct?
•Bi-digitally palpate the tissue around the lips.
Check for nodules, bullae, abnormalities,
mucocele, fibroma

11. Exam: Lips

12. Exam: Lips
•Evert the lip and examine the tissue
•Observe frenum attachment/tissue tension
•Clear mucous filled pockets may be seen on
the inner side of the lip (mucocele). This is a
frequent, non-pathologic entity which
represents a blocked minor salivary gland

13. Exam: Lips-palpationExam: Lips-palpation
Color, consistencyColor, consistency
Area for blocked minor salivary glandsArea for blocked minor salivary glands
Lesions, ulcersLesions, ulcers

14. Exam: Lips
•Frenum:
–Attachment
–Level of attached gingiva

15. Exam: Lips
•Palpate in the
vestibule, observe
color

16. Buccal Mucosa

17. Examination: Buccal Mucosa
Observe color, character of the mucosa
Normal variations in color among ethnic groups
Amalgam tattoo
Palpate tissue
Observe Stenson’s duct opening for
inflammation or signs of blockage
Visualize muscle attachments, hamular
notch, pterygomandibular folds

18. Examination: Buccal Mucosa
Linea alba
Stenson’s duct

19. Examination: Buccal Mucosa
Lesions – white, red
Lichen Planus, Leukedema

20. Palpation of the Buccal Mucosa and
Mucobuccal Fold

21. Gingiva
•Note color, tone,
texture, architecture &
mucogingival
relationships

22. Gingiva
•How would you describe the gingiva?
–Marginal vs. generalized?
–Erythematous vs. fibrous
•Drug reactions: Anti-epileptic, calcium channel
blockers, immunosuppressant

23. Hard Palate
1. Incisive Papillae
2. Palatine Rugae
3. Palatine Raphe
4. Fovea Palatina
5. Vibrating Line
6. Uvula
Indirect Visual InspectionDirect Visual Inspection Palpation

24. Exam: Hard palateExam: Hard palate
Minor salivary glands, attached gingiva
Note presence of tori: tx plan any pre-
prosthetic surgery

25. Soft Palate and Uvula
Examined by either indirect visualization or
palpation. Palpation is completed by using
the index finger and pressing upward

26. Exam: Soft palateExam: Soft palate
How does soft palate raise upon “aah”?How does soft palate raise upon “aah”?
Vibrating line, tonsilar pillars, tonsils, Vibrating line, tonsilar pillars, tonsils,
oropharynxoropharynx

27. Exam: OropharanyxExam: Oropharanyx
Color, consistency of tissueColor, consistency of tissue
Look to the back, beyond the soft palateLook to the back, beyond the soft palate
Note occasional small globlets of Note occasional small globlets of
transparent or pink opaque tissue which are transparent or pink opaque tissue which are
normal and may include lymphoid tissuenormal and may include lymphoid tissue

28. Tonsils

29. Exam: TonsilsExam: Tonsils
Tucked in at base of anterior & posterior
tonsilar pillars
Globular tissue that has “punched out”
appearing areas
Regresses after adulthood
May see white “orzo rice like” or “torpedo”
shaped white concretions within the tissue

30. Exam: Maxilla & MandibleExam: Maxilla & Mandible
•Evaluate for Epulis
fissuratum
•If you make a new
denture will the excess
tissue resolve?

31. Tongue
Dorsal and Ventral view

32. TONGUE
•Tongue
1. Lingual Tonsil
2. Circumvallate Papillae
3. Foliate Papillae
4. Median Sulcus
5. Filiform Papillae
6. Fungiform Papillae

33. Tongue
Visual Inspection Palpation

34. Exam: Tongue
•The tongue and the floor of the mouth are
the most common places for oral cancer to
occur
•It can occur other places; so visualize all
areas
•You may observe:
–Circumvalate papillae, epiglottis

35. Exam: Tongue
•Have the patient stick out their tongue
•Wrap the tongue in a dry gauze and gently
pull it from side to side to observe the lateral
borders
•Retract the tongue to view the inferior
tissues

36. Exam: Tongue

37. Exam: Tongue
•You may observe
lingual varicosities

38. Exam: Tongue
•You may observe geographic tongue
(erythema migrans)

39. Exam: Tongue
•You may observe drug reaction

40. Exam: Tongue
•Observe signs of nutritional deficiencies,
immune dysfunction

41. Exam: Tongue
•You may observe oral
cancer

42. Floor of Mouth

43. Floor of Mouth

44. Exam: Floor of mouthExam: Floor of mouth
Visualize, palpate - bimanuallyVisualize, palpate - bimanually
Wharton’s duct Wharton’s duct
Must dry to observeMust dry to observe
Does “lesion” wipe off?Does “lesion” wipe off?
Where are the two mostWhere are the two most
likely areas for oral cancer?likely areas for oral cancer?
 lateral border of the tonguelateral border of the tongue
Floor of mouthFloor of mouth

45. Palpation of the floor of the mouth

46. Exam: Floor of mouthExam: Floor of mouth

47. Exam: Floor of mouthExam: Floor of mouth
Squamous Cell CarcinomaSquamous Cell Carcinoma

48. Exam: Floor of mouthExam: Floor of mouth
Squamous Cell CarcinomaSquamous Cell Carcinoma

49. Exam: Leukoplakic area
Edentulous Mandibular Ridge

50. Exam: Floor of mouthExam: Floor of mouth
Oral Cancer:Oral Cancer:
RedRed
WhiteWhite
Red and WhiteRed and White
Does the patient have important risk factors Does the patient have important risk factors
for oral cancer?for oral cancer?
Counseling for smoking and alcoholCounseling for smoking and alcohol
Cessation Cessation

51. Ulcer Examination
Ulcers should be evaluated for the character of their:
Base Depth
Edges Color
Discharge Relations to surrounding tissues

52. Squamous Cell Carcinoma

53. Triaging Lesions *
•Describe it’s characteristics
–Size, shape, color, consistency, location
•How long has it been present?
•Is it related to a trauma?
–Fractured cusp, occlusal trauma
•Has it occurred before?
•Can you wipe it off?
•Does the patient have specific risk factors for
neoplastic lesions?

54. Triaging Lesions *
•Any lesion that is suspicious should be re-
evaluated in 2 weeks
–Lesions due to infectious processes would have
healed in that time frame
–If it remains, the lesions should be biopsied

55. Tooth Examination
• Caries Pattern
• Missing Teeth
• Size, Color, and Structural Changes
• Eruption Pattern
• Percussion
• MOBILITY

56. Exam: Maxilla & MandibleExam: Maxilla & Mandible
• size, shape, contour
• pre-prosthetic treatment
•Tori removal
• tuberosity reduction
•Soft or hard tissue or both

57. Exam: Maxilla & MandibleExam: Maxilla & Mandible

58. Exam: Maxilla & MandibleExam: Maxilla & Mandible

59. Occlusion
•Orthodontic
classification
•Interferences

60. Occlusion

61. Systematic Oral ExaminationSystematic Oral Examination
Done at initial exam & at recalls unless
patient history requires sooner
You must visualize all areas of the oral cavity
Oral cancer can occur in other places than
the lateral borders of the tongue & the floor
of the mouth
Be complete
Do good, do no harm, do justice, respect
autonomy

62. Visualize all areas

63. Breath
•Oral odors can indicate:
–Infection: caries, periodontal dx
–URT infections
–Chronic G.I. disturbances
–Lung abscess
–Diabetic acidosis
–Uremia, kidney problem
–Liver failure: mousy, musty odor
–Self-medication with alcohol

64. THANK YOUTHANK YOU