Intra oral examination

intraoral examinations which includes
1 lips
2tongue
3 bucal and labial mucosa
4 palate
5 floor of mouth
6 gingiva
7 gingivitis
8 periodontitis

1. -Akanksha Singh -Final year Intra oral examination

2. After extra oral examination we proceed towards intra oral examination The structures to be examined are :- Lips Labial and buccal mucosa Palate Floor of mouth Tongue Gingiva Teeth

3. 1.Lips While examination of lips we will check for: contusion pigmentation ulceration Double lip L ip pit swelling Angular pit cold sore

4. Labial and Buccal mucosa For the examination of the labial and buccal mucosa the lip and cheek are retracted respectively and observed in sufficient light. The healthy mucosa appears to be smooth, shiny, pink and moist. Opening of Stensen’s duct can be seen opposite to 2 nd molar. ABNORMAL FINDINGS: COLOR: The black spots (macule) may be seen on the mucosa due to the deposition of melanin as a response of local chronic conditions like tobacco, smoking or chronic autoimmune mucositis.

5. The red patches may be seen on the mucosa which can be solitary or generalized. The red patches on the mucosa can be seen due to : 1, Erythroplakia 2, Allergic reactions 3, Candidiasis (atrophic/ erythmatous) 4, Carcinoma in-situ Similarly like red patches the white patches are also seen which may be due to: 1, Leukoplakia 2, Leukoedema 3, Linea alba 4, white sponge nevus

6. CONSISITENCY: The consistency of the mucosa may become fibrous instead of smooth which may be due 1, Oral sub mucous fibrosis 2, chronic cheek bite 3, linea alba 4, Fordyce’s granules 5, Red or white lesions 6, Candidiasis These fibrous appearing mucosa may be scrapable or non scrapable depending upon the cause. Other factors to be seen are the swelling, ulceration or presence of nodules and Fordyce's granules.

7. Soft and hard palate After the proper illumination of light we will check for: Discoloration Swelling/fistula/ tori /ulcer Cleft Perforation: usually caused by gumma Asymmetry of structures Any scar Papillary hyperplasia further the palate is palpated to check for the swelling or tenderness on the palate.

8. Normal palate discoloration of palate Tori papillary hyperplasia

9. Floor of mouth For the examination of the floor of mouth the patient is asked to elevate the tongue and then the floor is examined with proper illumination of light. The opening of Wharton’s duct is observed. The pooling of saliva is seen. The floor is also seen for ulceration and swelling. depending on the color we can find the cause of swelling. For e.g., if the swelling is Red : hemangioma Blue: ranula While examination of floor of mouth we can also check the presence or absence of ankyloglossia.

10. Hemangioma Ranula Ankyloglossia

11. Tongue Dorsal surface is examined while keeping the tongue at rest. COLOR : We will check for the presence of pigmentation For e.g. yellow color : Jaundice black color : Heavy smokers SIZE We will check for the presence of macroglossia or microglossia. FISSURE We will then check for the presence of fissures on the surface of tongue Transverse congenital Longitudinal syphilis

12. Papilla : Normal Hypertrophic Absent Border : Normal Scalloped VENTRAL SURFACE: Varicosity: present Absent

13. Varicosity of tongue is a physiological process caused due to advancing age leading to elastolytic degeneration of the sublingual veins. Frenal attachment : High Normal

14. GINGIVA Gingiva is the part of the oral mucosa that covers the alveolar process of the jaw and surrounds the neck of the teeth. It is the most important structure to be examined in the oral cavity to check for the periodontal condition.

15. COLOR: The normal color of the gingiva is coral pink or pale pink The color of the gingiva depends upon : Vascular supply Thickness and degree of keratinisation of epithelium Presence of pigment containing cells. The change in color signifies the diseased gingiva Acute: red Chronic: bluish pink bluish red (cyanotic)

16. Size: The size of the gingiva depends on bulk of cellular + intercellular elements and blood supply The healthy gingiva fits snugly around the teeth. The alteration in the size is the common feature of gingival disease. The increase in the size of gingiva is commonly known as the gingival enlargement They are further classified as: Inflammatory enlargement : i ) Acute ii) chronic

17. 2, Drug induced enlargement 3, Systemic disease or condition: Pregnancy Puberty Vitamin c deficiency Leukemia Pyogenic granuloma 4, Neoplastic enlargement Benign enlargement Malignant enlargement

18. Contour: The marginal gingiva follows the scalloped outline on the facial and lingual surfaces. The interdental papilla are pointed and pyramidal and also fills the space present interdentally. The diseased marginal gingiva becomes rounded, rolled and bulbous . The interdental gingiva becomes bulbous, flat and cratered Normal gingiva Diseased gingiva

19. Position: The level at which gingival margin is attached to the tooth - At CEJ Exposure of the tooth by the apical migration of the gingiva is known as gingival recession . Consistency: Firm and resilient except the free marginal gingiva. It is tightly bounded to the underlying bone. The gingiva becomes edematous and fibrotic in diseased condition.

20. Texture: Stippling or the orange peel appearance is seen on the attached gingiva on drying it with the cotton. It appears on the gingiva after 5 years of age and remains throughout the life in the healthy gingiva The stippling is lost in the diseased gingiva.

21. Gingivitis Gingivitis is defined as the inflammation of the gingiva. It is further classified as : Acute and Chronic : Localized or Generalized

22. Signs and symptoms: Bright red or purple gums Spongy and swollen gums They are mainly painless unless pressure applied Easily bleed even on gentle brushing Loss of stippling

23. Causes: Build up of bacteria due to accumulation of the plaque which lead to irritation of the gingiva. Poor oral hygiene Smoking Faulty prosthesis Malocclusion Breathing through mouth Local trauma Vitamin deficiency Gingivitis is usually a reversible condition, but if they are left untreated it may lead to the irreversible and a severe condition mainly known as PERIODONTITIS.

24. Periodontitis It  is the inflammation of the gums and supporting structures of the teeth. It may also be defined as the disease involving one or more of the four components of the peridontium

25. Signs and symptoms: All the signs of the gingivitis are present , in addition to: Bone loss Halitosis Pocket formation Occasional suppuration Tooth mobility Spacing between the teeth Gum recession Increased sensitivity and food impaction

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