Examination of the oral cavity2 tour

Examination of the Examination of the Face & Oral CavityFace & Oral Cavity

Dr. Natheer H Al-RawiDr. Natheer H Al-Rawi

1Dr. Natheer Al-Rawi

Oral ExaminationOral Examination

Many diseases (systemic or local) Many diseases (systemic or local) have signs that appear on the have signs that appear on the face, face, head & neck or intra-orallyhead & neck or intra-orally

Making a complete examination can Making a complete examination can help you create ahelp you create a differential differential diagnosis diagnosis in cases of abnormalities in cases of abnormalities and make treatment and make treatment recommendations based on recommendations based on accurate assessment of the accurate assessment of the signssigns && symptomssymptoms of diseaseof disease

Oral ExaminationOral Examination

Each disease process may have Each disease process may have individualindividual manifestationsmanifestations in an in an individual patientindividual patient

And there may be And there may be individual host individual host reaction reaction toto the diseasethe disease

Careful assessment will guide the Careful assessment will guide the clinician to clinician to accurate diagnosisaccurate diagnosis

Scope of ResponsibilityScope of Responsibility

Diseases of the Diseases of the head & neckhead & neck Diseases of the Diseases of the supporting hard & supporting hard &

soft tissuessoft tissues Diseases of the Diseases of the lips, tongue, lips, tongue,

salivary glands, oral mucosasalivary glands, oral mucosa Diseases of the Diseases of the oral tissues oral tissues which which

are a are a component of systemic component of systemic diseasedisease

EquipmentEquipment

Assure that you have all the Assure that you have all the supplies necessary to complete an supplies necessary to complete an oral examinationoral examination MirrorMirror Tissue retractor (tongue blade)Tissue retractor (tongue blade) Dry gauzeDry gauze ExplorerExplorer

You must You must drydry some of the tissues in some of the tissues in order to observe the any color order to observe the any color changeschanges

Exam of the Head & Neck; Exam of the Head & Neck; Oral CavityOral Cavity Be systematicBe systematic Consistently complete the exam in Consistently complete the exam in

the same orderthe same order

Extra-oral examinationExtra-oral examination

ObserveObserve: : color of skin Examination area of head & neck

DetermineDetermine: : gross functioning of cranial nerves Normal vs. abnormal

Paralysis Stroke, trauma, Bell’s Palsy

TMJTMJ PalpatePalpate upon openingupon opening

What is the maximummaximum inter maxillary inter maxillary space?space?

Is the opening Is the opening symmetricalsymmetrical?? Is there Is there popping, clicking, grindingpopping, clicking, grinding?? Use your Use your stethoscopestethoscope to listen to soundsto listen to sounds

Lymph node Lymph node palpationpalpation

Thyroid Gland Thyroid Gland PalpationPalpation Place hands over Place hands over

the tracheathe trachea Have the patient Have the patient

swallowswallow The thyroid gland The thyroid gland

moves upwardmoves upward

Exam: LipsExam: Lips

Observe the color & its consistency-Observe the color & its consistency-intra-orally and externallyintra-orally and externally

Is the vermillion border distinct?Is the vermillion border distinct? Bi-digitally palpate the tissue Bi-digitally palpate the tissue

around the lips. Check for nodules, around the lips. Check for nodules, bullae, abnormalities, mucocele, bullae, abnormalities, mucocele, fibromafibroma

Exam: LipsExam: Lips Evert the lip and examine the tissueEvert the lip and examine the tissue Observe frenum attachment/tissue Observe frenum attachment/tissue

tensiontension Clear mucous filled pockets may be Clear mucous filled pockets may be

seen on the inner side of the lip seen on the inner side of the lip ((mucocelemucocele). This is a frequent, ). This is a frequent, non-pathologic entity which non-pathologic entity which represents a blocked minor salivary represents a blocked minor salivary glanglandd

Exam: Lips-palpationExam: Lips-palpation

Color, consistencyColor, consistency Area for blocked minor salivary Area for blocked minor salivary

glandsglands Lesions, ulcersLesions, ulcers

Frenum:Frenum: AttachmentAttachment Level of attached gingivaLevel of attached gingiva

Exam: Lips-sun exposureExam: Lips-sun exposure

Palpate in the Palpate in the vestibule, observe vestibule, observe colorcolor

Examination: Buccal Mucosa

Observe Observe color, character of the mucosa Normal variations in color among ethnic

groups Amalgam tattoo

PalpatePalpate tissue Observe Stenson’s duct opening for

inflammation or signs of blockage Visualize muscle attachments,

hamular notch, pterygomandibular folds 17Dr. Natheer Al-Rawi

Examination: Buccal Examination: Buccal MucosaMucosa

Linea alba Stenson’s duct

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

Gingiva

Note color, tone, texture, architecture & mucogingival relationships

GingivaGingiva

How would you describe the gingiva?How would you describe the gingiva? Marginal vs. generalized?Marginal vs. generalized? Erythematous vs. fibrousErythematous vs. fibrous

Drug reactions: Anti-epileptic, calcium Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant channel blockers, immunosuppressant

Exam: Hard palate

Minor salivary glands, attached gingiva

Note presence of tori: tx plan any pre-prosthetic surgery

Exam: Soft palate

How does soft palate raise upon “aah”?

Vibrating line, tonsilar pillars, tonsils, oropharynx

Exam: Tonsils

Tucked in at base of anterior & posterior tonsilar pillars

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

Exam: 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

Exam: Tongue

You may observe lingual varicosities

Exam: Tongue

You may observe geographic tongue (erythema migrans)

Exam: Tongue

You may observe drug reaction

Exam: Tongue

Observe signs of nutritional deficiencies, immune dysfunction

Exam: Tongue

You may observe oral cancer

Exam: Floor of mouth

Visualize, palpate - bimanuallyVisualize, palpate - bimanually Wharton’s duct Must dry to observe

Does “lesion” wipe off?

Palpation of the floor of the mouth

Exam: Floor of mouthExam: Floor of mouth

Squamous Cell Carcinoma

Exam: Leukoplakic area

Edentulous Mandibular Ridge

Exam: Maxilla & Mandible

• Size, shape, contour

• Pre-prosthetic treatment

•Tori removal

• Tuberosity reduction

•Soft or hard tissue or both

Exam: Maxilla & Mandible

Exam: Maxilla & MandibleExam: Maxilla & Mandible

Evaluate for Epulis fissuratum

If you make a new denture will the excess tissue resolve?

Occlusion

Orthodontic classification

Interferences

Occlusion

Systematic Oral Examination Done at initial exam & at recalls

unless patient history requires sooner

You must visualize all areas of the oral cavity

Do good, do not harm, do justice, respect autonomy

Visualize all areas

Watch the vedio

Thank You

Examination of the oral cavity2 tour

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