Examination of the Oral Cavity2

7/17/2019 Examination of the Oral Cavity2

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Examination ofExamination of

the Oral Cavity the Oral Cavity Physical EvaluationPhysical Evaluation



Oral ExaminationOral Examination

Many diseases (systemic or local)Many diseases (systemic or local)have signs that appear on thehave signs that appear on theface, head & neck or intraorally face, head & neck or intraorally

Making a complete examinationMaking a complete examinationcan help you create a di!erentialcan help you create a di!erentialdiagnosis in cases ofdiagnosis in cases ofa"normalities and makea"normalities and maketreatment recommendationstreatment recommendations"ased on accurate assessment of"ased on accurate assessment ofthe signs & symptoms of diseasethe signs & symptoms of disease



Oral ExaminationOral Examination

Each disease process may haveEach disease process may have

individual manifestations in anindividual manifestations in an

individual patientindividual patient

#nd there may "e individual host #nd there may "e individual host

reaction to the diseasereaction to the disease

Careful assessment $ill guide theCareful assessment $ill guide the

clinician to accurate diagnosisclinician to accurate diagnosis



%cope of responsi"ility %cope of responsi"ility

iseases of the head & neck iseases of the head & neck

iseases of the supporting hardiseases of the supporting hard

& soft tissues& soft tissues iseases of the lips, tongue,iseases of the lips, tongue,

salivary glands, oral mucosasalivary glands, oral mucosa

iseases of the oral tissues $hichiseases of the oral tissues $hichare a component of systemicare a component of systemic

diseasedisease



E'uipmentE'uipment

#ssure that you have all the supplies #ssure that you have all the supplies

necessary to complete an oralnecessary to complete an oral

examinationexamination

Mirror Mirror issue retractor (tongue "lade)issue retractor (tongue "lade)

ry gauery gaue

*ou must dry some of the tissues in *ou must dry some of the tissues in

order to o"serve the nuances of anyorder to o"serve the nuances of any

color changescolor changes



Exam of the +ead & eck-Exam of the +ead & eck-

Oral Cavity Oral Cavity .e systematic.e systematic

Consistently complete the examConsistently complete the exam

in the same order in the same order %ee clinic handout for a general%ee clinic handout for a general

guideguide



Extraoral examinationExtraoral examination

O"serve/ color of skinO"serve/ color of skin

Examination area of head & neck Examination area of head & neck

etermine/ gross functioning ofetermine/ gross functioning of

cranial nervescranial nerves

ormal vs0 a"normalormal vs0 a"normal ParalysisParalysis

%troke, trauma, .ell1s Palsy %troke, trauma, .ell1s Palsy




M2M2

Palpate upon openingPalpate upon opening 3hat is the maximum intermaxillary 3hat is the maximum intermaxillary

space4space4 5s the opening symmetrical45s the opening symmetrical4

5s there popping, clicking, grinding45s there popping, clicking, grinding4 3hat do these sounds tell you a"out the 3hat do these sounds tell you a"out the

anatomy of the 6oint4anatomy of the 6oint4

3hen do sounds occur4 3hen do sounds occur4

7se your stethoscope to listen to sounds7se your stethoscope to listen to sounds




8ymph node8ymph node

palpationpalpation 9efer to handout9efer to handout



hyroid :land Evaluationhyroid :land Evaluation




hyroid :landhyroid :land

PalpationPalpation Place hands overPlace hands over

the tracheathe trachea +ave the patient+ave the patient

s$allo$ s$allo$

he thyroid glandhe thyroid gland

moves up$ardmoves up$ard



Exam/ 8ipsExam/ 8ips

O"serve the color & itsO"serve the color & its

consistencyintraorally andconsistencyintraorally and

externally externally

5s the vermillion "order distinct45s the vermillion "order distinct4

.idigitally palpate the tissue.idigitally palpate the tissue

around the lips0 Check foraround the lips0 Check for

nodules, "ullae, a"normalities,nodules, "ullae, a"normalities,

mucocele, ;"romamucocele, ;"roma




Evert the lip and examine the tissueEvert the lip and examine the tissue

O"serve frenum attachment<tissueO"serve frenum attachment<tissue

tensiontension

Clear mucous ;lled pockets may "eClear mucous ;lled pockets may "e

seen on the inner side of the lipseen on the inner side of the lip

(mucocele)0 his is a fre'uent,(mucocele)0 his is a fre'uent,

nonpathologic entity $hichnonpathologic entity $hichrepresents a "locked minor salivaryrepresents a "locked minor salivary

glandgland



Exam/ 8ipspalpationExam/ 8ipspalpation

Color, consistency Color, consistency

#rea for "locked minor salivary #rea for "locked minor salivary

glandsglands 8esions, ulcers8esions, ulcers




=renum/=renum/ #ttachment #ttachment

8evel of attached8evel of attached

gingivagingiva



Exam/ 8ipssun exposureExam/ 8ipssun exposure




Palpate in thePalpate in the

vesti"ule, vesti"ule,

o"serve color o"serve color



Examination/ .uccalExamination/ .uccal

MucosaMucosa O"serve color, character of the mucosaO"serve color, character of the mucosa

ormal variations in color among ethnicormal variations in color among ethnic

groupsgroups

#malgam tattoo #malgam tattoo Palpate tissuePalpate tissue

O"serve %tenson1s duct opening forO"serve %tenson1s duct opening for

in>ammation or signs of "lockagein>ammation or signs of "lockage

?isualie muscle attachments, hamular ?isualie muscle attachments, hamular

notch, pterygomandi"ular foldsnotch, pterygomandi"ular folds




MucosaMucosa 8inea al"a8inea al"a

%tenson1s duct%tenson1s duct




MucosaMucosa 8esions @ $hite, red8esions @ $hite, red

8ichen Planus, 8eukedema8ichen Planus, 8eukedema



:ingiva:ingiva

ote color, tone,ote color, tone,

texture,texture,

architecture &architecture &

mucogingivalmucogingivalrelationshipsrelationships



:ingiva:ingiva

+o$ $ould you descri"e the gingiva4+o$ $ould you descri"e the gingiva4 Marginal vs0 generalied4Marginal vs0 generalied4

Erythematous vs0 ;"rousErythematous vs0 ;"rous

rug reactions/ #ntiepileptic,rug reactions/ #ntiepileptic,calcium channel "lockers,calcium channel "lockers,

immunosuppressantimmunosuppressant



Exam/ +ard palateExam/ +ard palate

Minor salivary glands, attachedMinor salivary glands, attached

gingivagingiva

ote presence of tori/ tx planote presence of tori/ tx planany preprosthetic surgeryany preprosthetic surgery



Exam/ %oft palateExam/ %oft palate

+o$ does soft palate raise upon+o$ does soft palate raise upon

AaahB4AaahB4

?i"rating line, tonsilar pillars, ?i"rating line, tonsilar pillars,tonsils, oropharynx tonsils, oropharynx



Exam/ Oropharanyx Exam/ Oropharanyx

Color, consistency of tissueColor, consistency of tissue

8ook to the "ack, "eyond the soft8ook to the "ack, "eyond the soft

palatepalate ote occasional small glo"lets ofote occasional small glo"lets of

transparent or pink opa'uetransparent or pink opa'ue

tissue $hich are normal and maytissue $hich are normal and mayinclude lymphoid tissueinclude lymphoid tissue



Exam/ onsilsExam/ onsils

ucked in at "ase of anterior &ucked in at "ase of anterior &

posterior tonsilar pillarsposterior tonsilar pillars

:lo"ular tissue that has:lo"ular tissue that has

Apunched outB appearing areasApunched outB appearing areas

9egresses after adulthood9egresses after adulthood

May see $hite Aoro rice likeB orMay see $hite Aoro rice likeB orAtorpedoB shaped $hiteAtorpedoB shaped $hite

concretions $ithin the tissueconcretions $ithin the tissue



Exam/ ongueExam/ ongue

he tongue and the >oor of thehe tongue and the >oor of the

mouth are the most commonmouth are the most common

places for oral cancer to occur places for oral cancer to occur

5t can occur other places- so5t can occur other places- so

visualie all areas visualie all areas

*ou may o"serve/ *ou may o"serve/ Circumvalate papillae, epiglottisCircumvalate papillae, epiglottis




+ave the patient stick out their+ave the patient stick out their

tonguetongue

3rap the tongue in a dry gaue 3rap the tongue in a dry gaue

and gently pull it from side toand gently pull it from side to

side to o"serve the lateralside to o"serve the lateral

"orders"orders

9etract the tongue to vie$ the9etract the tongue to vie$ the

inferior tissuesinferior tissues




*ou may o"serve *ou may o"serve

linguallingual

varicosities varicosities




*ou may o"serve geographic *ou may o"serve geographic

tongue (erythema migrans)tongue (erythema migrans)




*ou may o"serve drug reaction *ou may o"serve drug reaction




O"serve signs of nutritionalO"serve signs of nutritional

de;ciencies, immune dysfunctionde;ciencies, immune dysfunction




*ou may o"serve *ou may o"serve

oral cancer oral cancer



Exam/ =loor of mouthExam/ =loor of mouth

?isualie, palpate "imanually ?isualie, palpate "imanually

3harton1s duct 3harton1s duct

Must dry to o"serveMust dry to o"serve oes AlesionB $ipe o!4oes AlesionB $ipe o!4

3here are the t$o most 3here are the t$o most

likely areas for oral cancer4likely areas for oral cancer4 lateral "order of the tonguelateral "order of the tongue

=loor of mouth=loor of mouth



Palpation of the >oor of thePalpation of the >oor of the

mouthmouth




%'uamous Cell Carcinoma%'uamous Cell Carcinoma



Exam/ 8eukoplakic areaExam/ 8eukoplakic area

Edentulous Mandi"ular9idge




Oral Cancer/Oral Cancer/ 9ed9ed

3hite 3hite 9ed and 3hite9ed and 3hite

oes the patient have importantoes the patient have important

risk factors for oral cancer4risk factors for oral cancer4 Counseling for smoking and alcoholCounseling for smoking and alcohol

CessationCessation



%'uamous Cell%'uamous Cell

CarcinomaCarcinoma



riaging 8esionsriaging 8esions

escri"e it1s characteristicsescri"e it1s characteristics %ie, shape, color, consistency, location%ie, shape, color, consistency, location

+o$ long has it "een present4+o$ long has it "een present4

5s it related to a trauma45s it related to a trauma4 =ractured cusp, occlusal trauma=ractured cusp, occlusal trauma

+as it occurred "efore4+as it occurred "efore4

Can you $ipe it o!4Can you $ipe it o!4 oes the patient have speci;c riskoes the patient have speci;c risk

factors for neoplastic lesions4factors for neoplastic lesions4



riaging 8esionsriaging 8esions

#ny lesion that is suspicious #ny lesion that is suspicious

should "e reevaluated in Dshould "e reevaluated in D

$eeks $eeks 8esions due to infectious processes8esions due to infectious processes

$ould have healed in that time $ould have healed in that time

frameframe

5f it remains, the lesions should "e5f it remains, the lesions should "e"iopsied"iopsied



Exam/ Maxilla &Exam/ Maxilla &

Mandi"leMandi"le• sie, shape, contour

• preprosthetic treatment

•ori removal

• tu"erosity reduction

•%oft or hard tissue or "oth




Mandi"leMandi"le




Mandi"leMandi"le Evaluate forEvaluate for

Epulis ;ssuratumEpulis ;ssuratum

5f you make a5f you make ane$ denture $illne$ denture $ill

the excess tissuethe excess tissue

resolve4resolve4



OcclusionOcclusion

OrthodonticOrthodontic

classi;cationclassi;cation

5nterferences5nterferences



OcclusionOcclusion



%ystematic Oral%ystematic Oral

ExaminationExamination one at initial exam & at recallsone at initial exam & at recalls

unless patient history re'uires sooner unless patient history re'uires sooner *ou must visualie all areas of the *ou must visualie all areas of the

oral cavity oral cavity Oral cancer can occur in other placesOral cancer can occur in other places

than the lateral "orders of the tonguethan the lateral "orders of the tongue& the >oor of the mouth& the >oor of the mouth

.e complete.e complete o good, do no harm, do 6ustice,o good, do no harm, do 6ustice,

respect autonomy respect autonomy



?isualie all areas ?isualie all areas



.reath.reath

Oral odors can indicate/Oral odors can indicate/ 5nfection/ caries, periodontal dx 5nfection/ caries, periodontal dx 79 infections79 infections

Chronic :050 distur"ancesChronic :050 distur"ances 8ung a"scess8ung a"scess ia"etic acidosisia"etic acidosis

7remia, kidney pro"lem7remia, kidney pro"lem 8iver failure/ mousy, musty odor 8iver failure/ mousy, musty odor %elfmedication $ith alcohol%elfmedication $ith alcohol



ocumentation/ocumentation/

omenclatureomenclature 5nfection Control 5C5nfection Control 5C o change in medicalo change in medical

statusstatus CM+ CM+

MesialMesial

MM

istalistal 8ingual<Palatal8ingual<Palatal 8 8

=acial ==acial =

.uccal ..uccal .

5ncisal5ncisal 5 5

Occlusal OOcclusal O

#malgam #malgam #m #m

CompositeComposite

CpCp

9estoration9estoration 9est 9est

Calcium hydroxide CaO+Calcium hydroxide CaO+

Cement "aseCement "ase

C.C.

inc Phos0 Cementinc Phos0 Cement

CMCM

:lass 5onomer Cemnt :5:lass 5onomer Cemnt :5

8idocaine8idocaine 8ido 8ido

i



ocumentation/ocumentation/

omenclatureomenclature EpinephrineEpinephrine

EpiEpi

.ridge.ridge .rdg .rdg

Cro$nCro$n

CrnCrn

Post & corePost & core P&C P&C

:utta Percha:utta Percha

:P:P

Partial denturePartial denture

9P9P Complete dentureComplete denture

=<==<=

EndodonticsEndodontics Endo Endo

Open & rain O<Open & rain O<

ProphylaxisProphylaxis

Prophy Prophy

%caling & 9t Plan0 %c9p%caling & 9t Plan0 %c9p

.roken #ppointment.roken #ppointment.# .#

Canceled #ppt0Canceled #ppt0 C# C#

ExtractionExtraction

ExtExt onvital ? onvital ?



ChartingCharting

%ym"ols/%ym"ols/ 9estorations F missing teeth/9estorations F missing teeth/

"lue<"lack "lue<"lack

Pathology, a"normalitiesPathology, a"normalities

radiographic ;ndings/radiographic ;ndings/ redred



ChartingCharting

9estorations/9estorations/ 9ed9ed ecay ecay

9ed outline9ed outline =aulty restoration=aulty restoration

.lue<"lack .lue<"lack #malgam #malgam .lack outline.lack outline 9esin<composite9esin<composite

GG .lack GG .lack =issure sealant=issure sealant .lack <<< through cro$n.lack <<< through cro$n Cro$n<inlay<onlay Cro$n<inlay<onlay

5mplant5mplant



ChartingCharting

Pathology/Pathology/ 9ed9ed ecay ecay

=ood impaction=ood impaction

H =urcationH =urcation

ImmImmOpenContact<iastemaOpenContact<iastema

J over rootJ over root Missing toothpart ofMissing toothpart of

;xed prosthetic;xed prosthetic

applianceappliance



ChartingCharting

Pathology/Pathology/ 7neven marginal ridges7neven marginal ridges

riftrift

ExtrudedExtruded K orK or Periapical areaPeriapical area

(a"scess, surgery)(a"scess, surgery)

over toothover tooth ooth to "eooth to "eextractedextracted



ChartingCharting

9emem"er/ the dental chart is a legal9emem"er/ the dental chart is a legal

documentdocument

=ailure to document means it didn1t=ailure to document means it didn1t

happenhappen

7se "lue or "lack ink 7se "lue or "lack ink

o not use A$hite outB- if errorcross outo not use A$hite outB- if errorcross out

$ith a single strike through and initial $ith a single strike through and initial

ocument/ocument/ ?isits, meds prescri"ed, meds taken, ?isits, meds prescri"ed, meds taken,

conversations $< physicians, other health careconversations $< physicians, other health care

$orkers $orkers

E l f lE l f t l



Example of entalExample of ental

ChartingCharting

Examination of the Oral Cavity2

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