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Examination of the oral cavity

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Examination of the oral cavity

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Examination of the oral cavity

  1. 1. Examination of the Oral Cavity
  2. 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. 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. 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. 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. 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. 7. Exam of the Head & Neck; Oral Cavity • Be systematic • Consistently complete the exam in the same order
  8. 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. 9. Examination of Lips and Labial Mucosa
  10. 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. 11. Exam: Lips
  12. 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. 13. Exam: Lips-palpationExam: Lips-palpation  Color, consistencyColor, consistency  Area for blocked minor salivary glandsArea for blocked minor salivary glands  Lesions, ulcersLesions, ulcers
  14. 14. Exam: Lips • Frenum: – Attachment – Level of attached gingiva
  15. 15. Exam: Lips • Palpate in the vestibule, observe color
  16. 16. Buccal Mucosa
  17. 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. 18. Examination: Buccal Mucosa  Linea alba  Stenson’s duct
  19. 19. Examination: Buccal Mucosa  Lesions – white, red  Lichen Planus, Leukedema
  20. 20. Palpation of the Buccal Mucosa and Mucobuccal Fold
  21. 21. Gingiva • Note color, tone, texture, architecture & mucogingival relationships
  22. 22. Gingiva • How would you describe the gingiva? – Marginal vs. generalized? – Erythematous vs. fibrous • Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant
  23. 23. Hard Palate 1. Incisive Papillae 2. Palatine Rugae 3. Palatine Raphe 4. Fovea Palatina 5. Vibrating Line 6. Uvula Indirect Visual Inspection Direct Visual Inspection Palpation
  24. 24. Exam: Hard palateExam: Hard palate  Minor salivary glands, attached gingiva  Note presence of tori: tx plan any pre- prosthetic surgery
  25. 25. Soft Palate and Uvula Examined by either indirect visualization or palpation. Palpation is completed by using the index finger and pressing upward
  26. 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. 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 ofNote occasional small globlets of transparent or pink opaque tissue which aretransparent or pink opaque tissue which are normal and may include lymphoid tissuenormal and may include lymphoid tissue
  28. 28. Tonsils
  29. 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. 30. Exam: Maxilla & MandibleExam: Maxilla & Mandible • Evaluate for Epulis fissuratum • If you make a new denture will the excess tissue resolve?
  31. 31. Tongue Dorsal and Ventral view
  32. 32. TONGUE • Tongue 1. Lingual Tonsil 2. Circumvallate Papillae 3. Foliate Papillae 4. Median Sulcus 5. Filiform Papillae 6. Fungiform Papillae
  33. 33. Tongue Visual Inspection Palpation
  34. 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. 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. 36. Exam: Tongue
  37. 37. Exam: Tongue • You may observe lingual varicosities
  38. 38. Exam: Tongue • You may observe geographic tongue (erythema migrans)
  39. 39. Exam: Tongue • You may observe drug reaction
  40. 40. Exam: Tongue • Observe signs of nutritional deficiencies, immune dysfunction
  41. 41. Exam: Tongue • You may observe oral cancer
  42. 42. Floor of Mouth
  43. 43. Floor of Mouth
  44. 44. Exam: Floor of mouthExam: Floor of mouth  Visualize, palpate - bimanuallyVisualize, palpate - bimanually  Wharton’s ductWharton’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. 45. Palpation of the floor of the mouth
  46. 46. Exam: Floor of mouthExam: Floor of mouth
  47. 47. Exam: Floor of mouthExam: Floor of mouth  Squamous Cell CarcinomaSquamous Cell Carcinoma
  48. 48. Exam: Floor of mouthExam: Floor of mouth  Squamous Cell CarcinomaSquamous Cell Carcinoma
  49. 49. Exam: Leukoplakic area Edentulous Mandibular Ridge
  50. 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 factorsDoes the patient have important risk factors for oral cancer?for oral cancer?  Counseling for smoking and alcoholCounseling for smoking and alcohol  CessationCessation
  51. 51. Ulcer Examination Ulcers should be evaluated for the character of their: Base Depth Edges Color Discharge Relations to surrounding tissues
  52. 52. Squamous Cell Carcinoma
  53. 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. 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. 55. Tooth Examination • Caries Pattern • Missing Teeth • Size, Color, and Structural Changes • Eruption Pattern • Percussion • MOBILITY
  56. 56. Exam: Maxilla & MandibleExam: Maxilla & Mandible • size, shape, contour • pre-prosthetic treatment •Tori removal • tuberosity reduction •Soft or hard tissue or both
  57. 57. Exam: Maxilla & MandibleExam: Maxilla & Mandible
  58. 58. Exam: Maxilla & MandibleExam: Maxilla & Mandible
  59. 59. Occlusion • Orthodontic classification • Interferences
  60. 60. Occlusion
  61. 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. 62. Visualize all areas
  63. 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. 64. THANK YOUTHANK YOU

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