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Module 14: Oral Examination (Subgroup 2: Oral Cavity and Mucosal Surfaces…
Module 14: Oral Examination
Subgroup 1: Visual Inspection of Lips and Vermillion Border
Normal findings
At rest, the lips normally touch; surface of lips is smooth and intact with a normal color and texture; vermillion border is even and not raised
Notable findings
changes in shape or texture; chapped or cracked lips; pigment changes/variation in color; lip pits; irregular vermillion border; lips don't meet at rest; cheilosis at the commissures; herpetic lesions; soft tissue lesions; swelling of lips; asymmetrical mouth - may indicate neurological condition, tumors or infection
Preparation: Briefly explain procedure. Ask patient to remove dentures. Ask patient to remove lipstick with tissue. Provide safety glasses. Wash hands; put on gloves. Place patient in supine position. Clinician sits.
Inspection: visually inspect lips and vermillion border
Subgroup 2: Oral Cavity and Mucosal Surfaces
Normal findings
Smooth, intact, and coral pink to bluish brown in color; no lesions; minor salivary glands in lips feel like small beads; intact frenum on maxillary and mandibular arches. Normal variations: Fordyce granules (ectopic sebaceous glands)
Notable findings
Changes in color or texture; swelling; trauma; lesions; pale or reddened mucosa/ dry mucosa; linea alba; leukoplakia; lichen planus; halitosis
oral cavity - preliminary visual inspection
inspect entire oral cavity/ oropharynx; look for conditions that would modify or postpone procedure (Ex: herpetic lesions; red, inflamed throat)
labial mucosa of lower lip- visual
index fingers of both hands inside; thumbs on outside; evert and retract lip fully away from teeth and alveolar ridge to view entire labial mucosal surface and vestibule of lower lip
labial mucosa of upper lip - visual
same finger placement as lower lip; stretch tissue away from dental arches; visually examine entire mucosal surface adjacent to maxillary teeth; tissue between dental arches
buccal mucosa - near maxillary arch - visual
evert the cheek and stretch tissue up and away from maxillary teeth on right side so that no folds remain to conceal abnormalities; repeat for left side
buccal mucosa - near mandibular arch - visual
stretch the cheek down and away from mandibular arch on right side so that no folds remain to conceal abnormalities; repeat for left side
Subgroup 3: Underlying Structures of Lips and Cheeks
lower lip - palpate
compress tissues between index fingers and thumbs
right cheek - palpate
left hand w/ middle and ring finger extraorally on right cheek; right hand index finger intraorally opposite left hand; compress tissues and palpate entire buccal mucosa; repeat for left side
upper lip - palpate
compress tissues between index fingers and thumbs; palpate from right commissure to left
Normal findings
Firm tissue; moist tissue; intact tissue
Notable findings
Swellings or nodules; changes in texture; tenderness during palpation; minor salivary glands in lips feel like small beads when palpated
Subgroup 4: Floor of Mouth
Normal findings
sublingual frenum; sublingual caruncles on either side of frenum
Notable findings
change in color or texture; lesions; swelling; mucocele or ranula (fluid filled swelling caused by pooling of saliva within tissues due to trauma of salivary gland duct); swelling due to salivary calculi or stones; leaukoplakia
anterior region - visual
Ask patient to touch the tip of the tongue to the roof of the mouth
posterior region - visual
Ask patient to relax tongue and protrude it slightly. Grasp tip of tongue with damp folded gauze square. Use right hand to gently pull to left commissure. Use left hand to apply gentle pressure upward against the submandibular gland. Repeat for left side
palpation
Place right index finger on floor of mouth. Place middle and ring fingers of the left hand under the patient's chin on right side of the head. Ask patient to relax tongue and close mouth slightly. Gently move tongue out of the way with index finger. Palpate floor of the mouth by pressing upward with with your extraoral fingers and downward with your index finger. Palpate from right posterior region forward to anterior region. Then back to left posterior.
Subgroup 5: Salivary Gland Function
Normal findings
normal flow of saliva
Notable findings
xerostomia; swellings in floor of mouth from blocked saliva glands or ducts or trauma
submandibular and sublingual ducts- examine
Ask patient to raise tongue toward roof of mouth. Use guaze square to gently dry the area around sublingual caruncles and sublingual fold. Press down slightly with cotton-tipped applicator in region of caruncles. A drop of stream of saliva should be evident
parotid salivary ducts - examine
Ask patient to open mouth halfway. Retract the right cheek and locate the parotid papilla on the buccal mucosa opposite to maxillary right molars. Dry the papilla with gauze. Press the area slightly above parotid papilla with cotton-tipped applicator. Drop of saliva should be expressed from papilla. Repeat for left side.
Subgroup 6: The Tongue
ventral surface - visual
Ask patient to open wide and touch tip of tongue on roof of mouth. frequent site of oral cancer
dorsal surface - visual
Ask patient to relax tongue and protrude it slightly. Grasp tongue with gauze and pull forward; frequent oral cancer site
Normal findings
ventral surface
distinct lingual veins; raised linear structures; enlarged vessels relating to aging may result in lingual varicosities
dorsal surface
median groove; filiform; fungiform; circumvallate papillae; networks of grooves may be pronounced with aging
lateral surface
foliate papillae; scalloped outline from being pressed into embrasure spaces
Notable findings
ulceration; lesions or swellings; nodules detectible upon palpation; variation in size, color, or texture; food debris may produce inflammation or malodor; assymetrical shape; dry mouth; papillae absent; geographic tongue, macroglossia; ankyloglossia; black hairy tongue w/ use of antibiotics
lateral borders - visual
pull tongue to left commissure and evert slightly to visualize lateral surface and foliate papillae
palpation
palpate body of tongue between index finger and thumb; be alert for swellings or nodules
Subgroup 7: Palate, Tonsils, Oropharynx
Normal findings
hard palate
mucosa firmly attached to bone; pale pink in color with bluish to to brown hue; palatine raphae and rugae; firm when palpated; common variation is palatine torus
soft palate
spongy texture; firm but flexible; symmetrical elevation
tonsils
large in childhood; small or absent in adults
uvula
at midline
Notable findings
palate
swelling; lesions; tumors; cleft palate; color changes;texture changes (common in smokers);snuff dipper's or tobacco chewer's patch; petechiae (red spots due to trauma); ulcerations; trauma;
tonsils
inflamed; enlarged; pus
oropharynx
reddened and inflamed; sore throat; discomfort when swallowing or eating
uvula
deviates from midline
palate - visual
inspect hard and soft palate, uvula, oropharynx, and tonsils
hard and soft palate - palpate
use intermittent pressure with index finger to palpate hard and soft palate
tonsils and oropharynx - visual
Position mouth mirror with reflecting surface down. Ask patient to say "ah" while depressing back of tongue downward and forward. Visually inspect tonsils and oropharynx