The document discusses the importance of conducting a thorough oral examination to diagnose diseases. It outlines examining the head and neck extra-orally, as well as examining the lips, buccal mucosa, gingiva, hard palate, soft palate, tonsils, tongue, floor of the mouth, maxilla, mandible and occlusion intra-orally. The examination should be done systematically and completely to visualize any abnormalities and accurately assess signs and symptoms of disease. A thorough oral exam is essential for diagnosis and treatment planning.
Diana grandi relation between tonsillar hypertrophy,
Examination of Oral Cavity & Face
1. Examination of the Face
& Oral Cavity
Dr. Natheer H Al-Rawi
Dr. Natheer Al-Rawi 1
2. 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
Dr. Natheer Al-Rawi 2
3. 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
Dr. Natheer Al-Rawi 3
4. 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
Dr. Natheer Al-Rawi 4
5. Equipment
Assure that you have all the supplies necessary
to complete an oral examination
Mirror
Tissue retractor (tongue blade)
Dry gauze
Explorer
You must dry some of the tissues in order to
observe the any color changes
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6. Exam of the Head & Neck; Oral Cavity
Be systematic
Consistently complete the exam in the same
order
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7. 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
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8. Extra-oral examination
TMJ
Palpate upon opening
What is the maximum inter maxillary space?
Is the opening symmetrical?
Is there popping, clicking, grinding?
Use your stethoscope to listen to sounds
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10. Extra-oral examination
Thyroid Gland Palpation
Place hands over the
trachea
Have the patient swallow
The thyroid gland moves
upward
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11. 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
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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
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13. Exam: Lips-palpation
Color, consistency
Area for blocked minor salivary glands
Lesions, ulcers
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14. Exam: Lips
Frenum:
Attachment
Level of attached gingiva
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16. Exam: Lips
Palpate in the vestibule,
observe color
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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
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21. Gingiva
How would you describe the gingiva?
Marginal vs. generalized?
Erythematous vs. fibrous
Drug reactions: Anti-epileptic, calcium channel
blockers, immunosuppressant
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22. Exam: Hard palate
Minor salivary glands, attached gingiva
Note presence of tori: tx plan any pre-
prosthetic surgery
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23. Exam: Soft palate
How does soft palate raise upon “aah”?
Vibrating line, tonsilar pillars, tonsils,
oropharynx
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24. Exam: Tonsils
Tucked in at base of anterior & posterior
tonsilar pillars
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25. 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
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26. 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
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44. 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
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