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
Dr. Natheer Al-Rawi 5

6. Exam of the Head & Neck; Oral Cavity
 Be systematic
 Consistently complete the exam in the same
order
Dr. Natheer Al-Rawi 6

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
Dr. Natheer Al-Rawi 7

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
Dr. Natheer Al-Rawi 8

9. Extra-oral examination
 Lymph node palpation
Dr. Natheer Al-Rawi 9

10. Extra-oral examination
 Thyroid Gland Palpation
 Place hands over the
trachea
 Have the patient swallow
 The thyroid gland moves
upward
Dr. Natheer Al-Rawi 10

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
Dr. Natheer Al-Rawi 11

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
Dr. Natheer Al-Rawi 12

13. Exam: Lips-palpation
 Color, consistency
 Area for blocked minor salivary glands
 Lesions, ulcers
Dr. Natheer Al-Rawi 13

14. Exam: Lips
 Frenum:
 Attachment
 Level of attached gingiva
Dr. Natheer Al-Rawi 14

15. Exam: Lips-sun exposure
Dr. Natheer Al-Rawi 15

16. Exam: Lips
 Palpate in the vestibule,
observe color
Dr. Natheer Al-Rawi 16

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
Dr. Natheer Al-Rawi 17

18. Examination: Buccal Mucosa
 Linea alba
 Stenson’s duct
Dr. Natheer Al-Rawi 18

19. Examination: Buccal Mucosa
 Lesions – white, red
 Lichen Planus, Leukedema
Dr. Natheer Al-Rawi 19

20. Gingiva
 Note color, tone, texture,
architecture &
mucogingival
relationships
Dr. Natheer Al-Rawi 20

21. Gingiva
 How would you describe the gingiva?
 Marginal vs. generalized?
 Erythematous vs. fibrous
 Drug reactions: Anti-epileptic, calcium channel
blockers, immunosuppressant
Dr. Natheer Al-Rawi 21

22. Exam: Hard palate
 Minor salivary glands, attached gingiva
 Note presence of tori: tx plan any pre-
prosthetic surgery
Dr. Natheer Al-Rawi 22

23. Exam: Soft palate
 How does soft palate raise upon “aah”?
 Vibrating line, tonsilar pillars, tonsils,
oropharynx
Dr. Natheer Al-Rawi 23

24. Exam: Tonsils
 Tucked in at base of anterior & posterior
tonsilar pillars
Dr. Natheer Al-Rawi 24

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
Dr. Natheer Al-Rawi 25

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
Dr. Natheer Al-Rawi 26

27. Exam: Tongue
Dr. Natheer Al-Rawi 27

28. Exam: Tongue
 You may observe lingual
varicosities
Dr. Natheer Al-Rawi 28

29. Exam: Tongue
 You may observe geographic tongue (erythema
migrans)
Dr. Natheer Al-Rawi 29

30. Exam: Tongue
 You may observe drug reaction
Dr. Natheer Al-Rawi 30

31. Exam: Tongue
 Observe signs of nutritional deficiencies, immune
dysfunction
Dr. Natheer Al-Rawi 31

32. Exam: Tongue
 You may observe oral
cancer
Dr. Natheer Al-Rawi 32

33. Exam: Floor of mouth
 Visualize, palpate - bimanually
 Wharton’s duct
 Must dry to observe
 Does “lesion” wipe off?
Dr. Natheer Al-Rawi 33

34. Palpation of the floor of the mouth
Dr. Natheer Al-Rawi 34

35. Exam: Floor of mouth
Dr. Natheer Al-Rawi 35

36. Exam: Floor of mouth
 Squamous Cell Carcinoma
Dr. Natheer Al-Rawi 36

37. Exam: Floor of mouth
 Squamous Cell Carcinoma
Dr. Natheer Al-Rawi 37

38. Exam: Leukoplakic area
Edentulous Mandibular Ridge
Dr. Natheer Al-Rawi 38

39. Exam: Maxilla & Mandible
• Size, shape, contour
• Pre-prosthetic treatment
•Tori removal
• Tuberosity reduction
•Soft or hard tissue or both
Dr. Natheer Al-Rawi 39

40. Exam: Maxilla & Mandible
Dr. Natheer Al-Rawi 40

41. Exam: Maxilla & Mandible
 Evaluate for Epulis
fissuratum
 If you make a new
denture will the excess
tissue resolve?
Dr. Natheer Al-Rawi 41

42. Occlusion
 Orthodontic classification
 Interferences
Dr. Natheer Al-Rawi 42

43. Occlusion
Dr. Natheer Al-Rawi 43

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
Dr. Natheer Al-Rawi 44

45. Visualize all areas
Dr. Natheer Al-Rawi 45

46.  Watch the vedio
Dr. Natheer Al-Rawi 46

47. Thank You
Dr. Natheer Al-Rawi 47