intraoral examinations which includes 1 lips 2tongue 3 bucal and labial mucosa 4 palate 5 floor of mouth 6 gingiva 7 gingivitis 8 periodontitis

1. -Akanksha Singh
-Final year
Intra oral examination

2.  After extra oral examination we proceed towards intra
oral examination
 The structures to be examined are :-
1. Lips
2. Labial and buccal mucosa
3. Palate
4. Floor of mouth
5. Tongue
6. Gingiva
7. Teeth

3. 1.Lips
While examination of lips we will check for:
contusion pigmentation ulceration
Double lip Lip pit swelling
Angular pit cold
sore

4. Labial and Buccal mucosa
For the examination of the labial and buccal mucosa
the lip and cheek are retracted respectively and
observed in sufficient light.
The healthy mucosa appears to be smooth, shiny, pink
and moist.
Opening of Stensen’s duct can be seen opposite to 2nd
molar.
ABNORMAL FINDINGS:
COLOR: The black spots (macule) may
be seen on the mucosa due to
the deposition of melanin as a response of local

5. The red patches may be seen on the mucosa which can be
solitary or generalized.
The red patches on the mucosa can be seen due to :
1, Erythroplakia
2, Allergic reactions
3, Candidiasis (atrophic/ erythmatous)
4, Carcinoma in-situ
Similarly like red patches the white patches are also seen
which may be due to:
1, Leukoplakia
2, Leukoedema
3, Linea alba
4, white sponge nevus

6. CONSISITENCY:
The consistency of the mucosa may become fibrous
instead of smooth which may be due
1, Oral sub mucous fibrosis
2, chronic cheek bite
3, linea alba
4, Fordyce’s granules
5, Red or white lesions
6, Candidiasis
These fibrous appearing mucosa may be scrapable
or non scrapable depending upon the cause.
Other factors to be seen are the swelling, ulceration
or presence of nodules and Fordyce's granules.

7. Soft and hard palate
After the proper illumination of light we will check
for:
• Discoloration
• Swelling/fistula/tori /ulcer
• Cleft
• Perforation: usually caused by gumma
• Asymmetry of structures
• Any scar
• Papillary hyperplasia
further the palate is palpated to check for the
swelling or tenderness on the palate.

8. Normal palate discoloration
of palate
Tori papillary
hyperplasia

9. Floor of mouth
For the examination of the floor of mouth the patient
is asked to elevate the tongue and then the floor is
examined with proper illumination of light.
The opening of Wharton’s duct is observed.
The pooling of saliva is seen.
The floor is also seen for ulceration and swelling.
depending on the color we can find the cause of
swelling.
For e.g., if the swelling is Red : hemangioma
Blue: ranula
While examination of floor of mouth we can also
check the presence or absence of ankyloglossia.

10. Hemangioma
Ranula

11. Tongue
Dorsal surface is examined while keeping the
tongue at rest.
COLOR:
We will check for the presence of pigmentation
For e.g. yellow color : Jaundice
black color : Heavy smokers
SIZE
We will check for the presence of macroglossia or
microglossia.
FISSURE
We will then check for the presence of fissures on
the surface of tongue
Transverse congenital
Longitudinal syphilis

12. Papilla : Normal
Hypertrophic
Absent
Border : Normal
Scalloped
VENTRAL SURFACE:
Varicosity: present
Absent

13. Varicosity of tongue is a physiological process
caused due to advancing age leading to elastolytic
degeneration of the sublingual veins.
Frenal attachment : High
Normal

14. GINGIVA
Gingiva is the part of the oral mucosa that covers the
alveolar process of the jaw and surrounds the neck
of the teeth.
It is the most important structure to be examined in
the oral cavity to check for the periodontal condition.

15. COLOR:
The normal color of the gingiva is coral pink or pale
pink
The color of the gingiva depends upon :
1. Vascular supply
2. Thickness and degree of keratinisation of
epithelium
3. Presence of pigment containing cells.
The change in color signifies the diseased gingiva
Acute: red
Chronic: bluish pink

16. Size:
The size of the gingiva depends on bulk of cellular +
intercellular elements and blood supply
The healthy gingiva fits snugly around the teeth.
The alteration in the size is the common feature of
gingival disease.
The increase in the size of gingiva is commonly
known as the gingival enlargement
They are further classified as:
1. Inflammatory enlargement : i) Acute
ii) chronic

17. 2, Drug induced enlargement
3, Systemic disease or condition:
• Pregnancy
• Puberty
• Vitamin c deficiency
• Leukemia
• Pyogenic granuloma
4, Neoplastic enlargement
• Benign enlargement
• Malignant enlargement

18. Contour:
The marginal gingiva follows the scalloped outline
on the facial and lingual surfaces.
The interdental papilla are pointed and pyramidal
and also fills the space present interdentally.
The diseased marginal gingiva becomes rounded,
rolled and bulbous.
The interdental gingiva becomes bulbous, flat and
cratered
Normal gingiva
Diseased gingiva

19. Position: The level at which gingival margin is
attached to the tooth - At CEJ
Exposure of the tooth by the apical migration of the
gingiva is known as gingival recession.
Consistency: Firm and resilient except the free
marginal gingiva. It is tightly bounded to the
underlying bone.
The gingiva becomes edematous and fibrotic in
diseased condition.

20. Texture:
Stippling or the orange peel appearance is seen on
the attached gingiva on drying it with the cotton.
It appears on the gingiva after 5 years of age and
remains throughout the life in the healthy gingiva
The stippling is lost in the diseased gingiva.

21. Gingivitis
Gingivitis is defined as the inflammation of the
gingiva.
It is further classified as : Acute and Chronic
: Localized or Generalized

22. Signs and symptoms:
•Bright red or purple gums
•Spongy and swollen gums
•They are mainly painless unless pressure applied
•Easily bleed even on gentle brushing
•Loss of stippling

23. Causes:
• Build up of bacteria due to accumulation of the
plaque which lead to irritation of the gingiva.
•Poor oral hygiene
• Smoking
• Faulty prosthesis
• Malocclusion
• Breathing through mouth
• Local trauma
• Vitamin deficiency
Gingivitis is usually a reversible condition, but if they
are left untreated it may lead to the irreversible and a
severe condition mainly known as PERIODONTITIS.

24. Periodontitis
It is the inflammation of the gums and supporting
structures of the teeth.
It may also be defined as the disease involving one
or more of the four components of the peridontium

25. Signs and symptoms:
All the signs of the gingivitis are present , in addition
to:
•Bone loss
•Halitosis
•Pocket formation
•Occasional suppuration
•Tooth mobility
•Spacing between the teeth
•Gum recession
•Increased sensitivity and food impaction