This document provides guidance on performing an intra-oral examination. It discusses examining different areas of the mouth including the lips, labial mucosa, buccal mucosa, buccal vestibule, tongue, hard palate, soft palate, uvula, oropharynx, floor of the mouth, and teeth. Common lesions, abnormalities, and examination techniques are described for each area. The document also provides details on evaluating the dental pulp through tests like heat, cold, and electrical pulp testing as well as using transillumination to examine for cracked teeth.

1. INTRA-ORAL
Examination

2. Content
Introduction
Examination Of lips and Labial Mucosa
Large lips
Lesions on the lips
Labial frenum
Buccal Mucosa
Buccal Vestibule
Common lesions
Tongue ( Dorsal – Ventral surfaces )
Tounge coating
Nerve supply

3. Introduction

4. Introduction

5. Topic one

6. Criteria of examination:
Upper & Lower lip :
- First check Vermilion border for surface lesions
- Should be Grasped gently between thumbs and index of both hands.
- Palpate the lip for submucosal masses/Nodules ( Bidigital palpation )
that are less than 1cm in diameter - Minor Salivary Glands -
Then everting the lip and examine the labial mucosa, vestibule, anterior gingiva.
Border of the mouth ( Commissure )

7. Large lips
May be an indication of variation of normal Like :
- Angioedema ( Allergy )
sudden diffuse swelling, firm and non pitting usually only on one lip is affected
but occasionally the whole face is involved
- Acromegaly
- included in Melkerson – Rosenthal Syndrome
“ Neurological Disorder “

8. Other Lesions On the lip :
1- Angular Cheilitis :
Candidal infection & low vertical dimension
2- Angular Cheilosis :
Vitamin deficiency & Protein Deficiency
3- Rhagades
in the form of Scar lines around the vermilion border in Congenital Syphilis
4- Herpes labialis

9. Other Lesions On the lip :
5- Smokers patch
6-Bloody Crusted Lip ( Erythema Multiform )
7- Contact Allergy due to mouth washes, Cosmetics , food
Lichen planus ( white striation in popular form, Ulcer in bullous erosive form )
8-Actinic Keratosis (Solar Keratosis )

10. Labial Frenum
Normally : appears as slender, midline band, it’s web like attachment at the height of
muco-labial vestibule
Level of attachment should be beyond the attached gingiva to avoid conveying the pull
action of labial muscles to marginal gingiva would result into gingival recession
A Fibrotic thick frenum helps to form diastema between central incisors

11. Buccal Mucosa
Bi-digital palpation of the Buccal Mucosa may reveal nodularity due to
presence of minor salivary glands
Bi-digital and Bi-manual palpation are carried out to determine the
consistency, flexibility of the cheek or buccal mucosa
Technique:
The buccal mucosa must be supported from out side by the four fingers of one
hand and the index finger of the other hand running inside the buccal mucosa
in different directions to palpate any deeply seated lesions
Similarly, Inspect the buccal vestibular mucosa and the buccal gingiva

12. Buccal vestibule
Inspection:
Can be inspected by retracting the cheeks whilethe mouth is opened and
then ask the patient to occludethe teeth
the buccal and labial vestibules are visualized to demonstrate their extensions,
Contour,Depth
Palpation:
the facial surfaces of maxilla,mandibleare palpatedto identify typical
elevationsor depressionsin the contour of the bone.
The palpationof the buccal vestibule can be done by slowly sliding the tip of the finger along the
alveolar surfaces at the periapicallevel
to Identify the tenderness or enlargementof periapical inflammatory lesions.
Also Signs as egg shell Crackling or Fluctuation should be noticed

13. On mucosal surface:
Look For Signs of inflammation ( Redness & Swelling ), Ulceration, Pigmentation and lesions
If any lesion is found, Describe them in site, size, shape and contour
Normal Variations appear as
- whitish ridge of tissues opposite the occlusal plane of teeth “ Linea Alba Buccalis “
- Fleshy swelling opposite the 2nd upper molar
“ opening of Stenson’s duct of parotid gland “

14. Common Lesions
1- White Lesion
Frictional Keratosis, Leukoplakia, Candidiasis, Aspirin burns, Smoker Keratosis,
papular Lichen planus
2- ulcerative lesion
Traumatic ulcer, aphthous ulcer, intra-oral herpes simplex
3-pigmented lesion
(petechia, ecchymosis) which give dark red to bluish coloration, melanoma,
amalgam tattoo
4- Warty lesions :
viral warts – papilloma
5- Neoplastic Lesion Seen as swelling or ulcer

15. Tongue and floor of the mouth
Dorsal Surface of the tongue
( normally appear pale pink rough surface )
1- Filiform papillae
( small whitish, hair like projections)
they may become elongated ( Hairy tongue )
they may become very short ( atrophic tongue )
2- Fungiform papillae
( the larger and more prominent
at the lateral border and tip )
3- Circumvallate papillae
nodular, irregular contours in the posterior region.
They are round and have groove around them.
this groove consists of the opening of Von Ebner Glands and also Contains
Taste buds
** the median groove or fissures on the dorsal surface of the tongue is referredto
as Fissured tongue and is common anatomic variation.

16. Tongue and floor of the mouth
Ventral Surface of the tongue
Appears vascular and smooth with the exception of the lingual frenum and
the thin webbed projections of
The plica fimbriata lateral to the frenum.

17. Normal tongue Coating
Normally tongue coating increase in the morning as salivary flow decreases
during sleep & then decreases while chewing food, speech with normal flow
of saliva.
Causes of increase tongue coating :
Drugs, mouth breathing, febrile illness,
excessive vomiting,dehydration Smoking,
Stomach upset

18. Decreasing tongue Coating
( Atrophy of tongue Coating )
1- Nutritional deficiency
Anemia, malnutrition – Vitamin B12 deficiency – alcoholism –
malabsorption – iron deficiency – plummer vinson syndrome)
2- Drugs as chemotherapy, antibiotics
3- Diseases as atrophic lichen planus
4- peripheralVascular changes as with
- Obliteratoin of small vessels secondary to diseases
( submucous Fibrosis ) – scleroderma
- Micro angiopathy “Diabetes Mellitus”
- syphilitic bald tongue
- S.L.E

19. Nerve Supply of the tongue
1- Posterior 1/3 of the Tongue:
Glossopharyngeal
( general sensation + Taste sensation )
2- Anterior 2/3 of the tongue:
General Sensation :
Lingual Branch of mandibular nerve
Taste Sensation : Chorda tympani
- Motor nerve :
All of the tongue Supplied by –
Hypoglossal Nerve
Except:
1- Palatoglossus Muscle
2- Glossopharyngeus
Supplied By :
Pharyngeal plexus “ Vagus Nerve “

20. Tongue lesions and
examination.

21. Common tongue lesions:

22. 




23. 




24. 




25. 




26. 




27. Tongue infections:
Candidal infection herpes syphilis

28. 


29. Enlargement of the tongue:







30. 




31. 





32. 




33. Examination of the tongue:



34. 





35. Content:
• Hard Palate
• Soft palate
• Uvula
• oropharynx
• Floor of the Mouth
• Examination of the teeth

36. Hard palate:
Hard palate examination done by:
A) Inspection: by two ways
a. Indirect inspection: done be the mirror.
b. Direct vision: (for better vision) the patient
mouth is opened widely.

37. Hard palate:
B) Palpation:
❖ The palatal alveolus is palpated at
periapical level for tender foci or hard
bone enlargement at the midline called
torus palatinus.
❖ Any abnormal sensation must be
detected as egg shell crackling or
fluctuation.

38. Hard palate:
❖ The normal palatal mucosa
appears pale pink and
homogenous in color.
❖ The normal anatomical
consideration must be considered
(palatal rugae, incisive papilla
and median palatine raphe)

39. Hard palate:
Common lesions of the hard
palate:
❖ Pizza burn
❖ Cleft palate
❖ Minor salivary gland tumor
❖ Nicotinic stomatitis
❖ Torus palatinus
❖ Inflammatory papillary
hyperplasia
❖Different types of cysts

40. Pizza burn.

41. Cleft palate.
A cleft palate happens if the tissue that makes up the roof of the mouth does
not join together completely during pregnancy.

42. Minor salivary gland tumor.
Usually present as a non-ulcerated,
painless submucosal mass of the oral
cavity, typically in the hard or soft palate.
Symptoms of minor salivary gland
tumors depend on tumor location,
extent, tumor type, and whether the
tumor is causing a mass effect or is
invading local structures.

43. Nicotinic stomatitis
❖ lesion of the roof of the mouth.
❖ The concentrated heat stream of smoke
from tobacco products causes Nicotinic
Stomatitis.
❖ These changes are observed most often in
pipe.

44. Torus palatinus
Torus palatinus refers to a bony growth on the roof
of your mouth.
These growths are harmless, but can be
uncomfortable and inconvenient.

45. Inflammatory papillary hyperplasia
is a benign lesion of the palatal mucosa. It is
usually found in denture-wearers but also has
been reported in patients without a history of
use of a maxillary prosthesis use.

46. Different types of cysts
Non Odontogenic
Odontogenic

47. Soft palate
Diagnosis of Soft palate and uvula done by:
1. Inspection: The soft palate is easily
inspected during the direct visualization of the
hard palate.
Depression of the tongue with mirror is usually
necessary to fully demonstrate the soft palate.
2. Palpation: Palpation of the soft palate
cause gagging and is not routinely
performed unless an abnormality is
observed visually.

48. Soft palate
The mucosa of the soft palate typically
appears reddish pink with prominence of
the underlying vascularity.
The soft palate or older persons may
appear somewhat yellow due to increased
submucosal fat.
The soft palate appears loose and mobile.

49. Soft palate
❖ Common lesions of the soft
palate:
❖ Herpangina
❖ Herpes zoster
❖ Recurrent apthous ulcer
❖ Petechia and ecchymosis

50. Herpangina
a viral illness that causes a high fever and
blister-like sores in the mouth and throat.
The illness is contagious and spreads quickly
among kids in school environments where
children are close to each other.

51. Herpes zoster
Herpes zoster (HZ) is a viral disease
which is primarily caused by the nerve
tissue.
Varicella zoster virus (VZV) is a DNA virus
that causes both primary and recurrent
infection.
also known as shingles, is a unique
condition induced by VZV reactivation.
Neuropathic pain, headache, malaise and
sleep disruption

52. Recurrent apthous ulcer in soft palate
presence of small, painful sores (ulcers) inside
the mouth that typically begin in childhood
and recur frequently. Mouth injury, stress, and
some foods may trigger an attack.

53. Petechia and ecchymosis
Petechiae on the palate are characteristic of streptococcal pharyngitis

54. Oropharyngeal region:
The most prominent structures in the oropharynx are the
tonsils
They are salmon - pink with nodular
surface
The posterior wall of oropharynx also
contains accessory lymphoid tissue
(adenoid), which appears as slightly
elevated mucosal colored papules. The
accessory lymphoid tissue at the
posterolateral border of the tongue
(lingual tonsils), palatine, and
pharyngeal tonsils which comprises
waldeyer's throat ring.

55. Uvula
Bifid Uvula
Deviated uvula
Abnormalities in Uvula

56. Floor of the mouth
Examination of the Floor of
Mouth:
Inspection: It is done by asking the
patient to raise the tongue. Normal
structures include lingual frenum,
orifices of sublingual and
submandibular salivary glands, lingual
veins any change in shape, color, and
integrity in the mucosa should be
noted.
Lingual
vestibule
Wharton’s duct openings
Sublingual
Carunculae

57. Palpation: Is usually performed
bimanually (i.e. by fixing the tissues
extra orally by the fingers of one hand
while the fingers of the other hand
manipulates the tissues).
The reason for palpation for this area is
to detect enlarged submandibular or
submental lymph nodes, salivary stones
along the course of Wharton's ducts
and any nodular enlargement of the
salivary glands.
Floor of the mouth

58. Mandibular tori: are bony, hard,
bilateral prominences of the lingual
alveolar process, commonly seen in
adults in the mandibular canine region.
Floor of the mouth

59. Common lesion of the floor of the mouth:
❖ Mucous retention cyst ( Ranula)
❖ Ulcer
❖ Salivary stones
❖ Tongue tie

60. Mucous retention cyst
Ranula is a clinical term for a mucocele or
mucous retention cyst located on the floor of
the mouth and arises from trauma to the
sublingual or submandibular salivary glands

61. Ulcer

62. Salivary stones
❖ Sialolithiasis is the medical term for salivary
gland stones (calculi).
❖ These stones can cause pain and swelling of
your salivary gland.
❖ Causes include dehydration, smoking and
certain autoimmune diseases.

63. Tongue tie
Tongue tie (ankyloglossia) is when a band of
tissue connects the underside of the tongue to
the floor of the mouth, which keeps it from
moving freely.

64. Examination of the Teeth:
This examination is carried out
through inspection with naked eye
and a mouth mirror
exploration with a suitable explorer
percussion with end of mirror handle
or single-ended explorer.
Pulp testing (Function Evaluation)
Radiographic examination
Transillumination

65. Pulp testing (Function Evaluation)
This test is an attempt to determine
vitality or non-vitality of the dental pulp
and it is an important diagnostic aid in
daily dental practice.
Heat testing of the pulp can be
performed by heating a small ball or
stick of gutta-percha in a flame until
tip applied to the tooth
Cold testing of the pulp can be done
through application of cold air, an ice
or cotton pledget soaked in ethyl

66. Electrical pulp testing:
Electrical pulp testing: offers an
advantage of more controlled, graded
stimulus compared with thermal tests,
as stimulus level can be digitally
displayed.
The physiological basis for the use of
electrical stimulation is based upon the
fact that, pain is specific sensory
experience mediated through nerve
structures that are separate from those
mediating other sensations as touch,
pressure

67. Transillumination
There are many commercially available
tools for transillumination. You can also
use the fiberoptic in your highspeed
handpiece. Without a bur in place
position the head of the handpiece on
the tooth surface and press to rheostat
so the light comes on. Curing lights can
also be used for crack detection.
Transillumination is one of ways to
determine if a tooth is cracked or not,
by passing a strong beam of light
through a sample and using the pattern
of light transmission for diagnosis.

68. Procedure: For cracked teeth we apply a strong
light source to the tooth so that the light is
traveling perpendicular to the plane of the
suspected crack. In most instances this means
we apply the light source to the labial or lingual
tooth surfaces. In a tooth that is not cracked the
light will travel uninterrupted from the buccal
surface to the lingual, which can be observed on
the occlusal table of the tooth by its uniform
illumination. When a tooth is cracked the light
hits the crack and is dispersed, therefore it does
not cross over and illuminate the side of the
tooth beyond the crack.
Transillumination

69. Examination of the Teeth:
The following should be
considered in examining the
teeth:
color, stains, number, form, size,
structure, erosion, abrasion,
fracture, vitality, functional
contours, carious lesions as well
as contact relationship.

70. Teeth Color and Stains:
The tooth color should be inspected
carefully, however primary teeth are
generally bluish white, while permanent
teeth are generally more opaque with
variation of grey and yellow hues with
aging.
The reason for this is thinness of enamel and
thickness of the dentin.

71. Teeth color may show alterations which
may be physiological or pathological
and intrinsic or extrinsic.
Teeth discoloration may result from
developmental disturbances as
amelogenesis imperfect,
dentinogenesis imperfect, brown
hereditary teeth and dental fluorosis or
mottling.
Examination of the Teeth:

72. Extrinsic and Intrinsic Teeth Staining:
dental fluorosis or mottled teeth,
tetracycline teeth staining and
erythroblastosis fetalis.
intrinsic teeth staining:

73. Examination of gingival and peridontal supporting structure.

74. Anatomy of the
Periodontium
Detection of
plaque
Examination of the
Periodontium:
Inspection
Palpation
Probing
Factors affecting periodontal
disease:
Probing (pocket) depth
Loss of attachment
Bleeding on probing
Tooth mobility
Bone Resorbtion
Furcation
Involvement
outline

75. Anatomy of the Periodontium
The periodontium is the supporting apparatus of the
teeth, which attaches the tooth to the bone of the
jaws and comprises the following tissues:
1- The gingiva.
2- The periodontal ligament.
3- The root cementum.
4- The alveolar bone.

76. Healthy Gingival Unit:

 The free gingiva
 The interdental papillae
 The attached gingiva

77. 





Healthy Gingival Unit:

78. Healthy vs Diseased Gingiva:

79. Healthy vs Diseased Gingiva:

80. Gingival Enlargment:
Gingival margin is significantly coronal to the
CEJ
Probing depth more than 3mm(normal
sulcus is 3mm)
( Gingival enlargement = distance from
gingival margin to CEJ)
Edematous Gingiva
Fibrous Gingiva

81. The periodontal ligament

 0.05
to 0.25 mm

82. The cementum


83. The alveolar process:


84. Detection of plaque :





85. Disclosing Agents
Use of disclosing agents Iodine containing solutions Erythrosine

86. Examination of the Periodontium:







87. Probing And Charting:

88. Technique of Probing

 Mesiobuccal, midbuccal, distobuccal, distolingual, midlingual
and mesiolingual.

 10- 15 degree


89. Factors affecting periodontal disease:






90. • Probing Depth:

 Clinical attachment level (CAL)


 Deep periodontal pocket Recession or both
 Furcation involvement

91. Clinical significance of Probing depth
 PD > 3mm mains Pathology:


 Deep pocket associated with:




92. Loss Of Clinical Attatchment:
 Loss of attachment



why?
Different pocketdepthswith the same amount of attachment
loss CAL gingival level CEJ

93. Calculating Clinical Attachment

 1-The probing depth
 2- Gingival margin





94. I- Gingival margin at CEJ


95. II- CAL in presence of recession



96. III- CAL in presence of gingival enlargement

 Some clinicians prefer

97. Bleading on probing
 Bleading on
 Bleeding + = active disease ,inflammation
 Bleeding - = stable condition


98. Tooth mobility:
. Is the loosening of a tooth in its socket





99. Scale for Mobility Assessment
 : normal mobility
 Slight mobility
 Moderate mobility
 Severe mobility

101. Bone Resorption :

102. Assissing alveolar bone loss Radiograph
 Radiograph
 Transgingival probing (bone sounding

103. Disadvantages of radiograph:
 Radiograph


104. FURCATION INVOLVEMENT

 How do you evaluate?



105. Furcation Classification:


