This document provides guidance on examining the oral cavity and oropharynx. Key areas to examine include the lips, checking for color, consistency, lesions or abnormalities; the buccal mucosa, looking for lesions; the gingiva, noting color, tone and architecture; the hard and soft palates; the tongue, checking all surfaces for lesions or signs of nutritional deficiencies; the floor of the mouth, visualizing and palpating for lesions or masses; and the oropharynx, checking for normal color and consistency of tissues. The lateral borders of the tongue and floor of the mouth are the most common sites for oral cancer, so these areas require close examination. A systematic and complete examination of all oral tissues

1. ORAL CAVITY &
OROPHARYNX

7. Palpation of the floor of the mouth

8. 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

9. Exam: Lips

11. 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

12. Exam: Lips-palpation
• Color, consistency
• Area for blocked minor salivary
glands
• Lesions, ulcers

13. Exam: Lips
• Frenum:
– Attachment
– Level of attached gingiva

14. Exam: Lips-sun exposure

15. Exam: Lips
• Palpate in the vestibule, observe
color

16. Examination: Buccal Mucosa
• Linea alba
• Stensen’s duct

17. Examination: Buccal Mucosa
• Lesions – white, red
• Lichen Planus, Leukedema

18. Gingiva
• Note color, tone,
texture, architecture
& mucogingival
relationships

19. Gingiva

20. Gingiva

21. Exam: Hard palate

23. 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

24. Exam: Tongue
• Have the patient stick out their 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

25. Exam: Tongue

26. Exam: Tongue
• You may observe
lingual varicosities

27. Exam: Tongue
• You may observe geographic tongue
(erythema migrans)

28. Exam: Tongue
• You may observe drug reaction

29. Exam: Tongue
• Observe signs of nutritional deficiencies,
immune dysfunction

30. Exam: Tongue
• You may observe
oral cancer

32. Palpation of the floor of the mouth

33. Exam: Floor of mouth
• Visualize, palpate - bimanually
• Wharton’s duct
• Must dry to observe
• Does “lesion” wipe off?
• Where are the two most
likely areas for oral cancer?
• lateral border of the tongue
• Floor of mouth

34. Exam: Floor of mouth
• Oral Cancer:
• Red
• White
• Red and White
• Does the patient have important
risk factors for oral cancer?
• Counseling for smoking and alcohol
• Cessation

35. Exam: Floor of mouth

36. Exam: Floor of mouth
• Squamous Cell Carcinoma

37. Exam: Floor of mouth
• Squamous Cell Carcinoma

38. Exam: Leukoplakic area
Edentulous Mandibular Ridge

39. Retromolar trigone
• The small area behind the wisdom teeth.

42. TMJ & OcclusionTMJ & Occlusion

43. Occlusion
• Orthodontic
classification

44. Occlusion

45. Systematic Oral
Examination
• Done at initial exam & at recalls
unless patient history requires
sooner
• You must visualize all areas of the
oral cavity

46. Systematic Oral
Examination
• Oral cancer can occur in other
places than the lateral borders of
the tongue & the floor of the mouth
• Be complete
• Do good, do no harm, do justice,
respect autonomy

47. Visualize all areas

48. Exam: Oropharanyx
• Color, consistency of tissue
• Look to the back, beyond the soft
palate
• Note occasional small globlets of
transparent or pink opaque tissue
which are normal and may include
lymphoid tissue

49. Exam: Soft palate
• How does soft palate raise upon
“aah”?
• Vibrating line, tonsilar pillars, tonsils,
oropharynx

54. ORAL CAVITY &
OROPHARYNX