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Oral cavity & oropharynx
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
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Oral cavity & oropharynx
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- 7. Palpation of thefloor of the mouth
- 8. Exam: Lips • Observethe 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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- 11. Exam: Lips • Evertthe 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
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- 15. Exam: Lips • Palpatein 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
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- 23. Exam: Tongue • Thetongue 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 • Havethe 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
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- 26. Exam: Tongue • Youmay observe lingual varicosities
- 27. Exam: Tongue • Youmay observe geographic tongue (erythema migrans)
- 28. Exam: Tongue • Youmay observe drug reaction
- 29. Exam: Tongue • Observesigns of nutritional deficiencies, immune dysfunction
- 30. Exam: Tongue • Youmay observe oral cancer
- 32. Palpation of thefloor of the mouth
- 33. Exam: Floor ofmouth • 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 ofmouth • 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 ofmouth
- 36. Exam: Floor ofmouth • Squamous Cell Carcinoma
- 37. Exam: Floor ofmouth • Squamous Cell Carcinoma
- 38. Exam: Leukoplakic area EdentulousMandibular Ridge
- 39. Retromolar trigone • Thesmall area behind the wisdom teeth.
- 42. TMJ & OcclusionTMJ& Occlusion
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- 45. Systematic Oral Examination • Doneat initial exam & at recalls unless patient history requires sooner • You must visualize all areas of the oral cavity
- 46. Systematic Oral Examination • Oralcancer 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
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- 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
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