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EXAMINATION OF ORAL CAVITY

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WHY????

• 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

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Scope of examination

• 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

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HISTORY

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AGE

AGE• Congenital

• Vitamin deficiency and malnutrition

• Carcinoma of buccal mucosa, lips, tongue

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• OCCUPATION– COUNTRY MANS LIP

• RESIDENCE– Australia– Caucasians– Negroes

OCCUPATION

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SYMPTOMS

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• Mode of onset

• Duration

• Progress

SWELLING / ULCER

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• PAINLESS LESIONS – Leukoplakia, mucous retention cysts, early carcinomas.

• PAINFUL LESIONS – Apthous ulcers, dental ulcers, abscess.

• Localized / radiating to ear

PAIN

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• Excessive Salivation

• Painful lesions

• Mass lesions – irritation

• Inability/difficulty to swallow due to ankyloglossia

SIALORIA

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• Ankyloglossia

• Tongue Tie

• Dysarthria

• Hoarseness of voice

• Cough with expectoration

HISTORY

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• Trismus• Ear pain• Eye pain• Dysphagia• Hearing loss• History of leukoplakia / erythroplakia

HISTORY

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MOKINGPIRITEPSISUPERFICIAL GLOSSITISYPHILISPICESHARP TOOTH

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• SMOKING– Type– Pack Years– Mode Of Smoking

• ALCOHOL INTAKE

• TOBACCO CHEWING

PERSONAL HISTORY

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• Build and Nourishment• Pallor

GENERAL EXAMINATION

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LOCAL EXAMINATION

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INSPECTION

• REQUIREMENTS

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LIPS

• Exterior surface of lips

• Cleft lip

• Pigmentation

• Swelling / ulcer

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LIPS

• Evert the lip and examine the tissue.

• Observe frenulum attachment.

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LIPS

• 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

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• To examine the gums lip must be everted fully.

• Healthy gums are bright pink in colour.

GUMS

GINGIVA

• Note color, tone, texture, architecture & mucogingival relationships

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GUMS

GINGIVA

• How would you describe the gingiva?– Marginal vs. generalized?– Erythematous vs. fibrous

• Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant

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GUMS

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GUMS

• Cancrum oris is infective ulceration affecting alveolous and progresses to produce orocutaneous fistula.

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BUCCAL MUCOSA

• Observe color, character of the mucosa

• Stenson’s duct

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• LEUKOPLAKIA / ERYTHROPLAKIA

BUCCAL MUCOSA

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Lesions – white, red

Lichen Planus, Submucous fibrosis

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BUCCAL MUCOSA

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• Congenital cleft• Perforation• Ulceration• swelling

PALATE

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TONGUE

VOLUME• Macroglossia

COLOUR• White – • Red glazed tongue• Blue• black

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ULCER• Tuberculous – tip and lateral borders

• Gummatous – dorsum

• Carcinomatous – anywhere

• Dental – lateral borders and ventral surface

TONGUE

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Lingual thyroid – • swelling at foramen caecum

Mobility of tongueAnkyloglossia

TONGUE

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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:– Circumvallate papillae, epiglottis

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• Wrap the tongue in a dry gauze and gently pull it from side to side to observe the lateral borders

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TONGUE

• You may observe lingual varicosities

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TONGUE

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Exam: Tongue

• geographic tongue (erythema migrans)

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TONGUE

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Exam: Tongue

• You may observe drug reaction

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TONGUE

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• Observe signs of nutritional deficiencies, immune dysfunction

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TONGUE

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• Ulceration, proliferative growth

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TONGUE

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• Frenulum

• Ranula

• Sublingual dermoid

FLOOR OF MOUTH

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PALPATION

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LIP

• Any lesion of lip should be palpated

• Benign neoplasms are firm & lobulated

• Carcinoma – hard

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• Apthous ulcers – small discrete shallow tender ulcers with a rim of inflammation

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LIP

• Hunterian chancre - in primary syphilis is rubbery hard

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LIP

Carcinoma of lip • hard in consistency

• restricted mobility

• fixity

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TONGUE

• Method of palpation

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• Dental ulcers are very tender with no induration of edge / base.

• Carcinomatous ulcers show induration of base and edge.

TONGUE

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PALATE

• Hard irregular swelling on hard palate with normal appearing overlying mucosa – minor salivary gland tumor

• Malignant lesions of hard palate are hard fixed ulcerative or proliferative lesions

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ALVEOLUS AND GINGIVA

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ALVEOLUS AND GINGIVA

• GINGIVITIS

• GINGIVAL HYPERTROPHY

• EPULIS

• ALVEOLAR CARCINOMA

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FLOOR OF MOUTH

• UNIDIGITAL PALPATION

• BIDIGITAL PALPATION

• RANULA

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RANULA

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BUCCAL MUCOSA

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MANDIBLE

• Bidigital palpation of mandible

• Temporo mandibular joint

• Movements at TMJ

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PALPATION OF LYMPH NODES

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DIFFERENTIAL DIAGNOSIS OF ULCERS ONN TONGUE

• Apthous ulcers• Dental ulcers• Carcinomatous• Syphilis• Tuberculous

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INVESTIGATIONS

• HAEMOGRAM• WEDGE BIOPSY FROM EDGE OF ULCER• FNAC OF LYMPH NODES• CECT OF NECK• ORTHOPANTOMOGRAM

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ORTHOPANTOMOGRAM

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