Examination of the Examination of the Face & Oral CavityFace & Oral Cavity
Dr. Natheer H Al-RawiDr. Natheer H Al-Rawi
1Dr. Natheer Al-Rawi
Oral ExaminationOral Examination
Many diseases (systemic or local) Many diseases (systemic or local) have signs that appear on the have signs that appear on the face, face, head & neck or intra-orallyhead & neck or intra-orally
Making a complete examination can Making a complete examination can help you create ahelp you create a differential differential diagnosis diagnosis in cases of abnormalities in cases of abnormalities and make treatment and make treatment recommendations based on recommendations based on accurate assessment of the accurate assessment of the signssigns && symptomssymptoms of diseaseof disease
2Dr. Natheer Al-Rawi
Oral ExaminationOral Examination
Each disease process may have Each disease process may have individualindividual manifestationsmanifestations in an in an individual patientindividual patient
And there may be And there may be individual host individual host reaction reaction toto the diseasethe disease
Careful assessment will guide the Careful assessment will guide the clinician to clinician to accurate diagnosisaccurate diagnosis
3Dr. Natheer Al-Rawi
Scope of ResponsibilityScope of Responsibility
Diseases of the Diseases of the head & neckhead & neck Diseases of the Diseases of the supporting hard & supporting hard &
soft tissuessoft tissues Diseases of the Diseases of the lips, tongue, lips, tongue,
salivary glands, oral mucosasalivary glands, oral mucosa Diseases of the Diseases of the oral tissues oral tissues which which
are a are a component of systemic component of systemic diseasedisease
4Dr. Natheer Al-Rawi
EquipmentEquipment
Assure that you have all the Assure that you have all the supplies necessary to complete an supplies necessary to complete an oral examinationoral examination MirrorMirror Tissue retractor (tongue blade)Tissue retractor (tongue blade) Dry gauzeDry gauze ExplorerExplorer
You must You must drydry some of the tissues in some of the tissues in order to observe the any color order to observe the any color changeschanges
5Dr. Natheer Al-Rawi
Exam of the Head & Neck; Exam of the Head & Neck; Oral CavityOral Cavity Be systematicBe systematic Consistently complete the exam in Consistently complete the exam in
the same orderthe same order
6Dr. Natheer Al-Rawi
Extra-oral examinationExtra-oral examination
ObserveObserve: : color of skin Examination area of head & neck
DetermineDetermine: : gross functioning of cranial nerves Normal vs. abnormal
Paralysis Stroke, trauma, Bell’s Palsy
7Dr. Natheer Al-Rawi
Extra-oral examinationExtra-oral examination
TMJTMJ PalpatePalpate upon openingupon opening
What is the maximummaximum inter maxillary inter maxillary space?space?
Is the opening Is the opening symmetricalsymmetrical?? Is there Is there popping, clicking, grindingpopping, clicking, grinding?? Use your Use your stethoscopestethoscope to listen to soundsto listen to sounds
8Dr. Natheer Al-Rawi
Extra-oral examinationExtra-oral examination
Lymph node Lymph node palpationpalpation
9Dr. Natheer Al-Rawi
Extra-oral examinationExtra-oral examination
Thyroid Gland Thyroid Gland PalpationPalpation Place hands over Place hands over
the tracheathe trachea Have the patient Have the patient
swallowswallow The thyroid gland The thyroid gland
moves upwardmoves upward
10Dr. Natheer Al-Rawi
Exam: LipsExam: Lips
Observe the color & its consistency-Observe the color & its consistency-intra-orally and externallyintra-orally and externally
Is the vermillion border distinct?Is the vermillion border distinct? Bi-digitally palpate the tissue Bi-digitally palpate the tissue
around the lips. Check for nodules, around the lips. Check for nodules, bullae, abnormalities, mucocele, bullae, abnormalities, mucocele, fibromafibroma
11Dr. Natheer Al-Rawi
Exam: LipsExam: Lips Evert the lip and examine the tissueEvert the lip and examine the tissue Observe frenum attachment/tissue Observe frenum attachment/tissue
tensiontension Clear mucous filled pockets may be Clear mucous filled pockets may be
seen on the inner side of the lip seen on the inner side of the lip ((mucocelemucocele). This is a frequent, ). This is a frequent, non-pathologic entity which non-pathologic entity which represents a blocked minor salivary represents a blocked minor salivary glanglandd
12Dr. Natheer Al-Rawi
Exam: Lips-palpationExam: Lips-palpation
Color, consistencyColor, consistency Area for blocked minor salivary Area for blocked minor salivary
glandsglands Lesions, ulcersLesions, ulcers
13Dr. Natheer Al-Rawi
Exam: LipsExam: Lips
Frenum:Frenum: AttachmentAttachment Level of attached gingivaLevel of attached gingiva
14Dr. Natheer Al-Rawi
Exam: Lips-sun exposureExam: Lips-sun exposure
15Dr. Natheer Al-Rawi
Exam: LipsExam: Lips
Palpate in the Palpate in the vestibule, observe vestibule, observe colorcolor
16Dr. Natheer Al-Rawi
Examination: Buccal Mucosa
Observe Observe color, character of the mucosa Normal variations in color among ethnic
groups Amalgam tattoo
PalpatePalpate tissue Observe Stenson’s duct opening for
inflammation or signs of blockage Visualize muscle attachments,
hamular notch, pterygomandibular folds 17Dr. Natheer Al-Rawi
Examination: Buccal Examination: Buccal MucosaMucosa
Linea alba Stenson’s duct
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Examination: Buccal Mucosa Lesions – white, red Lichen Planus, Leukedema
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Gingiva
Note color, tone, texture, architecture & mucogingival relationships
20Dr. Natheer Al-Rawi
GingivaGingiva
How would you describe the gingiva?How would you describe the gingiva? Marginal vs. generalized?Marginal vs. generalized? Erythematous vs. fibrousErythematous vs. fibrous
Drug reactions: Anti-epileptic, calcium Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant channel blockers, immunosuppressant
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Exam: Hard palate
Minor salivary glands, attached gingiva
Note presence of tori: tx plan any pre-prosthetic surgery
22Dr. Natheer Al-Rawi
Exam: Soft palate
How does soft palate raise upon “aah”?
Vibrating line, tonsilar pillars, tonsils, oropharynx
23Dr. Natheer Al-Rawi
Exam: Tonsils
Tucked in at base of anterior & posterior tonsilar pillars
24Dr. Natheer Al-Rawi
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
25Dr. Natheer Al-Rawi
Exam: 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
26Dr. Natheer Al-Rawi
Exam: Tongue
27Dr. Natheer Al-Rawi
Exam: Tongue
You may observe lingual varicosities
28Dr. Natheer Al-Rawi
Exam: Tongue
You may observe geographic tongue (erythema migrans)
29Dr. Natheer Al-Rawi
Exam: Tongue
You may observe drug reaction
30Dr. Natheer Al-Rawi
Exam: Tongue
Observe signs of nutritional deficiencies, immune dysfunction
31Dr. Natheer Al-Rawi
Exam: Tongue
You may observe oral cancer
32Dr. Natheer Al-Rawi
Exam: Floor of mouth
Visualize, palpate - bimanuallyVisualize, palpate - bimanually Wharton’s duct Must dry to observe
Does “lesion” wipe off?
33Dr. Natheer Al-Rawi
Palpation of the floor of the mouth
34Dr. Natheer Al-Rawi
Exam: Floor of mouth
35Dr. Natheer Al-Rawi
Exam: Floor of mouthExam: Floor of mouth
Squamous Cell Carcinoma
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Exam: Floor of mouth
Squamous Cell Carcinoma
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Exam: Leukoplakic area
Edentulous Mandibular Ridge
38Dr. Natheer Al-Rawi
Exam: Maxilla & Mandible
• Size, shape, contour
• Pre-prosthetic treatment
•Tori removal
• Tuberosity reduction
•Soft or hard tissue or both
39Dr. Natheer Al-Rawi
Exam: Maxilla & Mandible
40Dr. Natheer Al-Rawi
Exam: Maxilla & MandibleExam: Maxilla & Mandible
Evaluate for Epulis fissuratum
If you make a new denture will the excess tissue resolve?
41Dr. Natheer Al-Rawi
Occlusion
Orthodontic classification
Interferences
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Occlusion
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Systematic Oral Examination Done at initial exam & at recalls
unless patient history requires sooner
You must visualize all areas of the oral cavity
Do good, do not harm, do justice, respect autonomy
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Visualize all areas
45Dr. Natheer Al-Rawi
Watch the vedio
46Dr. Natheer Al-Rawi
Thank You
47Dr. Natheer Al-Rawi
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