The ability to perform a thorough physical examination of the superficial structures of the head, neck, and oral cavity is essential for all dentists and any clinician involved in diagnosing and treating oral disease. This examination should be carried out on all new dental patients and repeated at least yearly on patients of record. To perform this examination procedure successfully, the examiner needs the following:
1. Adequate knowledge of the anatomy of the region to be able to recognize normal structures and their common variations
2. A well-practiced technique for displaying all of the skin and mucosal surfaces of the head, neck, and oral cavity with minimal discomfort to the patient and a routinethat ensures the systematic examination of all the tissues that can be approached in this way
3. Knowledge of the variety of disease processes that can affect the superficial structures of the head, neck, and oral cavity
4. The ability to succinctly record (in writing) both normal and abnormal findings noted during the examination
1. Adequate knowledge of the anatomy of the region to be able to recognize normal structures and their common variations
2. A well-practiced technique for displaying all of the skin and mucosal surfaces of the head, neck, and oral cavity with minimal discomfort to the patient and a routinethat ensures the systematic examination of all the tissues that can be approached in this way
3. Knowledge of the variety of disease processes that can affect the superficial structures of the head, neck, and oral cavity
4. The ability to succinctly record (in writing) both normal and abnormal findings noted during the examination
The order of examination is a matter of individual choice, but an established and reproducible routine is desirable. Ideally, necessary intraoral and bite-wing radiography should be available when the systematic examination of the oral cavity is carried out. Examination gloves, tongue blades or dental hand mirrors, a dental explorer and periodontal probe, gauze pads, a dental chair, a lamp or flashlight (for illuminating the oral cavity), and a stethoscope are the basic equipment needed.
The examination routine encompasses the following eight steps:
1. Note the general appearance of the individual and evaluate emotional reactions and the general nutritional state. Record the character of the skin and the presence of petechiae or eruptions, as well as the texture, distribution, and quality of the hair. Examine the conjunctivae and skin for petechiae, and examine the sclerae and skin for evidence of jaundice or pallor. Determine the reaction of the pupils to light and accommodation, especially when neurologic disorders are being investigated.
2. Palpate for adenopathy. The superficial and the deep lymph nodes of the neck are best examined from behind the patient, with the patients’s head inclined forward sufficiently to relax the tissues overlying the lymph nodes. Look for distention of the superficial veins as well as for evidence of thyroid enlargement (see also the section on neck and lymphnodes). Palpate any swellings, nodules, or suspected anatomic abnormalities.
3. Examine in sequence the inner surfaces of the lips, the mucosa of the checks, the maxillary and mandibular mucobuccal folds, the palate, the tongue, the sublingual space, the gingivae, and then the teeth and their supporting structures. Last, examine the tonsillar and the pharyngeal areas and any lesion, particularly if the lesion is painful. Any noted asymmetry should be investigated further.
4. Completely visualize the smooth mucosal surfaces of the lips, cheeks, tongue, and sublingual space by using two tongue depressors or mirrors. Perform a more detailed examination of the teeth and supporting tissues with the mouth mirror, the explorer, and the periodontal probe.
5. Have the patient extend the tongue for examination of the dorsum; then have the patient raise the tongue to the palate to permit good visualization of the sublingual space. The patient should extend the tongue forcibly out to the right and left sides of the mouth to permit good visualization of the sublingual space and to permit careful examination of the left and right margins. A piece of gauze wrapped lightly around the tip of the tongue helps when manually moving the patient’s tongue. Examine the tonsillar fossae and the oropharynx.
6. Use bimanual or bi-digital palpation for examination of the tongue, cheeks, floor of the mouth, and salivary glands. Palpation is also useful for determining the degree of tooth movement. Two resistant instruments, such as mirror handles or tongue depressors, placed on the buccal and lingual surfaces of the tooth furnish more accurate information than when fingers alone are directly employed.
7. Examine the teeth for dental caries, occlusal relations, possible prematurities, inadequate contact areas or restorations, evidence of food impaction, gingivitis, periodontal disease, and fistulae.
8. After the general examination of the oral cavity has been completed, make a detailed study of the lesion or the area involved in the chief complaint.
A list of normal anatomic structures that may be identified by superficial examination of the head, neck, and oral cavity is provided in Table 2-6. No attempt is made to identify each
The examination routine encompasses the following eight steps:
1. Note the general appearance of the individual and evaluate emotional reactions and the general nutritional state. Record the character of the skin and the presence of petechiae or eruptions, as well as the texture, distribution, and quality of the hair. Examine the conjunctivae and skin for petechiae, and examine the sclerae and skin for evidence of jaundice or pallor. Determine the reaction of the pupils to light and accommodation, especially when neurologic disorders are being investigated.
2. Palpate for adenopathy. The superficial and the deep lymph nodes of the neck are best examined from behind the patient, with the patients’s head inclined forward sufficiently to relax the tissues overlying the lymph nodes. Look for distention of the superficial veins as well as for evidence of thyroid enlargement (see also the section on neck and lymphnodes). Palpate any swellings, nodules, or suspected anatomic abnormalities.
3. Examine in sequence the inner surfaces of the lips, the mucosa of the checks, the maxillary and mandibular mucobuccal folds, the palate, the tongue, the sublingual space, the gingivae, and then the teeth and their supporting structures. Last, examine the tonsillar and the pharyngeal areas and any lesion, particularly if the lesion is painful. Any noted asymmetry should be investigated further.
4. Completely visualize the smooth mucosal surfaces of the lips, cheeks, tongue, and sublingual space by using two tongue depressors or mirrors. Perform a more detailed examination of the teeth and supporting tissues with the mouth mirror, the explorer, and the periodontal probe.
5. Have the patient extend the tongue for examination of the dorsum; then have the patient raise the tongue to the palate to permit good visualization of the sublingual space. The patient should extend the tongue forcibly out to the right and left sides of the mouth to permit good visualization of the sublingual space and to permit careful examination of the left and right margins. A piece of gauze wrapped lightly around the tip of the tongue helps when manually moving the patient’s tongue. Examine the tonsillar fossae and the oropharynx.
6. Use bimanual or bi-digital palpation for examination of the tongue, cheeks, floor of the mouth, and salivary glands. Palpation is also useful for determining the degree of tooth movement. Two resistant instruments, such as mirror handles or tongue depressors, placed on the buccal and lingual surfaces of the tooth furnish more accurate information than when fingers alone are directly employed.
7. Examine the teeth for dental caries, occlusal relations, possible prematurities, inadequate contact areas or restorations, evidence of food impaction, gingivitis, periodontal disease, and fistulae.
8. After the general examination of the oral cavity has been completed, make a detailed study of the lesion or the area involved in the chief complaint.
A list of normal anatomic structures that may be identified by superficial examination of the head, neck, and oral cavity is provided in Table 2-6. No attempt is made to identify each
structure during a routine head and neck examination. However, the ability to recognize all of these structures is basic to performing a physical examination of this region in which asymmetries, swellings, discolorations, changes in texture, and tender areas may have to be differentiated from normal structures. Abnormalities that should be specifically sought and noted are discussed below, under the specific regions covered by the oral examination.