summary of Oral Examination station

Summary of Mouth station (learnt in semester 2)

its quite tedious.

you'll need a torchlight.

you'll need a torchlight.

you'll need a torchlight.

(that is how much you need a torchlight)

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to-do list

1. GIEP
2. Wash hands
3. Inspection of the exterior mouth
4. inspection of the vestibules
5. inspection of oral proper
6. inspection of teeth
7. inspection of tongue, tongue maneuver and inspection of mucosa
8. inspection of lingal frenulum
9. inspection of the oropharynx
10. inspection of tonsils
11. check for halitosis, fetor hepaticus etc.
12. report, thank SP, wash hands and leave

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Exterior mouth

• any deformities of lips, and opening of mouth
  (cleft lips, microstoma etc)
• presence/absence of angular stomatitis
• note if there is any scars, swelling, or discolouration.
• discolouration may be cyanosis
• presence/absence of herpes labialis (herpes ulcer on lips)

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Vestibules

(Use Tongue depressor & Torch Light.)

ask patients to pull the lips up and down. either that, use a glove.

• check for any ulcers in the vestibules. most commonly apthous ulcers.
• check the opening of the salivary glands. (Parotid opening is at the opposite of 2nd molar teeth. sublingual and submandibular glands are underneath the tongue)
  Check for presence, any inflammation, blockage etc.
  http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=cm&part=A3627&blobname=ch119f6.jpg

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Oral Proper (use torch light & tongue depressor)

• check for any ulcers.
• check the palates. check for presence of cleft-palate, and rash (SLE) etc.

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Teeth

• Check Dental hygene.
• any extraction of tooth? (predisposes to I.E.)
• count number of teeth. there should be 32.

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tongue

when you check the tongue, do not just check the surface. ask patient to move the tongue left right, up, so as to check all the surface. the leukoplakia may be at the side of the tongue, etc.

• check hydration status
• check for any discolourataion (may be cynosis, or leukoplakia)
• check for swelling / glossitis (vit B12 deficiencies)
• check surfaces for any vegitation. (candida, lichen etc)

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lingal frenulum

This is the place where skin discolouration can be seen most clearly in the mouth.

• check for jaundice, paller and cyanosis.
• check the opening of the submandibular and sublingual salivary glands.
• check for anything else; like leukoplakia or ulcers.

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Oropharynx

ask the patient to say "ah...." while holding the tongue down with the tongue depressor. you should be able to view the back of the throat, the uvula, and tonsils (if inflamed)

• check the back of throat for inflammation (redness, swelling, etc)
• check uvula. is it central?
• check palatine tonsils. is it visible? if so, is it inflamed?

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odours

here, you briefly smell the patient's mouth.

• check for fetor hepaticus - its a sweet, faecal smell. indicating liver failure.

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http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&part=A3627