11/13/24, 7\:07 PM Guide | Oral cavity examination

Oral cavity examination

Table of contents
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Gather equipment

Headtorch or pen torch
Tongue depressors (x2)

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
Gain consent to proceed with the examination.
Ask the patient to sit on a chair.
If the patient has any dentures or implants, ask them to remove them for the assessment.
Check if the patient currently has any pain before proceeding with the clinical examination.

General inspection

Inspect the patient's face for swelling\:
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Parotid gland swelling\: causes loss of the angle of the jaw and a hamster-like appearance of the cheek on the a
Submandibular gland swelling\: apparent below and anterior to the angle of the mandible.
General inspection

Closer inspection

Ask the patient to open their mouth and inspect the oral cavity using your light source. Note if the patient has di
their mouth due to pain, suggesting the presence of trismus.

Lips

With the patient's mouth open, use your light source to inspect the lips for abnormalities such as\:
Angular stomatitis\: a common in
including iron de
Hyperpigmented macules\: pathognomonic for Peutz-Jeghers syndrome, an autosomal dominant genetic disorder that
results in the development of polyps in the gastrointestinal tract.
Ulceration\: may be secondary to trauma, infections (e.g. herpes simplex) or rarely malignancy.
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Inspect the lips

Tongue

Ask the patient to stick out their tongue and inspect for abnormalities such as\:
Oral candidiasis\: a fungal infection commonly associated with immunosuppression. It is characterised by
pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.
Glossitis\: smooth erythematous enlargement of the tongue associated with iron, B12 and folate de
malabsorption secondary to in
Ulceration\: may be secondary to trauma, infections (e.g. herpes simplex) or rarely malignancy.
Hairy leukoplakia\: a white patch on the side of the tongue with a hairy appearance associated with Epstein-Barr virus
infection in immunocompromised patients.
Inspect the tongue
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Teeth and gums

Using two tongue depressors inspect the teeth and gums.
Teeth
Inspect the teeth for abnormalities\:
Missing teeth\: may be secondary to infection or trauma.
Nicotine staining\: present in patients who smoke (a signi
Tooth decay\: indicative of poor oral hygiene.
Gums
Inspect the gums for abnormalities\:
Gingivitis\: in
leukaemia.
Periodontitis\: can develop if gingivitis is left untreated and involves in
can ultimately lead to the formation of peridontal abscesses and tooth loss.
Ulceration\: may be secondary to trauma, infections (e.g. herpes simplex) or rarely malignancy.
Inspect the teeth

Buccal mucosa and parotid duct

Using one tongue depressor move the tongue to either side and inspect the buccal mucosa and parotid duct.
Buccal mucosa
Inspect the buccal mucosa for abnormalities\:
Aphthous ulcers\: benign, non-contagious, erythematous, painful small, round oral ulcers with circumscribed margins. Their
aetiology is unclear and likely multifactorial.
Other ulcers\: if an ulcer has been present for more than 7-10 days, malignancy should be considered.
Leukoplakia\: non-painful white patch or plaque on the oral mucosa. Leukoplakia can undergo malignant transformation and
is strongly associated with smoking.
Parotid duct
Inspect the parotid duct for abnormalities\:
Parotid gland sialolithiasis\: a calci
prominence of the duct.
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Parotid gland sialoadenitis\: infection of the parotid gland, typically secondary to sialolithiasis but other causes include viral
infections (e.g. mumps). There may be erythema around the duct and visible discharge.
Pleomorphic adenoma\: the most common type of tumour a
solitary, slow-growing, painless,
Inspect the buccal mucosa (1/2)
Parotid gland
The parotid glands are the largest salivary glands and are located posterolaterally to the mandibular ramus
(bilaterally). On each side of the face, the parotid duct pierces the buccinator muscle and opens into the oral cavity
through the buccal mucosa, opposite the maxillary second molar.

Back of the mouth

Ask the patient to relax their tongue and cheeks to remove muscular tension.
Using one tongue depressor, gently depress the tongue and inspect the back of the mouth.
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Inspect the back of the mouth (1/2)
Palate and uvula
Inspect the palate and uvula for abnormalities such as\:
Oral candidiasis\: a fungal infection commonly associated with immunosuppression. It is characterised by
pseudomembranous white slough which can be easily wiped away to reveal underlying erythematous mucosa.
Ulceration\: may be secondary to trauma, infections (e.g. herpes simplex) or rarely malignancy.
Papillomas\: tumours derived from epithelium, that appear as cauli
palate and uvula. They are associated with human papillomavirus (HPV) infection.
Aphthous ulcer [13]
Palate and uvula anatomy
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The palate forms the roof of the mouth and separates the nasal cavity from the oral cavity. It can be further sub-divided
into the\:
Hard palate\: the immobile portion of the palate comprised of bone.
Soft palate\: the mobile portion of the palate comprised of muscle
palate elevates during swallowing to prevent a food bolus from entering the nasopharynx.
The uvula is a
positioned in the midline of the palate.
Tonsils, pharyngeal arches and uvula
Inspect the tonsils for abnormalities\:
Enlargement\: most often due to infection (tonsilitis), in which case there is also erythema and often exudate. Tonsillar
enlargement may also be a chronic condition (e.g. tonsillar hypertrophy).
Asymmetry\: tonsilitis can cause asymmetrical tonsillar swelling, however other causes of unilateral tonsillar swelling include
tonsillar stones and malignancy.
Tonsillar ulceration\: may be caused by viral infections (e.g. herpes simplex), however, malignancy should also be
considered.
Tonsillar stones\: caused by mineralisation of debris trapped within the tonsils. The stones may be visible on inspection of
the tonsils and are usually asymptomatic.
Inspect the pharyngeal arches for abnormalities\:
Peritonsillar swelling\: typically caused by a peritonsillar abscess (quinsy), in which pus is trapped between the tonsillar
capsule and the lateral pharyngeal wall.
Pharyngitis\: in
Inspect the uvula for abnormalities\:
Uvula deviation\: may be caused by a peritonsillar abscess, with the uvula deviating away from the abscess. A vagus nerve
lesion can also cause uvula deviation away from the side of the lesion. If there are no other symptoms or signs, uvula
deviation is likely a normal
Pharyngitis [14]
Tonsilar anatomy
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The palatine tonsils are located at the right and left sides of the back of the throat between the palatoglossal and
palatopharyngeal arches of the soft palate. The palatoglossal arch is also known as the anterior tonsillar pillar and the
palatopharyngeal arch is also known as the posterior tonsillar pillar. The tonsils appear as pinkish lumps and play an
important role in immunity.

Floor of the mouth

Ask the patient to lift their tongue to the roof of their mouth and assess the
Submandibular gland sialolithiasis\: a calci
and increased prominence of the duct. There may be erythema around the duct and visible discharge.
Submandibular gland sialoadenitis\: infection of the submandibular gland, typically secondary to sialolithiasis but other
causes include viral infections (e.g. mumps). There may be erythema around the duct and visible discharge.
Ulceration\: may be secondary to trauma, infections (e.g. herpes simplex) or rarely malignancy.
Inspect the
Submandibular and sublingual glands
The paired submandibular glands are located on the
glands are responsible for the majority of salivary duct calculi, possibly due to the torturous uphill course of the
submandibular gland's duct. The submandibular gland's ducts open out on either side of the lingual frenulum as small
prominences known as sublingual caruncles.
The paired sublingual glands are also located on the
responsible for producing saliva. The glands are drained by 8-20 ducts known as the ducts of Rivinus. The largest
sublingual duct joins the submandibular duct to drain through the same sublingual caruncle. The rest of the ducts open
into the mouth on an elevated region of mucous membrane known as the plica sublingualis.

Palpation

If permitted by the patient and examiner, proceed to bimanual palpation of the mouth.
Don some non-sterile gloves (if not already wearing some).
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Bimanual palpation of the mouth

1. With one
lumps from both sides.
2. Palpate the lateral walls of the mouth to assess the parotid gland and duct.
3. Palpate the
Any intraoral swelling should be described according to its site, size, thickness, colour, texture, consistency and tenderness.
Don gloves (if not already wearing)

To complete the examination...

Explain to the patient that the examination is now
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.
Summarise your
Example summary
" T o d a y I p e r f o r m e d a n e x a m i n a t i o n o f t h e o r a l c a v i t y o n M r S m i t h , s u b m a n d i b u l a r s w e l l i n g.
"
a 3 0- y e a r-o l d m a l e w h o p r e s e n t e d w i t h a
" O n i n s p e c t i o n , d e n t i t i o n w a s n o r m a l a n d a s m a l l , e r y t h e m a t o u s s w e l l i n g w a s n o t e d o n t h e
l i n g u a l f r e n u l u m . O n b i m a n u a l p a l p a t i o n , t h e l u m p w a s h a r d a n d n o n-t e n d e r . These
salivary duct stone.
"
“ F o r c o m p l e t e n e s s , I w o u l d l i k e t o p e r f o r m t h e f o l l o w i n g f u r t h e r a s s e s s m e n t s a n d i n v e s t i g a t i o n s.
”

Further assessments and investigations

Examination of the neck, ears and temporomandibular joint.
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Flexible nasal endoscopy\: to visualise the oropharynx.
Orthopantomogram\: to further assess dental pathology.
Ultrasound neck +/-
CT and MRI\: to image the oral cavity and neck +/- chest if cancer is suspected (according to local guidelines)
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