Mouth assessment

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Parts of the mouth Illu mouth.jpg
Parts of the mouth

A mouth assessment is performed as part of a patient's health assessment. The mouth is the beginning of the digestive system and a substantial part of the respiratory tract. Before an assessment of the mouth, patient is sometimes advised to remove any dentures. The assessment begins with a dental-health questionnaire, including questions about toothache, hoarseness, dysphagia (difficulty swallowing), altered taste or a frequent sore throat, current and previous tobacco use and alcohol consumption and any sores, lesions or bleeding of the gums. [1]

Contents

Lips

Normal lips Mouth.jpg
Normal lips

The lips are normally symmetrical, pink, smooth, and moist. There should be no growths, lumps, or discoloration of the tissue. Abnormal findings are asymmetricality, cyanosis, a cherry-red or pale color or dryness. Diseases include mucocele, aphthous ulcer, angular stomatitis, carcinoma, cleft lip, leukoplakia, herpes simplex and chelitis.

Teeth

Tooth condition indicates a person's general health. [2] Teeth should be clean with no decay, white with shiny enamel and smooth surfaces and edges. Adults should have a total of 32 teeth (16 teeth in each arch). By the age of 2+12, children have a total of 20 deciduous teeth (10 in each arch). Abnormal findings are missing, loose, broken and misaligned teeth. Diseases of the teeth include baby-bottle tooth decay, epulis, meth mouth and Hutchinson's teeth.

Gums

To assess the gums, a tongue depressor gently retracts the cheek to allow inspection of the upper and lower gums. They should appear symmetrical, moist and pinkish, with well-defined margins. Dark-skinned people may have a melanotic line along the gum margin. Abnormal findings include swelling, cyanosis, paleness, dryness, sponginess, bleeding or discoloration. Diseases include leukoplakia, epulis, gingival hyperplasia, gingivitis, periodontitis and aphthous ulcer (canker sore).

Oral mucosa

To check the oral mucosa, the patient's cheek is exposed with a tongue depressor and the tissues inspected with a penlight. Healthy tissue appears moist, smooth, shiny and pink. Stensen's duct is opposite the second molar. Abnormal findings include dryness, cyanosis, paleness and Fordyce spots, and signs of disease include canker sores, Koplik's spots (an early indication of measles), candidiasis and leukoplakia.

Hard palate

The patient tilts their head back and opens their mouth for the hard-palate assessment. Visual inspection with a penlight shows a healthy palate as whitish in color, with a firm texture and irregular transverse rugae. Abnormal findings include yellowness or extreme pallor, and diseases include torus palatinus, cleft palate, submucous cleft palate, High-arched palate, Kaposi's sarcoma and leukoplakia.

Soft palate and uvula

The soft palate is checked with a penlight. It should be light pink, smooth and upwardly movable. To check the uvula, a tongue blade is pressed down on the patient's tongue and the patient is asked to say "ah"; the uvula should look like a pendant in the midline and rise along the soft palate. Abnormal findings include deviation of the uvula from the midline, an asymmetrical rise of the soft palate or uvula and redness of either. Diseases include bifid uvula, cleft palate and carcinoma. If cranial nerve 10 is injured, the soft palate does not rise when the mouth is opened.

Tongue

All sides of the tongue are assessed. To inspect the dorsal side (top) of the tongue, a patient sticks out their tongue. A healthy dorsal tongue is symmetrical, pink, moist, slightly rough from the papillae, possibly with a thin, whitish coating. The sides of the tongue are inspected with a gloved hand holding a piece of gauze. The tongue is moved side to side and inspected; it should be pink, moist, smooth and glistening. Assessment of the ventral (bottom) surface of the tongue is done by having the patient touch the tip of their tongue against the roof of their mouth. If healthy, it should have prominent veins and be pink, smooth, moist, glistening and free of lesions. The frenulum should be centered under the tongue. Abnormal findings includes marked redness, cyanosis or extreme pallor. Diseases include scrotal or fissured tongue, migratory glossitis (geographic tongue), atrophic glossitis, black hairy tongue, caviar lesions, carcinoma, macroglossia, candidiasis, aphthous ulcer and leukoplakia.

Tonsils (if present)

Tonsils diagram.jpg

To assess the tonsils, a patient opens their mouth and a tongue blade is used to depress the tongue. A penlight is used to inspect the back of the patient's throat, looking for pink, symmetrical and normal-size tonsils. Tonsil size is graded as follows:

Abnormal findings include bright-red, enlarged tonsils or white or yellow tonsillar exudate. Tonsillitis is an inflammation of the tonsils.

Special populations

Patients with Down syndrome and cretinism have delayed tooth eruption, and prolonged thumb-sucking may cause problems with mouth growth and tooth alignment. [3] Gingivitis is one of the most prevalent oral problems associated with pregnancy, occurring in 60–75 percent of pregnant women. [4]

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Uvula</span> Fleshy appendage that hangs from the back of the palate

The uvula, also known as the palatine uvula, is a conic projection from the back edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers. It also contains many serous glands, which produce thin saliva. It is only found in humans.

<span class="mw-page-title-main">Mouth ulcer</span> Sore on the mucous membrane of the oral cavity

A mouth ulcer (aphtha) is an ulcer that occurs on the mucous membrane of the oral cavity. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. Rarely, a mouth ulcer that does not heal may be a sign of oral cancer. These ulcers may form individually or multiple ulcers may appear at once. Once formed, an ulcer may be maintained by inflammation and/or secondary infection.

<span class="mw-page-title-main">Soft palate</span> Flexible part of maxilla

The soft palate is, in mammals, the soft tissue constituting the back of the roof of the mouth. The soft palate is part of the palate of the mouth; the other part is the hard palate. The soft palate is distinguished from the hard palate at the front of the mouth in that it does not contain bone.

<span class="mw-page-title-main">Aphthous stomatitis</span> Common condition of mouth ulcers

Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sore is also used, mainly in North America, although it may also refer to other types of mouth ulcers. The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, some food additives, or some hygienic chemical additives like SDS.

<span class="mw-page-title-main">Macroglossia</span> Medical condition

Macroglossia is the medical term for an unusually large tongue. Severe enlargement of the tongue can cause cosmetic and functional difficulties in speaking, eating, swallowing and sleeping. Macroglossia is uncommon, and usually occurs in children. There are many causes. Treatment depends upon the exact cause.

<span class="mw-page-title-main">Stomatitis</span> Medical condition

Stomatitis is inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.

Van der Woude syndrome (VDWS) is a genetic disorder characterized by the combination of lower lip pits, cleft lip with or without cleft palate (CL/P), and cleft palate only (CPO). The frequency of orofacial clefts ranges from 1:1000 to 1:500 births worldwide, and there are more than 400 syndromes that involve CL/P. VWS is distinct from other clefting syndromes due to the combination of cleft lip and palate (CLP) and CPO within the same family. Other features frequently associated with VWS include hypodontia in 10-81% of cases, narrow arched palate, congenital heart disease, heart murmur and cerebral abnormalities, syndactyly of the hands, polythelia, ankyloglossia, and adhesions between the upper and lower gum pads.

<span class="mw-page-title-main">Ankyloglossia</span> Congenital disorder of tongue mobility

Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth.

<span class="mw-page-title-main">Uvulopalatopharyngoplasty</span>

Uvulopalatopharyngoplasty is a surgical procedure or sleep surgery used to remove tissue and/or remodel tissue in the throat. This could be because of sleep issues. Tissues which may typically be removed include:

The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed lamina propria. The oral cavity has sometimes been described as a mirror that reflects the health of the individual. Changes indicative of disease are seen as alterations in the oral mucosa lining the mouth, which can reveal systemic conditions, such as diabetes or vitamin deficiency, or the local effects of chronic tobacco or alcohol use. The oral mucosa tends to heal faster and with less scar formation compared to the skin. The underlying mechanism remains unknown, but research suggests that extracellular vesicles might be involved.

<span class="mw-page-title-main">Veterinary dentistry</span> Branch of veterinary medicine

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

<span class="mw-page-title-main">Head and neck anatomy</span>

This article describes the anatomy of the head and neck of the human body, including the brain, bones, muscles, blood vessels, nerves, glands, nose, mouth, teeth, tongue, and throat.

<span class="mw-page-title-main">Tooth eruption</span> Process in tooth development

Tooth eruption is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligament plays an important role in tooth eruption. The first human teeth to appear, the deciduous (primary) teeth, erupt into the mouth from around 6 months until 2 years of age, in a process known as "teething". These teeth are the only ones in the mouth until a person is about 6 years old creating the primary dentition stage. At that time, the first permanent tooth erupts and begins a time in which there is a combination of primary and permanent teeth, known as the mixed dentition stage, which lasts until the last primary tooth is lost. Then, the remaining permanent teeth erupt into the mouth during the permanent dentition stage.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

<span class="mw-page-title-main">Tongue disease</span> Medical condition

Tongue diseases can be congenital or acquired, and are multiple in number. Considered according to a surgical sieve, some example conditions which can involve the tongue are discussed below. Glossitis is a general term for tongue inflammation, which can have various etiologies, e.g. infection.

<span class="mw-page-title-main">Jaw abnormality</span> Medical condition

A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.

Orofacial Myofunctional Disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.

Oral manifestations of systematic disease are signs and symptoms of disease occurring elsewhere in the body detected in the oral cavity and oral secretions. High blood sugar can be detected by sampling saliva. Saliva sampling may be a non-invasive way to detect changes in the gut microbiome and changes in systemic disease. Another example is tertiary syphilis, where changes to teeth can occur. Syphilis infection can be associated with longitudinal furrows of the tongue.

References

  1. "BPG Oral Health ENG - Oral Health Nursing Assessments and Interventions" (PDF). BPG Oral Health ENG. Retrieved 2015-07-15.
  2. Jarvis, Carolyn (2008). Physical Examination & Health Assessment. 5th edition. ISBN   978-1-4160-3243-4.
  3. "Archived copy" (PDF). Archived from the original (PDF) on 2008-12-03. Retrieved 2009-11-01.{{cite web}}: CS1 maint: archived copy as title (link)
  4. "Archived copy" (PDF). Archived from the original (PDF) on 2009-02-06. Retrieved 2009-11-01.{{cite web}}: CS1 maint: archived copy as title (link)