Intra Oral Examination in Clinical Practice

• The aim is to provide the required information to understand the relevance of the Intra Oral examination in clinical practice.
• By the end of the session students should be able to explain relevance and importance, identify areas of significance, explore techniques/observations/assessments, and recognize signs of disease or abnormalities in the hard and soft tissues.

What is Intra Oral Examination?

• A general initial assessment of the patient
• It identifies signs of health and disease in both hard and soft tissues
• Assess treatment needs and identify any concerning patient signs and symptoms and act accordingly.

Examination Focus Areas

• Lips
• Mucosa
• Hard & soft palates
• Floor of the mouth
• Tongue (including dorsum & lateral borders)
• Vestibules
• Fauces

Examining the Lips

• Check whether the mucosa is intact, trauma, swelling, lumps, color, pigmentation, and texture

Lip Examination Steps

• Wear your gloves
• Stretch the lips upwards and outwards
• Stretch the lips downwards and outwards
• Check for color, breaks/tears, lumps/bumps, and vessels

Apthous Ulcers

• Commonly seen on the mucous membrane
• Usually sore and painful, can vary in size
• Usually heal completely within 14 days
• May make oral examination/dental treatment more challenging due to patient discomfort

Buccal Mucosa

• Inside of the mouth and lining of the cheeks
• A healthy one is normally smooth, reddish/pink, and sometimes naturally pigmented
• Moist and flexible

Examining the Buccal Mucosa

• Check for color, breaks/tears, lumps/bumps, vessels and texture

Hard & Soft Palate

• Refer to the hard and soft palate lecture

Tongue

• Refer to the tongue lecture

Examining the Tongue

• Use gauze to pull the tongue out to the left and the right
• Check the tongue to the roof of the mouth for the underside and use gauze in the process

Floor of the Mouth

Vestibules

• Space between cheeks and gingiva
• Lateral wall is formed by the cheek

Fauces

• Represents the space between the cavity of the mouth and the pharynx

Other Intra-Oral Assessments

• See each lecture independently to gain knowledge on each subject
• Include plaque, gingivae, bleeding, mobility, more intra-oral assessments, periodontal assessment, radiographic, hard tissues - caries & NCTSL, plus caries risk assessment

Periodontal Assessment

• Gingival condition?
• Bleeding when probing?
• Probing depths?
• Classification of Periodontal Disease?
• Suppuration?
• Mobilities

Next steps

• Plaque and calculus deposits should be examined
• Assessments include disclosing, indices, observation, and documenting

Hard Tissues

• Caries
• Intrinsic or extrinsic staining
• Tooth surface loss
• Erosion
• Abrasion
• Attrition

Radiographic Assessment for Caries

• Assess tooth, surface, enamel/dentine
• Then assess primary or secondary
• Find restorations, margins, and leakage
• Assess pulpal distance and or response
• Identify pathology

Radiographic Assessment: Periodontal

• Look for degree of bone loss, and type of bone loss (horizontal/vertical)
• Distribution (generalized or localized)
• Check for furcation involvement and radiolucency at apices

Treatment Planning

• Consider the order of treatment, addressing pain/emergency as a priority
• Prevention
• NSPT/Restorative if required and refer as necessary
• Assess Risk, review and monitor

Summary

• Patient assessments are considered collectively and not in isolation
• Assessments include a physical examination and discussion
• Documentation is required