Intra Oral Examination medium

Intra Oral Examination

• Intra oral examination is part of the general initial patient assessment.
• The examination identifies signs of health and disease in hard and soft tissues of the oral cavity.
• It's used to assess treatment needs and identify concerning symptoms.
• Understanding what is normal for the patient is key to identify what is abnormal.

Intended Learning Outcomes

• Explain the relevance and importance of the intra oral examination.
• Identify important areas of focus in the intra-oral examination.
• Learn techniques and observations for a thorough intra-oral examination.
• Recognize signs of disease/abnormalities in soft and hard tissues.

Intra Oral Examination Components

• Lips: Mucosa, trauma, swelling, color/pigmentation, texture, and any other unusual findings
• Mucosa: Intact mucosa? Trauma? Swelling? Lumps? Color? Pigmentation? Texture?
• Hard & Soft Palates: Refer to separate lecture notes
• Floor of the mouth: Submandibular duct opening on sublingual papilla.
• Tongue: Refer to separate lecture notes
• Vestibules: Space between cheeks and gingiva. Formed by the cheek.
• Fauces: Space between mouth and pharynx. Includes hard and soft palate, uvula, palatine tonsils, and tongue.

What do we Mean by Intra Oral Examinations?

• Part of patient's general initial assessment.
• Carried out to find signs of health or disease in hard and soft oral tissues.
• Identifies treatment needs and assesses symptoms.
• Used to act appropriately based on the findings.

Aphthous Ulcers

• Commonly found on mucous membranes.
• Usually painful and sore.
• Vary in size.
• Typically heal within 14 days.
• Can make oral exams/dental procedures difficult due to discomfort.
• Possible causes include anemia, vitamin deficiencies, etc.

Fordyce Spots

• Harmless, painless.
• Small, yellowish-white spots.
• Found on the inner part of the cheek or lips.

Mucocele

• Harmless, painless.
• A fluid-filled cyst.
• May be caused by a disrupted saliva flow.
• Common locations are lips, cheeks, or tongue.

Buccal Mucosa

• Inside of the mouth; lining of the cheeks.
• Normally smooth, reddish/pink/naturally pigmented.
• Moist.
• Flexible, not rigid.
• Examination should assess color, breaks/tears, lumps/bumps, vessels, and texture. Possible abnormalities include chronic trauma, ulcerative granulomas, aspirin burns, lichen planus, and linea alba.

Hard and Soft Palate

• Refer to the relevant lecture.

Tongue

• Refer to the relevant lecture.
• Normal appearance is a key element when investigating issues with the tongue.

Examining the Tongue

• Use gauze and pull the tongue out, examining its left then right sides;
• Move tongue to roof of mouth to look at underside;
• Gauze prevents accidental swallowing of elements when examining the oral cavity .

Floor of the Mouth

• Contains lingual veins, frenulum, submandibular duct opening, and sublingual folds.
• Check if normal, and report any issues/abnormalities.

Vestibules

• The spaces between cheeks and the gingiva,
• Lateral walls are formed by the cheek.

Fauces

• The space between the mouth and the pharynx.
• Includes hard palate, soft palate, uvula, palatine tonsils, and the tongue.

More Intraoral Assessments to Consider

• Periodontal assessments (including recession, CAL, BPE, bleeding/plaque, furcations, and mobility).
• Further assessments (including plaque and calculus deposits).

Radiographic Assessment for Caries and Periodontal Issues

• Assessing tooth enamel, dentine, restoration margins, pulp, and pathology.
• Checking degree, type, and distribution of bone loss, furcation involvement, and radiolucency at apices.
• Important findings must be documented in reports that are collected during exams.

Treatment Planning

• Prioritize order of treatment (emergency/planned).
• Include prevention strategies.
• Determine need for NSPT or restorative treatment, if needed.
• Refer patient for specialist treatment if needed.
• Assess risk.
• Review the assessment.
• Monitor treatment plan.

Summary

• All patient assessments are considered collectively, not in isolation.
• Assessments include physical exams and verbal discussions.
• All assessments need to be documented.