Mouth, Nose, Throat: Development and Health History

Developmental Considerations - Infants and Children

• Children have 20 temporary teeth compared to adults who have 32
• Temporary teeth are lost starting at age 6 until about age 12

Developmental Considerations - Aging

• Nasal hair becomes coarser, potentially reducing air filtration and decreasing the sense of smell
• Loss of taste sensitivity can occur due to soft tissue atrophy
• Salivary secretion decreases with age
• Tooth surfaces can become worn with age
• Gums recede and erode
• Poor oral hygiene leads to tooth loss and difficulty in chewing
• Medications may have anticholinergic effects, further reducing salivation

Health History

• Rhinorrhea can indicate a cold, allergies, sinus infection or trauma
• Frequent colds can indicate immunosuppression
• Epistaxis can occur with trauma or due to irritants
• Allergies can effect the nose, mouth or throat
• Sores or lesions in the mouth or oral cavity may indicate malignancy
• Sore throats can be bacterial or viral
• Strep throat can lead to rheumatic fever
• It is important to determine if the tonsils are still in place
• Bleeding gums can indicate poor oral hygiene
• Voice changes can indicate health issues
• Dysphagia may be caused by GERD, pharyngitis, neurologic diseases, or cancer

Assessing the Nose - External Nose

• A normal nose appears symmetric, midline, and proportional
• Obstruction is assessed by blocking each nostril and having the person inhale

Assessing the Nose - Nasal Cavity

• Use an otoscope to view the nasal vestibule
• Normal nasal mucosa is pink, smooth, and moist
• Abnormalities include bleeding, swelling, redness, or discharge
• Rhinitis involves swollen, red mucosa, often with watery, thick, purulent, or green discharge due to an upper respiratory infection
• A deviated septum is significant if it obstructs airflow
• Observe turbinates for polyps, which are benign, smooth, gray, avascular, mobile, and nontender growths

Assessing the Sinuses

• Palpate the frontal and maxillary sinuses
• Tenderness indicates sinusitis or allergies
• Transillumination is done by placing a pen light under the superior orbital ridge in a darkened room
• Clear sinuses should transilluminate

Assessing the Lips

• Black people normally have bluish lips
• Bluish lips in light-skinned individuals indicate hypoxemia or hypothermia
• Pallor suggests anemia or shock
• Cherry red lips indicate CO poisoning or acidosis
• Angular cheilitis is inflammation at the corners of the mouth, often caused by candida infection
• Herpes simplex virus manifests as vesicles or pustules being highly contagious, mostly HSV-1 or possibly HSV-2
• Carcinoma appears mostly crusted or ulcerated

Assessing Teeth

• Normal teeth appear white, straight, and free of decay
• Upper molars should align with lower molars
• Upper incisors should slightly overlap lower incisors
• Yellowing can result from tobacco use
• Malocclusion denotes misalignment of upper and lower teeth
• Dental caries or tooth decay results from bacteria producing acids that destroy enamel

Assessing Gums

• Normal gums appear pink with well-defined margins between teeth
• Gingival hyperplasia is the enlargement of gums with possible SA of Dilantin
• Gingivitis involves redness, swelling, or bleeding caused by anaerobic bacteria due to poor hygiene or vitamin C deficiency
• Periodontitis, the result of untreated gingivitis, involves the absorption of bone

Assessing the Tongue

• Normal tongue is pink with a roughened dorsal surface and moist underneath
• Inspection involves holding the tongue with a cotton gauze pad while moving it side to side

Tongue Abnormalities

• Macroglossia indicates an enlarged tongue
• Macroglossia occurs in Down syndrome, acromegaly, cretinism, and myxedema
• A fissured tongue is congenital and benign, but can be caused by dehydration
• Candidiasis presents as a white, cheesy patch on the buccal mucosa or tongue
• Candidiasis occurs after antibiotic or steroid use, and with immunosuppression (AIDS)
• Atrophic glossitis (glossy tongue) has a smooth, shiny, burning surface related to pernicious anemia (vit B12 deficiency), folic acid deficiency, and iron deficiency anemia
• Black hairy tongue is often caused by fungal infection, usually due to prolonged antibiotic use
• Carcinoma can occur underneath the tongue

Assessing the Buccal Mucosa

• Normal mucosa is pink, smooth, and moist
• Inspect with light and tongue blade
• Note Stensen's ducts (parotid gland openings)
• Stensen's ducts appear inflamed and red with mumps
• Koplik's spots are a prodromal sign of measles
• Fruity breath odor may indicate ketoacidosis

Assessing the Palate

• The anterior hard palate is normally filled with irregular transverse rugae
• The anterior hard palate may appear yellow with jaundice in whites and yellow-brown in blacks
• The posterior soft palate is pinker, smooth, and upward movable
• The posterior soft palate contains the uvula
• The CN X (vagus nerve) reflex is checked by having the person say "ahhhh" which should make the uvula move

Palate Abnormalities

• Cleft palate is a congenital defect due to failure of the maxillary process to fuse
• Cleft palate causes a gap in the hard palate and the upper lip
• Cleft palate requires surgery

Assessing the Tonsils

• Normal tonsils are pink, barely visible on the sides of the mouth
• Inspection involves depressing the tongue with a tongue blade
• During an upper respiratory infection, the tonsils become bright red, swollen, and may contain exudate or white spots
• 1+ tonsils are visible
• 2+ tonsils are inflamed
• 3+ tonsils touching uvula
• 4+ tonsils touching each other