Oral Examination Techniques
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Questions and Answers

Which anatomical structure should be examined in relation to the retention of saliva in the mouth?

  • Floor of the mouth (correct)
  • Mandibular tori
  • Fungiform papillae
  • Circumvallate papillae

    • What is the recommended technique to inspect the dorsum of the tongue?

  • Protrusion with gauze (correct)
  • Visual inspection without movement
  • Bimanual palpation
  • Lateral movement

    • Ranulas are associated with which gland in the mouth?

  • Parotid gland
  • Minor salivary glands
  • Sublingual gland (correct)
  • Mandibular gland

    • What feature distinguishes the anterior two-thirds of the tongue from the posterior third?

    <p>Presence of papillae</p> Signup and view all the answers

    What is a primary method used to examine the floor of the mouth?

    <p>Bimanual palpation</p> Signup and view all the answers

    Which papillae are predominantly found on the anterior two-thirds of the tongue?

    <p>Filiform papillae</p> Signup and view all the answers

    What are mandibular tori?

    <p>Bony expansions of the mandible</p> Signup and view all the answers

    What is the clinical significance of examining the posterior part of the floor of the mouth?

    <p>Lesions are most easily missed in this area.</p> Signup and view all the answers

    What condition may cause the tongue to deviate towards the affected side upon protrusion?

    <p>Hypoglossal palsy</p> Signup and view all the answers

    What is the term for the elongation of filiform and fungiform papillae on the tongue?

    <p>Hairy tongue</p> Signup and view all the answers

    What is a possible link between fissured tongue and other conditions?

    <p>Melkersson-Rosenthal syndrome</p> Signup and view all the answers

    Which anatomical structure is tightly bound to the mucoperiosteum in the hard palate?

    <p>Gingivae</p> Signup and view all the answers

    Which condition is characterized by the atrophy and desquamation of the dorsal tongue's epidermis?

    <p>Geographic tongue</p> Signup and view all the answers

    What abnormal condition results from the abnormal growth of the tongue?

    <p>Macroglossia</p> Signup and view all the answers

    What might be observed in long-term edentulous patients concerning their tongue?

    <p>Enlarged tongue</p> Signup and view all the answers

    What is the typical appearance of a median rhomboid glossitis lesion?

    <p>Atrophic and erythematous</p> Signup and view all the answers

    What might patients mistakenly believe when they feel a lump distal to the upper molars?

    <p>It is an unerupted tooth</p> Signup and view all the answers

    What should be examined while the patient says 'Aah' during an oral examination?

    <p>The posterior tongue and tonsils</p> Signup and view all the answers

    A bifid uvula may indicate what condition?

    <p>Submucous cleft palate</p> Signup and view all the answers

    What is the normal appearance of healthy gingiva?

    <p>Firm and pale pink with a stippled surface</p> Signup and view all the answers

    How deep should the gingival sulcus normally be?

    <p>0-2 mm</p> Signup and view all the answers

    What may cause a deviation of the uvula to the contralateral side?

    <p>Glossopharyngeal palsy</p> Signup and view all the answers

    What does the term 'keratinized attached gingiva' refer to?

    <p>It is pale pink and well-demarcated from alveolar mucosa</p> Signup and view all the answers

    What should not exceed 1-2 mm when measuring periodontal health?

    <p>Gingival sulcus depth</p> Signup and view all the answers

    What method can be used to measure halitosis by smelling expired air?

    <p>Smelling the expired air 15 cm away from the patient's mouth</p> Signup and view all the answers

    What is a potential systemic cause of xerostomia?

    <p>Dehydration</p> Signup and view all the answers

    Which of the following methods is NOT a chemical method for measuring halitosis?

    <p>Palpation of the tonsils</p> Signup and view all the answers

    In the context of oral examination, which complaint is most relevant to understanding xerostomia?

    <p>Consistency of saliva</p> Signup and view all the answers

    Which technique could be used to determine the location of sialoliths during a physical examination?

    <p>Bimanual palpation</p> Signup and view all the answers

    What is the primary characteristic of pathologic halitosis?

    <p>It originates from intraoral and extraoral pathological conditions.</p> Signup and view all the answers

    Which of the following is a common cause of physiologic halitosis?

    <p>Smoking</p> Signup and view all the answers

    What is halitophobia?

    <p>A condition where a person perceives bad breath that doesn't exist</p> Signup and view all the answers

    Which condition is NOT a cause of oral halitosis?

    <p>Chronic renal insufficiency</p> Signup and view all the answers

    What does the term 'true halitosis' encompass?

    <p>Both physiological and pathological causes</p> Signup and view all the answers

    Which factor can contribute to physiologic halitosis through dehydration?

    <p>Alcohol consumption</p> Signup and view all the answers

    What is the focus of oral evaluation for halitosis?

    <p>Concordance of prosthesis and restoration margins</p> Signup and view all the answers

    Which of the following is a respiratory system disease that can cause halitosis?

    <p>Tuberculosis</p> Signup and view all the answers

    Study Notes

    Examination of the Floor of the Mouth

    • The floor of the mouth is best examined by asking the patient to push their tongue into the palate and then into each cheek.
    • This allows for inspection of the floor of the mouth, a common area for tumor development.
    • The posterior part of the floor of the mouth is the most difficult area to examine and lesions are easily missed.
    • During this examination, assess the quantity and consistency of saliva.
    • Normally, there is a pool of saliva in the floor of the mouth.

    Examination of the Tongue

    • The dorsum of the tongue is best inspected by protrusion, where it can be held with gauze.
    • The anterior two-thirds of the tongue is distinct from the posterior third.
    • The anterior two-thirds contains many filiform and a few fungiform papillae.
    • The posterior third contains several large lymphoid masses (lingual tonsil) and foliate papillae on the lateral borders.
    • A healthy child's tongue is rarely coated, but a mild coating is not uncommon in healthy adults.

    Normal Tongue Structure

    • Fissured (scrotal) tongue is a normal anatomical malformation, but may be related to Melkersson-Rosenthall Syndrome.
    • Varicoceles may be seen on the inferior border of the tongue
    • Ankyloglossy is the abnormal growth of the lingual frenilum and may cause speech disorders.
    • Hairy tongue is the elongation of filiform and fungiform papillae.
    • Geographic tongue (Erythema Migrans) is the atrophy and desquamation of the epidermis of the dorsal tongue.
    • Median Rhomboid glossitis is the loss of papillae anterior to foramen caecum.
    • Generally, these lesions are hereditary.
    • Macroglossia is the abnormal growth of the tongue and may be related to cretinism, mixedema, or acromegaly.
    • Long-term edentulous patients' tongues may enlarge abnormally.

    Examination of Palate and Oropharynx

    • The palate consists of an anterior hard palate and posterior soft palate, the tonsillar area, and oropharynx.
    • The mucosa of the hard palate is firmly bound down as a mucoperiosteum.
    • Anteriorly, ridges (rugae) are present on either side of the incisive papilla.
    • Tori (torus palatinus) are bony lumps located in the posterior center of the vault of the hard palate.
    • Palpation may be used for the examination of the hard palate, but soft palate and posterior areas should not be palpated due to the gagging reflex.

    Examination of Gingiva

    • Healthy gingivae are firm, pale pink, with a stippled surface and sharp gingival papillae reaching between teeth.
    • Look for gingival deformity, redness, swelling, or bleeding on gently probing the gingival margin.
    • The keratinized attached gingivae are normally clearly demarcated from the non-keratinized alveolar mucosa.
    • Bands of tissue (fraenae) run centrally from the labial mucosa onto the alveolar mucosa.
    • Healthy gingival sulcus depth must not exceed 1-2mm.
    • Periodontal attachment loss should be considered for depths greater than 1-2mm.
    • Gingival sulcus depth is measured using a periodontal probe.
    • Mobility of teeth is assessed by taking the tooth between the probe and mirror.

    Elongated Frenulums

    • Elongation of maxillary and mandibular labial frenulums may cause diastema of the anterior teeth and gingival recessing.

    Halitosis (Bad Breath)

    • Halitosis, aka fetor oris, defines the condition of bad smell in the exhaled air.
    • Halitosis may be classified as:
      • True halitosis: may be physiologic or pathologic
      • Pseudo halitosis: the patient is convinced they have bad breath, but don't, and worry about it.
      • Halitophobia: the patient avoids contact with people due to perceived bad breath.

    Causes of Physiologic Halitosis

    • Morning breath originates from the posterior tongue.
    • Alcohol consumption dehydrates tissues and may cause physiologic halitosis
    • Smoking dehydrates tissues and has a specific bad odour.
    • Overconsumption of odourous food like onion and garlic.
    • Overconsumption of foods including protein.
    • Overconsumption of coffee.

    Causes of Pathologic Halitosis

    • Pathologic halitosis cannot be eradicated with usual oral hygiene procedures.
    • It may originate from intraoral and extraoral pathological conditions.
    • Oral Causes of Halitosis (90%)
      • Gingival and periodontal diseases
      • Oral cancers
      • Oropharengeal anomalies
      • Prosthetic problems
      • Dental caries
      • Tartars
      • Xerostomia
      • Accumulation of debris on tongue
      • Chronic tonsil diseases
      • Postnasal flow (sinusitis)
      • Nasal obstruction
    • Extraoral causes of Halitosis
      • Respiratory system diseases (Lung Ca, Tuberculosis etc.)
      • Foreign bodies inside the respiratory tract
      • Gastrointestinal diseases (eusophagus and stomach ca, foreign bodies inside eusophagus, gastritis etc.)
      • Chronic Renal Insufficiency
      • Hematological Diseases
      • Malignities
      • Trimetilaminuria
      • Infectious mononucleosis etc.

    Evaluation of Halitosis

    • Anamnesis:
      • Patient must be with a friend or someone who knows the patient for subjective evaluation.
      • Oral hygiene habits must be learned.
      • Systemic anamnesis and drugs that the patient uses must be known.
    • Physical evaluation:
      • Concordance of prosthesis and restoration margins must be evaluated
      • Dental caries existence and periodontal health situation must be assessed
      • Margins of mobile prosthesis must be evaluated
      • Oral mucosa and tongue evaluation

    Measurement of Halitosis

    • Organoleptic Method:
      • Smelling the expired air 15 cm away from the patient's mouth.
      • Spreading the saliva to a petri box and smell after incubation.
      • The patient may lick his/her wrist and subsequently, when the licked place dries, the place may be smelled.
    • Chemical Methods:
      • Gas chromatography
      • Halimeter
      • Odour sensors
      • BANA test

    Xerostomia (Dry Mouth)

    • Xerostomia may have local or systemic causes.
    • Obliteration of the orifice of the parotid gland is not usually sufficient for the formation of xerostomia.

    Causes of Xerostomia

    • Congenital:
      • Hipoplasia or Aplasia of Salivary Glands
    • Infections of Salivary Glands:
      • Epidemic Parotitis, Tuberculosis etc.
    • Dehydratation
    • Sjögren and Mikulicz Syndromes
    • Neoplasms
    • Emotional Disorders
    • Obliteration of salivary gland canals or orifices
    • Central Nervous System Diseases
    • Drugs:
      • Anticolinergics, opiums, ergotamine, sempatomimetics
    • Atrophy of glands:
      • Age related, radiotherapy related
    • Vitamin deficiencies
    • Diabetes
    • Anemia
    • Menopause

    Evaluation of Xerostomia

    • Anamnesis:
      • Complaint of the patient, duration of complaint, consistency of saliva, taste alterations, systemic condition, drug use.
    • Physical Examination:
      • Amount and viscosity of saliva, pus discharge.
      • If evident, bimanual palpation is used to determine the location and count of sialoliths.
      • If evident, palpation of masses.

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    Description

    This quiz covers essential techniques for examining the floor of the mouth and the tongue. Learn how to properly inspect these areas for any abnormalities and understand their anatomical differences. It's crucial for identifying potential health issues in patients.

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