Examination of Oral Cavity

This is a simplified plan to examine the mouth and the tongue..

The Mouth and the tongue

Tongue

Anterior 2/3
  • Size
  • Shape
  • Papillae
  • No fissures
  • Congenital tie
  • Short ferenulum
  • Ankyloglossia
  • Congenital fissures
  • Geographical tongue
Taste

Corda tempani (facial nerve)

Sensation

Lingual nerve (trigeminal nerve)

Motor

Hypoglossal nerve

Paralyzed tongue deviate to the paralyzed side

Posterior 1/3 Not accessible except mirror or under anaesthesia
Lump (as any swelling)
Ulcer (as any ulcer)

Do not forget examination of cervical lymph nodes

TAKING HISTORY FROM A PATIENT WITH An oral cavity problem

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms Relation to the main complaint

  • Swelling
  • Ulcer
  • Pain
  • Causes of chronic superficial glossitis that predispose malignancy (six Ss)
    • Syphilis, Smoking, Sharp tooth, Spirits, Spices and Sepsis
  • Sequelae of malignancy of the tongue

Spread

Local (posterior 2/3)

Asphyxia

Lymphatic

Lymph nodes enlargement

Infiltration

Lingual artery

Haemorrhage

Lingual nerve

Pain referred to ear

Recurrent laryngeal nerve

Hoarseness of voice

Infection

Halitosis

Pain

Necrosis

Aspiration pneumonia

Ankyloglosia

Dysarthria

Dysphagia

cachexia

Causes of ulceration of the tongue

(Traumatic, Neoplastic, inflammatory, ischemic, autoimmune,..)

  • Aphthous ulcer
  • Trauma (dental)
  • Non-specific glossitis
  • Chancre
  • Gumma
  • TB
  • Carcinoma
  • Lichen planus
  • Herpetic ulcers
Causes of macroglossia
  • Multiple haemangiomata
  • Multiple lymphangiomata
  • Plexiform neurofibromatosis
  • Amyloid infiltration
  • Infiltrating carcinoma
  • Muscle hypertrophy (cretins)
Causes of swelling of the jaw
  • Infection
    • Alveolar (dental) abscess
    • Acute osteomyelitis
    • Actinomycosis
  • Cysts (odontomes)
    • Dental cyst
    • Dentigerous cyst
    • Other odontogenic cysts and cystic tumors
  • Neoplasm
    • Benign
      • Fibrous dysplasia
      • Giant cell granuloma
      • Odontogenic tumors
    • Locally invasive
      • Adamantinoma
    • Malignant
      • Osteogenic sarcoma
      • Malignant lymphoma (Burkitt’s tumor)
      • Secondary tumors (by direct invasion or blood spread)
  • Epulides
    • Fibrous epulis
    • Granulomatous epulis
    • Myeloid epulis
    • Sarcomatous epulis
    • Carcinomatous epulis
Dental Cyst vs. Dentigerous Cyst

Dental cyst

Dentigerous cyst

Adult Young age
In relation to carious tooth In relation to missing tooth
Maxilla Mandible
Incisors and canines Premolars and molars
Unilocular Tooth inside