Mouth and Oropharynx

Parts:

Mouth and OropharynxAre composed of a number of structures: Lips, inner and buccal mucosa, the tongue and floor of the mouth, teeth and gums, hard and soft palate, uvula, salivary glands, tonsillar pillars, and tonsils.

By age of 25 most of people have all their permanent teeth.

Assessing the mouth and oropharynxPLANNINGArrange for the client to sit with the head against a firm surface such as a headrest or examination table.

Equipment:Clean GlovesTongue Depressor2x2 gauze padpenlight

ImplementationPerformanceIntroduce self and verify the clients identity using agency protocol. Explain the procedure.Hand HygieneProvide PrivacyHistory of routine pattern of dental care, last visit to dentist; length of time ulcers or other lesions have been present; denture discomfort; medication client is receiving.Position in comfortable position; seated if possible.

Assessment:Lips and Buccal Mucosa

Normal FindingsDeviation from normal6. InspectSymmetry of contourColorTextureAsk to purse lips as if to whistleUniform pink colorSoft, moist, smooth textureSymmetry of contourAbility to purse lipsPallor, cyanosisBlisters, generalized and localized swelling; fissures, crusts or scalesInability to purse lips7.Inspect and palpate (inner lips and buccal mucosa for color, moisture, texture and the presence of lesions)Uniform pink colorMoist, smooth, smooth, glistening, and elastic texturePallor; leukoplakia(white patches, red, bleedingExcessive drynessMucosal cysts; irritations from dentures;abrassions, ulceration; nodules

Apply clean glovesAsk the client to relax the mouth, and for better visualization, pull the lip outward and away from the teethGrasp the lip on each side between the thumb and index fingerPalpate any lesion for size, tenderness and consistencyInspect the front teeth and gums

Teeth and Gums

8. Inspect the teeth and gums while examining the inner lips and buccal mucosa32 adult teethSmooth, white, shiny tooth enamelPink gumsMoist, firm texture to gumsNo retraction of gumsMissing teeth; ill fitting denturesBrown or black discoloration of the enamelExcessive red gumsSpongy texture; bleeding, tendernessReceding atrophies gums; swelling that partially cover the teeth

*Ask the client to open the mouthUsing the tongue depressor, retract the cheek. View the buccal mucosa from top to bottom and back to front. Use penlight to illuminate the surface. Repeat to the other side*Using penlight to assist visualization, move a finger along the cheek. Another finger may be moved outside the cheek.*Examine the back of the teeth*Inspect the gums around the molars. Check the for bleeding, color and retraction, edema and lesions.*assess the texture of the gums.

9. Inspect for denturesSmooth and intact denturesIll-fitting dentures; irritated and excoriated area under dentures

Tongue/Floor of the mouth

10. Inspect the surface of the tongue for position, color, and texture. ask the client to protrude the tongue.Central positonPink colorMoist, slightly rough; thin and whitish coatingSmooth, lateral margins; no lesionsRaised papillae(taste buds)Deviated from center damage CN VII (hypoglossal)Excessive tremblingSmooth, red tongue (may indicate iron, vit B12 or vit B3 deficiency)Dry and furry tongueNodes, ulceration, discolorations; areas of tenderness

11.Inspect tongue movementAsk the client to roll the tongue upward and move it side to sideMoves freely; no tendernessRestricted mobility

12. Inspect the base of the tongue and, the mouth floor and the frenulumAsk the client to place the tip of the tongue against the roof of the mouthSmooth tongue base with prominent veinsSwelling and ulceration

14. Palpate the tongue and floor of the mouth for any nodules, lumps, or excoriated areasUse a piece of gauze and grasp the tip with the other hand use the index finger palpate the back of the tongue, its border and baseSmooth and palpable nodulesSwelling and nodules

Salivary gland

14. Insect salivary duct openings for any swelling or rednessSame color of buccal mucosa and floor mouth.Inflammation(redness and swelling

Palates and Uvula

15. Inspect the hard and soft palate for color, shape, texture, and presence of bony prominencesLight pink, smooth, soft palateLighter pink hard palate, more irregular textureDiscolorationPalate same colorIrritationExosomes(bony growth) growing from the hard palate

Open the mouth wide and tilt the head backward. Then, depress the tongue using tongue depressor. Use penlight for appropriate visualization

16. Inspect the uvula position and the mobility while examining the palatesPositioned in midline of soft palateDeviation to one side from tumor or trauma; immobility ( cn #5 trigeminal or cn #10 vagus )

Oropharynx and Tonsils

17. Inspect the oropharynx for the color and texture. One side at a time to avoid eliciting gag reflex.Pink and smooth posterior wallReddened or edematous; presence of lesions, plaque or drainage

To expose the one side of the oropharynx, press a tongue depressor against the tongue on the same side.

18. Inspect the tonsils ( behind the fauces ) for color, discharge, and size,Pink and smoothNo dischargeOf normal size or not visibleGrade 1 (normal):The tonsils are behind the tonsillar pillarsInflamedPresence of dischargeSwollenGrade 2Grade 3Grade 4

19. Elicit gag reflexes by pressing the posterior tongue with tongue depressorPresentAbsent may indicate problems with glossopharyngeal (CN#9) or Vagus (CN#10) nerves

20.DOCUMENT FINDINGS

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