OBJECTIVE EXAMINATION

 Clinical examination — extra-oral

Symmetry and Profile
 Cutaneous Area
Cutaneous lesion of discoid lup

Lupus erythematosus
 Eyes

Observe the eyes for any

abnormalities

Yellow sclera is associated with jaundice and may

indicate an undiagnosed case of hepatitis (A or B),
other liver dysfunction or a blood disorder
Lymphatic nodes
The presence of neck masses is not
an uncommon finding, especially in
patients with oral infections or
advanced malignancies. The anterior
cervical chain is most commonly
involved, although other regional
lymph nodes may be enlarged as
well. Lymphadenopathy secondary to
infection generally is both mobile
and tender, while metastatic
lymphadenopathy is asymptomatic
and fixed to the underlying
structures; however, a significant
amount of variation exists in both
subjective and objective findings.
 Palpation of Lymph Nodes

Occipital nodes.
.Palpate the occipital nodes
about one inch above and
below the hairline.

Bilateral palpation of the occipital

nodes. Be sure to also observe the
skin in this area.
Auricular . Palpate the pre and post auricular nodes bilaterally
using the pads of the index, middle and ring fingers.

Postauricular nodes.

Pre-auricular nodes.
Cervical Chain. Palpate the nodes medial to the sternocleidomastoid muscle
using a bidigital technique and the nodes posterior to the muscle with a
bimanual technique.

Palpation of the anterior

cervical nodes.

Palpation of the posterior

cervical nodes
Supraclavicular. These nodes are examined using
digital compressions just superior to the clavicle.

Bilateral palpation of the supraclavicular

lymph nodes.
 Submandibular lymphatic nodes.
Palpate the submandibular
nodes by pulling or rolling the
tissues under the chin up and
over the inferior border of the
mandible. Ask the
patient to touch the roof of the
mouth with the tongue,
pressing firming against the
roof will allow you to assess
the muscles and any pathology
associated with the
Palpate the submandibular
submandibular lymph node
lymph nodes using a cupped
hand as shown.
areas.
 Submental lymphatic nodes.
Use digital palpation to determine the presence of an
abnormal submental lymph node.

Digital palpation of the submental lymph nodes

 Salivary glands

Palpation of parotid gland

(superficial lobe)
 Palpation of the submandibular glands.

Normally these glands should not be palpable. Induration and pain could be
signs of infection, blockage, immune system disorder or a neoplastic process.
In addition, non-tender parotid enlargement may occur with alcoholism,
diabetes, Sjogren’s syndrome, eating disorders, HIV infection and various
malignant/non-malignant states.
 TMJ

 Palpate upon opening

 What is the maximum intermaxillary space?
 Is the opening symmetrical?

 Is there popping, clicking, grinding?

 What do these sounds tell you about the anatomy of
the joint?
 When do sounds occur?

 Use your stethoscope to listen to sounds

 TMJ
Proper positioning of the fingers on Have the patient open and close
the TM joint. slowly

Crepitation, clicking, and popping of the temporomandibular joints are most

easily detected by placing the tips of the little fingers in the external auditory
canals and having the patient perform a series of excursive mandibular
movements
Lips
Bidigital palpation of the
upper and lower labial
mucosa
Exam: Lips-sun exposure
 ORAL EXAMINATION

examination of vestibule
of oral cavity
examination of oral
cavity itself
 Examination of lips’ frenum: its
attachment and level of attached gingiva
 Maxillary labial vestibule
showing frenulum

Mandibular labial
vestibule

Vestibule of oral cavity—the region between the lips and cheeks and the
teeth. The fold of tissue created by the vestibule between the lip and
teeth is called the vestibular or mucolabial (mucobuccal) fold
Occlusion
 Orthodontic
classification
 Interferences
Occlusion

Determination of occlusion
 Gingiva
Bidigital palpation of attached
gingiva and muccolabial fold.

Normal condition of alveolar

mucosa, gums tightly overlaps
tooth’ neck
Gingiva
 Note color, tone,
texture, architecture &
mucogingival
relationships
Gingiva
 How would you describe the gingiva?
 Marginal vs. generalized?
 Erythematous vs. fibrous
 Drug reactions: Anti-epileptic, calcium channel
blockers, immunosuppressant
 Soft tissues

Orifice of Stenson duct

Linea alba on the buccal

mucosa
Examination: Buccal Mucosa
 Linea alba
 Stenson’s duct
Examination: Buccal Mucosa
 Lesions – white, red
 Lichen Planus, Leukedema
Exam: Hard palate

 Minor salivary glands, attached gingiva

 Note presence of tori: tx plan any pre-
prosthetic surgery
Exam: Soft palate
 How does soft palate raise upon “aah”?
 Vibrating line, tonsilar pillars, tonsils,
oropharynx
Exam: Tongue
 Have the patient stick out their tongue
 Wrap the tongue in a dry gauze and gently
pull it from side to side to observe the
lateral borders
 Retract the tongue to view the inferior
tissues
Exam: Tongue
Exam: Tongue
 You may observe
lingual varicosities
Exam: Tongue
 You may observe geographic tongue
(erythema migrans)
Exam: Tongue
 You may observe drug reaction
Exam: Tongue
 Observe signs of nutritional deficiencies,
immune dysfunction
Exam: Tongue
 You may observe oral
cancer
Exam: Floor of mouth
 Visualize, palpate - bimanually
 Wharton’s duct
 Must dry to observe
 Does “lesion” wipe off?
 Where are the two most
likely areas for oral cancer?
 lateral border of the tongue
 Floor of mouth
Palpation of the floor of the mouth
Exam: Floor of mouth
Exam: Floor of mouth
 Squamous Cell Carcinoma
Exam: Floor of mouth
 Squamous Cell Carcinoma