MOUTH, THROAT

• Mouth (Oral Cavity / Vestibule)


  An oval shaped cavity, the beginning of the digestive tract & serves as an airway for the respiratory tract
• Mouth


  • Formed by the lips, cheeks, hard & soft palates, uvula, tongue & its muscles
  • Posteriorly, mandibular & maxillary arcs

  
• Throat (Pharynx)


  Connects the nose, mouth, larynx & esophagus
• Sections of the throat

  • Nasopharynx (behind the nose)
  • Oropharynx(behind the mouth)
  • Laryngo pharynx (behind the larynx)
• Lips


  • Muscular folds that surround the mouth; contain sensory receptors; very sensitive
  • Assist with eating, expression & speech
• Teeth


  • Needed for chewing & have esthetic value
  • 20 deciduous, 32 permanent
  • Deciduous – primary, milk, temporary or baby teeth
  • Permanent – 28 if molars did not erupt
• Tongue

  • Muscle controlled by CN XII – hypoglossal
  • Needed for chewing, swallowing, & speech
  • Sensory (taste) CN VII & CN IX (facial & glossopharyngeal)
• Hard Palate


  • Forms the floor of the nasal cavity
• Soft Palate


  • Posterior to hard palate, Elevates during swallowing to prevent food & saliva from entering the nasopharynx
• Uvula

  • Fleshy cone like structure in the center of the soft palate & prevents food from entering nasal passages
• Salivary Glands


  • Secrete saliva which contains amylase to convert starch to maltose
  • 3 major salivary glands (parotid, submandibular, sublingual)
  • Helps in digestion
  • Oral health
  • In the absence of saliva we cannot taste the food we eat
• Inspection of the Lips

  • Inspect color, condition, lesions, odor

  
• Normal findings for lips

  • Midline
  • Symmetrical
  • Skin intact; pink & moist
  • Coloring consistent with ethnic group/race
  • No unusual odors
• Deviations from normal for lips

  • Asymmetry of placement
  • Congenital deformity
  • Trauma
  • Paralysis
  • Surgical Alteration
  • Redness - Inflammatory or infectious disorder
  • Cyanosis- Vasoconstriction or hypoxia
  • Lesions - Infectious or inflammatory disorder
  • Cheilitis – inflammation of lips; drying, & cracking; Dehydration; Allergy; lip licking
  • Cheilosis - fissures at corners of lips; Deficiency of B vitamins; maceration related to overclosure
  • Halitosis - Infections or gastrointestinal problems, Poor oral hygiene
  • Chancre- Single, painless ulcer of primary syphilis
  • Angioedema - Allergic response based on client's allergic stimulus
  • Herpes Simplex - Herpes viral infection

  
• Most adults have 28 teeth, or 32 if the four third molars, or wisdom teeth, are erupted
• Deviations from normal for teeth

  • Loose, poorly anchored teeth - secondary trauma from periodontal (gum) disease & bacterial plaque buildup on teeth from poor oral hygiene
  • Malalignment - early loss of baby or adult teeth; improper fit of dental restorations; gingivitis; undue pressure on the teeth & gums; misalignment of the jaw after an injury; tumors of the mouth or jaw; common oral health problems in children
  • Dental caries - caused by the action of acids on the enamel surface
  • Discoloration of teeth - Chemicals or medications
  • Mottled enamel
• Inspection of the Oral Mucosa & Gums

  • Inspect color, condition, lesions of mucosa
  • Note condition of gingiva, bleeding, retraction, or hypertrophy
• Normal findings for oral mucosa & gums

  • Pink, moist, intact mucosa
  • Gums consistent in color with other mucosa; gums intact; no bleeding
  • Color variants acceptable if consistent with patient's ethnic group/race
• Deviations from normal for oral mucosa & gums

  • Gum hyperplasia / Gingival hyperplasia- can occur as a direct result of inflammation; often caused by plaque buildup on the teeth from food, bacteria & poor hygiene practices
  • Gum recession - Poor dental hygiene or vitamin deficiency; Aggressive tooth brushing; Hormonal changes
  • Pale or gray gingivae - Chronic gingivitis
  • Abrasions, erosion of underlying mucosa - poorly fitted dentures
  • Inflamed, bleeding gingivae
  • Allergic stomatitis - Reddened, inflamed oral mucosa, sometimes accompanied by ulcerations
  • Aphthous ulcer - Benign & non-contagious
  • Cancers - found on the lips, gums, oral mucosa or other areas of the mouth; associated with tobacco use and alcohol abuse prolonged sun exposure (cancer of the lip)
  • Leukoplakia - White, adherent mucosal thickening. Smoking is the most common cause
• Inspection of the Tongue

  • Inspect color, texture, moisture & mobility
• Normal findings for the tongue

  • Pink & moist, Papillae intact
  • Mucosa intact with no lesions or discolorations
  • Freely & symmetrically mobile
  • CN XII intact – hypoglossal
  • Geographic tongue - a normal variation, map-like appearance on the upper surface and sides of the tongue, harmless, benign condition that isn't linked to any infection or cancer

  
• Deviations from normal for the tongue

  • Absence of Papillae - reddened mucosa, ulcerations, Allergic, inflammatory, or infectious cause
  • Glossitis - occurs when the tongue becomes inflamed, due to infections, allergic reactions & injuries, among other causes
  • Color changes - May indicate underlying problems; red beefy tongue
  • Black, hairy tongue - due to antibiotic use for a medical condition; by using products that contain bismuth
  • Hypertrophy & discoloration of papillae: Poor oral hygiene, Dry mouth, Dehydration, Smoking or other oral tobacco
  • Cancers
• Inspection of the Oropharynx

  • Inspect oropharynx for color, lesions & drainage
• Normal findings for the oropharynx

  • Mucosa is pink, moist, intact
  • The lymphoid - rich posterior wall may have a slightly irregular surface
  • No lesions, erythema, swellings, exudate, or discharge

  
• Deviations from normal for the oropharynx

  • Postnasal drainage - Yellowish or green streaks of drainage on the posterior wall. Seen in acute sinusitis with post nasal drip
  • Pharyngeal Diphtheria - Gray membrane / adherent material
  • White or pale patches of exudates with eurythmic mucosa - Infection, including streptococcal bacterial infection or mononucleosis viral infection
  • Exudative pharyngitis - associated with Gonorrhea & chlamydia, sore throat
  • Erythema -Inflammatory response, typically associated with infectious pharyngitis; also common in smokers
  • Herphangina - Scattered vesicles/ulcerations
• Inspection of the Tonsils

  • Note color, size, and exudate
• Normal findings for the tonsils

  • Symmetrical, pink, clean crypts
  • Crypts may have normal variation of small food particles
• Deviations from normal for the tonsils

  • Peritonsillar Abscess
  • Reddened, hypertrophic tonsil, with or without Exudates
  • Acute infection or tonsillitis
  • Lymphoid cobble stoning, caused by enlarged lymphatic tissue
• Tonsillar Hypertrophy Grading Scale

  Used to note the degree of tonsil enlargement
• Palpation of the Lips / Tongue

  • Lightly palpate lips and tongue for consistency & tenderness
• Normal findings for lips and tongue

  • Lips - Soft, nontender, no masses
  • Tongue - Tissue is soft, supple, without nodules, thickenings, masses, or tenderness
• Deviations from normal for lips and tongue

  • Lips - Areas of induration, thickening, nodularity, or masses; Tender induration that soon develops vesicles
  • Tongue - Areas of induration, thickening, nodularity
• Normal findings for the glands

  • Stensen ducts - Visible with flow of saliva, no redness, pain or moistness in the area, Fordyce granules present
  • Wharton ducts - Frenulum is at the midline, ducts are visible with salivary flow, moistness in the area

  
• Deviations from normal for the glands

  • Stensen ducts - Reddened opening of the ducts
  • Wharton ducts - Presence of lesions, ulcers, nodules or hypertrophied ducts openings on either side of frenulum
• Palpation of the Glands

  • Palpate parotid, submandibular and sublingual glands

  
• Normal findings for palpation of the glands

  • Parotid glands - Nonpalpable & non-tender
  • Submandibular & sublingual glands - May be palpable but should be nontender, supple, and soft

  
• Deviations from normal for palpation of the glands

  • Parotid glands - Enlarged, tender parotid glands, Parotitis, Blocked ducts, Infection, Malignancy
  • Submandibular & sublingual glands - Presence of lesions, ulcers, Tenderness, swelling
• Throat Culture

  • Collected from the mucosa of the oropharynx and tonsillar regions using a culture swab, sample is cultured & examined for the presence of disease-producing microorganisms
• Parotid gland - produce pure serous
• Submandibular gland - produce both serous and mucuous but mainly serous