intra oral/extra oral

• Extra-oral examination


  Examination of the patient's external features
• When does the extra-oral assessment of the patient start?

  • As soon as you call them from the waiting room
• What to look for in extra-oral examination?

  • General appearance
  • Posture
  • Gait
  • Breathing
  • General well-being
  • Head
  • Eyes
• What is examined extra-orally?

  • Skin – lesions, moles, scars, trauma
  • Lips – cuts, cracks, cold sores
  • Lymph nodes
  • Salivary glands
  • Symmetry
• Palpation


  The process of using one's hands to examine the body
• Warm & tender


  Indicates infection
• Cool & painless


  Indicates malignancy
• Lips


  • Form external borders of the oral cavity
  • Covered by skin externally & mucous membrane internally
  • Contains Obicularis oris muscle
• Lip functions


  • Food intake
  • Tactile sensory organ
  • Articulation
  • Facial expression
  • Closes off oral cavity
• Vermillion Zone


  Innervation: Infraorbital nerve – upper, Mental nerve - lower
• Lymph glands


  • Examined during extra-oral examination
• Salivary glands


  • Examined during extra-oral examination
• TMJ examination


  • Mobility & range
  • Crepitus, or click
  • Deviation of the jaw on opening or closing
• It is important to be able to identify anatomy within the oral cavity to know what is normal, identify structures, past treatment & possible disease, identify what may need immediate attention and urgent referral, and link oral health to general health
• Oral cavity


  • The upper part of the digestive tract
  • The outer part is called the vestibule
  • The inner part is called the oral cavity proper
• How to examine the oral cavity

  • Lips (visual / palpation)
  • Cheeks (visual / palpation)
  • Floor of mouth (visual / raise the tongue with gauze / palpate if something noticed)
  • Tongue (hold with gauze / visually inspect the dorsum, ventral, right & left border)
  • Throat & tonsils (visually inspect / ask patient to say ahhhh)
  • Palate (Hard & soft) (visually inspect)
  • Gingivae (visually inspect / palpate if required)
  • Teeth (visually inspect / further investigations)
• Requirements for effective intra-oral soft tissue examination

  • Good light
  • Retraction
  • Mirror
• Cheeks


  • Covered by skin externally
  • Internal surface covered by non-keratinised mucosa
  • Bulk of cheek made up of Buccinator muscle
  • Numerous minor salivary glands
  • Stensons duct / parotid papillae
  • Buccal / labial Sulci
• Functions of the cheeks

  • Aids in mastication
  • Closes off oral cavity
  • Facial expression
• Floor of mouth


  • Covered by non-keratinised mucosa
  • Consists of mylohyoid, genioglossus, geniohyoid & digastric (anterior belly) muscles
  • Wharton's ducts present
  • Ducts of sublingual salivary glands
• Function of the floor of mouth

  • Salivation
  • Closes off oral cavity