Mouth

• Adult Physical Assessment


  Mouth & Throat, Nose & Sinuses

  
• Lips


  • Muscular folds that surround the mouth
  • Contain sensory receptors and are very sensitive
  • Lips assist with eating, expression, and speech
• Teeth


  • 20 deciduous, 32 permanent
  • Needed for chewing
  • Also have esthetic value
  • 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, and speech
  • Sensory (taste) CN VII and 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 and saliva from entering the nasopharynx
• Uvula


  • Fleshy conelike 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 (produce saliva): Parotid gland, Submandibular gland, Sublingual gland
  • 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 lips


  • Midline
  • Symmetrical
  • Skin intact
  • Pink, and moist
  • Coloring consistent with ethnic group/race
  • No unusual odors
• Inspection of the Teeth & Bite


  • Have patient open and close mouth
  • Note occlusion and number, color, condition of teeth

  
• Normal teeth


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


  • Loose, poorly anchored teeth
  • Malalignment
  • Dental caries
  • Discoloration of teeth
  • Mottled enamel
• Inspection of the Oral Mucosa & Gums


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

  • Gum hyperplasia / Gingival hyperplasia
  • Gum recession
  • Pale or gray gingivae
  • Abrasions, erosion of underlying mucosa
  • Inflamed, bleeding gingivae
  • Allergic stomatitis
  • Aphthous ulcer
  • Cancers
  • Leukoplakia
• Inspection of the Tongue


  • Inspect color, texture, moisture, and mobility
• Normal tongue


  • Pink and moist
  • Papillae intact
  • Mucosa intact with no lesions or discolorations
  • Freely and symmetrically mobile
  • CN XII intact – hypoglossal
  • Geographic tongue
• Deviations from normal tongue

  • Absence of Papillae
  • Color changes
  • Black, hairy tongue
  • Hypertrophy and discoloration of papillae
  • Cancers
• Inspection of the Oropharynx

  • Inspect oropharynx for color, lesions, and drainage
• Normal oropharynx


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

  • Postnasal drainage
  • Gray membrane / adherent material
  • White or pale patches of exudates with erythemic mucosa
  • Exudative pharyngitis
  • Erythema
  • Scattered vesicles/ulcerations
• Causes of changes to papillae

  • Poor oral hygiene
  • Dry mouth
  • Dehydration
  • Smoking or other oral tobacco use
• Conditions that can affect the oropharynx

  • Cancers
• Normal oropharynx


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

  • Postnasal drainage (yellowish or green streaks of drainage on the posterior wall)
  • Gray membrane / adherent material (Pharyngeal Diphtheria)
  • White or pale patches of exudates with erythemic mucosa (Infection, including streptococcal bacterial infection or mononucleosis viral infection)
  • Exudative pharyngitis (associated with Gonorrhea and chlamydia, sore throat)
  • Erythema (Inflammatory response, typically associated with infectious pharyngitis, also common in smokers)
  • Scattered vesicles/ulcerations (Herpangina)
• Normal tonsils


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

  • Peritonsillar Abscess
  • Reddened, hypertrophic tonsil, with or without Exudates (Acute infection or tonsillitis)
  • Lymphoid cobblestoning (caused by enlarged lymphatic tissue)
• Tonsil grading


  • 1+
  • 2+
  • 3+
  • 4+
• Normal lips


  • Soft, nontender, no masses
• Deviations from normal lips

  • Areas of induration, thickening, nodularity, or masses
  • Tender induration that soon develops vesicles
• Normal tongue


  • Tissue is soft, supple, without nodules, thickenings, masses, or tenderness
  • Sublingual glands may be palpable under the tongue but should be nontender, soft, and supple
• Deviations from normal tongue

  • Areas of induration, thickening, nodularity
• Normal parotid glands


  • Nonpalpable and nontender
• Deviations from normal parotid glands

  • Enlarged, tender parotid glands (Parotitis)
  • Blocked ducts
  • Infection
  • Malignancy
• Normal submandibular and sublingual glands

  • May be palpable but should be nontender, supple, and soft
• Structures of the nose

  • Nares (Nostrils) / Vestibules
  • Nasal Mucosa
  • Nasal Septum
  • Cilia
  • Turbinates (Superior, middle, and inferior)
  • Olfactory Nerve (CN I)

  
• Normal external nose


  • Midline placement
  • Shape symmetrical and consistent with age, gender, and race/ethnic group
  • No nasal flaring
  • No drainage

  
• Deviations from normal external nose

  • Misalignment of nose or shape inconsistent with patient's biographical information (Previous trauma, Congenital deformity, Surgical alteration, Mass, Acromegaly, Down syndrome)
  • Nasal flaring (Suggests respiratory distress, especially in infants, who are obligatory nose breathers)
  • Clear, bilateral drainage (Allergic rhinitis)
  • Clear, unilateral drainage (May be spinal fluid as a result of head trauma or fracture)
  • Clear, mucoid drainage (Viral Rhinitis)
  • Yellow or green drainage (Upper Respiratory Infection (URI))
  • Bloody drainage (Trauma, Hypertension, Bleeding disorders)

  
• Normal internal nose


  • Pink, variations consistent with ethnic group/race and with oral mucosa
  • Moist, with only clear, scant mucus present
  • Intact, with no lesions or perforations
  • No crusting or polyps
  • Septum located midline