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Question 1

What do you examine in the patient mouth ?

Answer 1

Lips and their commissure.
Oral mucous membrane.
Teeth and gingiva
Tongue and floor of the mouth.
Palate.
Pharyngeal arches, uvula, tonsils.

Question 2

What are the examination on indication for the mouth ?

Answer 2

Opening of salivary glands.
Palpation of the mouth : if suspicion of pathology.

Question 3

Technique and result of lip inspection.

Answer 3

Use tongue depressor or turn lip outward.
- red pinkish, moist inside

Note : color, shape, symmetry, scars, blisters, ulcerations, swellings, hemorrhage, moistness, infection, cracks

Question 4

Technique and result of oral mucosa

Answer 4

Mouth open as wide as possible. Use tongue depressor, insert it half way along their tongue, too far might activate gag reflex. Press it gas it left/right cheek to reveal all the mouth.
-pink, moist

Note : color, defect, swellings, ulceration, hemorrhagic, coating

Question 5

Technique and result of teeth and gingiva inspection.

Answer 5

Assess teeth : alignment (upper front of lower), number, condition, caries, tartar, prosthesis, artificial element
Assess gingiva : color, shape, hemorrhage, ulceration, transition between in gingiva and mucous membrane

Question 6

Technique and result of tongue / floor of mouth inspection

Answer 6

Observe tongue from all side. Mouth open wide, put out tongue and move it to each side.
Press tongue down with depressor to inspect base. Lift tongue to the roof to inspect underside of the tongue, frenulum, floor mouth.

Note tongue : smoothness, color, papillae, defect, swelling, ulceration, haemorrhage, coating
- pinkish, pale red

Note floor of mouth : color, defect, swellings, ulceration, hemorrhage, coating

Question 7

Technique and result of palate inspection

Answer 7

Tilt head back to look at soft/hard palate

Note : color, shape, symmetry, mobility, swelling, ulcer

Question 8

Technique of pharyngeal arches/uvula/tonsils examination

Answer 8

°ask patient if tonsils have been removed
Press tongue down using depressor : say eeh
- arches should move upward to enable deeper throat inspection
- uvula remains symmetrical and central

Pharyngeal arches :
-normally : slightly lumpy, pinkish/red
-inflammatory sign : fierce red, enlarged, coated

Oropharynx : color, swellings

Question 9

What do you do in case of dysphagia ?

Answer 9

Following a cerebral infraction for example.
Tap posterior pharyngeal wall to test sensation.

Question 10

Technique and result of salivary gland opening inspection

Answer 10

Locate opening of parotid gland on each side : near second upper molar.
- slightly raised, slit shape

Note : color, pus, bleeding, salivary stones

Locate opening of submandibular duct : lateral to lingual frenulum

Question 11

Technique and result of mouth palpation

Answer 11

Palpate with non sterile glove bimanually : one outside, one inside.
Assess symmetry.

Palpate tongue
- medial lesion is usually benign
- lateral lesion often malignant

Question 12

Abnormalities of the mucous membrane of the mouth ?

Answer 12

Small painful grey-white-yellow circular patches with red rims. Disappear after 1-2 weeks but can returns.
=> mouth ulcers

White irregular patches that can be scraped off easily, reddening
=> Candida infection

Question 13

Symptoms of leukoplakia ?

Answer 13

White patches on tongue / buccal mucosa that cannot be scarred off. Can develop into carcinoma.

Possibility of HIV infection.

Question 14

Changes of mouth without clinical significance :

Answer 14

Geographic tongue or lingua geographica : large red patches with smooth papillae

Black tongue

Lingua nigra : dark discoloration of underside of the tongue with enlarged papillae
- black hairy tongue

Question 15

Possible malignancy in the mouth ?

Answer 15

Irregular swellings, discoloured patches and defect in oral mucous / tongue.

Unilateral redness, swelling of a tonsil : could also be leukemia and Hodgkin’s lymphoma

Question 16

Clinical signs in the teeth ?

Answer 16

Poor condition (caries) :
- poor hygiene
- systemic illness
- with gum inflammation => gingivitis

! Teeth need to be in perfect condition before heart valve surgery !

Question 17

Clinical signs of infection in or around the mouth ?

Answer 17

Blister - cold sore : labial herpes

Red, swollen tonsils, white crypts : tonsillitis glandular fever = infectious mononucleosis

Pus or swollen, obstructed salivary gland ducts : gland infection

Pus on posterior wall of throat : rhinosinusitis

Question 18

What are common concerning symptoms in the mouth ?

Answer 18

Sore throat
Gum swelling, bleeding : if common while brushing teeth => gingivitis
Hoarseness
Malodorous breath

Question 19

Causes of sore throat ?

Answer 19

Pharyngitis frequently associated with acute upper respiratory illness.

Associated with :
- Aphthous ulcers and sore smooth tongue : nutritional deficiency
- Bacterial infection : fever, tonsillar exudates, swollen tender anterior cervical adenopathy, absence of cough
—— should do rapid testing or throat culture
- sore tongue : oral candidiasis, systemic illness

Question 20

Cause of hoarseness ?

Answer 20

Change in voice quality : husky, rough, harsh, lower pitched
Disease of larynx, extra-laryngeal lesion pressing on laryngeal nerve

Question 21

What do you ask to a hoarse voice patient ?

Answer 21

Medical history :
- Environnement allergies, acid reflux, irritants
- alcohol use, smoking, inhalation of fumes

Complaint :
- Acute : voice over use, acute viral laryngitis, possible neck trauma
- more than 2 weeks = long term : reflux, vocal cord nodules, hypothyroidism, head or neck cancer, thyroid mass, neurologic disorder
——> need laryngoscopy

Question 22

Cause of malodorous breath ?

Answer 22

Common cause :
- poor hygiene, tobacco smoking
- plaque retention on teeth, mouth appliance
- periodontal disease : gingivitis, ulcers, periodontitis

Systemic causes :
- respiratory : sinusitis, tonsillitis, pharyngitis, foreign bodies, neoplasm, abscesses, bronchiectasis
- digestive : gastric reflux, hepatic cirrhosis, impaired fat digestion, error of metabolism