The examination of the oral cavity

The oral examination is an area of physical diagnosis but much information can be gained through a systematic evaluation of the oral hard and soft tissues. While the primary objective is to distinguish between health and disease, a comprehensive oral examination—in conjunction with a thorough medical and dental history—can also provide valuable insight into the overall health and well-being of the patient.

When the clinical diagnosis of an oral lesion cannot be confirmed on the basis of its signs and symptoms, an oral examination can be supplemented by a biopsy of the oral soft tissues. In the vast majority of cases, the microscopic findings, in conjunction with the clinical examination, are sufficient to confirm the diagnosis.

Physical Examination.

Always begin the evaluation of a patient with oral symptoms with an extraoral head and neck examination. In many instances, the clinical information gained is invaluable in determining the etiology and progression of the oral disease for which the patient is seeking treatment.

Examine the lips both visually and by palpation. The vermilion border should be smooth and pliable. Actinic damage to the lips (actinic cheilitis), especially the lower lip, manifests either as an atrophic change with associated erythema or a leukoplakia with marked thickening of the epithelium.

Carefully evaluate the color of the oral mucous membranes. In healthy individuals, the labial mucosa is smooth, soft, and well lubricated by the minor salivary glands. Anxiety regarding the examination may result in a transient xerostomia. In such cases, the mucosa becomes tacky to the touch. Examination of the buccal mucosa is most easily accomplished by having the patient partially open the mouth, followed by stretching of the buccal mucosa with a mouth mirror or tongue blade.

The dorsal surface of the tongue is most easily visualized by having the patient protrude the tongue and attempt to touch the tip of the chin. The dorsal surface of the tongue should be uniformly covered by numerous hairlike filiform papillae.

Direct visual inspection of the hard palate is accomplished most easily with the use of an intraoral mirror. The hard palate, similar to the attached gingiva, normally is less pink than other oral mucosal sites because of its increased keratinization.

In contrast to the hard palate, the soft palate is nonkeratinized and salmon-pink in color. It is easily visible on direct examination by depressing the posterior tongue with a tongue blade and instructing the patient to say " Ahhh.

Deviation of the soft palate to one side or the other may indicate a neurologic problem or an occult neoplasm.

The gingivae are examined most easily with the mouth partially closed and the lips retracted with the fingers, a tongue blade, or plastic lip retractors. The attached gingiva (ie, gingiva adjacent to the crowns of the teeth) is keratinized and appears paler than other oral mucosa. This tissue usually is firm, stippled, and firmly attached to the underlying bone. Alterations in the clinical appearance of the gingivae can be an indicator of both localized and systemic disease. The most common cause of erythema of the gingivae is poor dental hygiene.

POST-TEXT ASSIGNMENTS

Exercise 5. Make up the sentences, using the following verbs in Passive Voice:

To gain through; to confirm the diagnosis; to lubricate well; to accomplished more easily; to visualize; to cover; to nonkeratinize; to examine.

Exercise 6. Insert prepositions:

1. A comprehensive oral examination… conjunction … a thorough medical and dental history—can also provide valuable insight … the overall health and well-being …the patient.

2. … the vast majority… cases, the microscopic findings, … conjunction … the clinical examination, are sufficient to confirm the diagnosis.

3. … such cases, the mucosa becomes tacky … the touch.

4. When the clinical diagnosis … an oral lesion cannot be confirmed … the basis … its signs and symptoms, an oral examination can be supplemented … a biopsy … the oral soft tissues.

5. The hard palate, similar … the attached gingiva, normally is less pink than other oral mucosal sites because … its increased keratinization.

6. Deviation … the soft palate … one side or the other may indicate a neurologic problem or an occult neoplasm.

7. … contrast … the hard palate, the soft palate is nonkeratinized and salmon-pink … color.

Exercise 7. Choose the proper continuation of the following sentences:

Exercise 8. Skim the text and look for the answers to the following questions:

1. Through what can much more information about the condition of the oral cavity be gained?

2. What is the difference between the primary and comprehensive oral examination?

3. How can the clinical diagnosis of an oral lesion be confirmed?

4. What is sufficient to confirm the clinical diagnosis of an oral lesion?

5. What does always the physical examination of the oral cavity begin with?

6. What are the main pathologies of the lips?

7. What is xerostomia?

8. What is the examination of the buccal mucosa most easily accomplished by?

9. What may the deviation of the soft palate to one side or the other may indicate?

10. What is the most common cause of erythema of the gingivae?

Exercise 9. Express in one word:

Exercise 10. Render the text using key words:

An evaluation; comprehensive; sufficient; an atrophic change; xerostomia; protrude; keratinization; nonkeratinized; neoplasm; hygiene.

PART II

PRE-TEXT ASSIGNMENTS

Exercise 1. Topic vocabulary:

apparent видимий

anodontia відсутність зубів

supernumerary додатковий

sequelae [sikwi: lə ] наслідок, ускладнення

radiograph рентгенівський знімок

recession відхід, віддалення

inherited успадкований

xerostomia сухість у роті

Exercise 2. Read the text closely and make up the questions to it: