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بسم الله الرحمن الرحيم ُ َ َ ”و مآ أوتيتم من العلم إلا قليلاً“صدق الله العظيم ُ َ َ َ ِ ِ ِ ِ ِ ِ

Clinical examination II By Dr/Maha Mahmoud Assistant professor of Oral Medicine

Peri/Intraoral Examination Good illumination is essential for the examination of the mouth. The patient should be seated properly and comfortably for proper examination of all areas of the mouth.

Peri/Intraoral Examination The perioral and intraoral examination procedure follows an eight –steps systematic assessment of the: • Lips • Labial mucosa,sulcus and commisures. • Buccal mucosa and sulcus. • Gingiva and alveolar ridge. • Tongue. • Floor of the mouth. • Hard and soft palate. • Teeth.

Lips • Begin examination by observing the lips with the patients mouth both closed and opened . • Apart lips indicate, mouth breathing ,tongue thrusting, or nasal obstruction • Note the color, texture, fissuring and any surface abnormality of the upper and lower vermillion border. Perioral Examination

The size of the lip should be considered: • Swelling of lip may be due to: • 1- Infection 2- Malignancy • 3- Angioneurotic edema.

Buccal Mucosa • Retract the Buccal mucosa. • Examine first the right then the left Buccal mucosa extending from the labial commissure and back to the anterior tonsillar pillar. • Note any change in pigmentation,color,texture and other abnormalities of the mucosa. • Make sure that the commissures are examined and are not covered by the retractors during the retraction of the cheek. Intraoral Examination

Gingiva and Alveolar Mucosa • Examine the buccal and labial aspect of the gingiva and alveolar mucosa by starting with the right maxillary posterior gingiva and alveolar mucosa and then move around the arch to the left posterior area. • Drop to the left mandibular posterior area and move around the arch to the right mandibular posterior area. • Second examine the palatal and lingual aspects, from right to left on the palatal maxilla and left to right on the lingual surface of the mandibular arch. Intraoral Examination

Gingiva and Alveolar Mucosa Intraoral Examination

Tongue Tongue dorsum • Inspect the dorsum of the tongue for any swellings ,ulceration, coating or variation in size, color or texture. • Note any changes in the tongue coating . • The patient is asked to protrude the tongue and it is examined for any changes in mobility or position. Intraoral Examination

Tongue Intraoral Examination

Tongue Margins • With the aid of mouth mirrors, inspect the right and left lateral margins of the tongue. • Grasping the tip of the tongue with a piece of gauze will assist full protrusion and will aid examination of the posterior aspect of the tongue lateral borders. Intraoral Examination

Tongue Ventral Surface: Examine the tongue ventral surface ,observe any changes in the blood vessels or in the lingual frenum. Intraoral Examination

Hard Palate • The hard palate can be inspected visually both directly and indirectly through the use of the mouth mirror. Intraoral Examination

Hard Palate Intraoral Examination

Soft Palate • The soft palate can be seen by use of a mouth mirror and reflected light as well as by depressing the tongue and having the patient elevate it by saying ahh. Intraoral Examination

Oropharynx Intraoral Examination

Floor of the Mouth With the tongue still elevated ,inspect the floor of the mouth for the presence of any pathological changes.. Intraoral Examination

Floor of the Mouth Intraoral Examination

Palpation Intraoral Examination

Teeth • Primary examination techniques for evaluating the teeth include visual inspection Transillumination, probing, palpation, percussion and evaluation of function. • Teeth are examined for the detection of caries, mobility, local factors, stains ,vitality , occlusion, and condition of restorations. Intraoral Examination

Teeth Intraoral Examination

Thank You

بسم الله الرحمن الرحيم