A mouth assessment is performed as part of a patient's

health assessment A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performin ...

. The mouth is the beginning of the digestive system and a substantial part of the respiratory tract. Before an assessment of the mouth, patient is sometimes advised to remove any dentures. The assessment begins with a dental-health questionnaire, including questions about

toothache Toothache, also known as dental pain,Segen JC. (2002). ''McGraw-Hill Concise Dictionary of Modern Medicine''. The McGraw-Hill Companies. is pain in the teeth or their supporting structures, caused by dental diseases or pain referred to the t ...

hoarseness A hoarse voice, also known as dysphonia or hoarseness, is when the voice involuntarily sounds breathy, raspy, or strained, or is softer in volume or lower in pitch. A hoarse voice, can be associated with a feeling of unease or scratchiness in the ...

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liq ...

(difficulty swallowing), altered taste or a frequent sore throat, current and previous tobacco use and alcohol consumption and any sores, lesions or bleeding of the gums.

Lips

The

lip The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be ...

s are normally

symmetrical Symmetry (from grc, συμμετρία "agreement in dimensions, due proportion, arrangement") in everyday language refers to a sense of harmonious and beautiful proportion and balance. In mathematics, "symmetry" has a more precise definiti ...

, pink, smooth, and moist. There should be no growths, lumps, or discoloration of the tissue. Abnormal findings are asymmetricality, cyanosis, a cherry-red or pale color or dryness. Diseases include

mucocele A mucocele is a distension of a hollow organ or cavity because of mucus buildup. By location Oral Oral mucocele is the most common benign lesion of the salivary glands generally conceded to be of traumatic origin. It is characterized by the pool ...

aphthous ulcer Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term ''canker sore'' i ...

, angular stomatitis, carcinoma,

cleft lip A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The te ...

leukoplakia Oral leukoplakia is a ''potentially malignant disorder'' affecting the oral mucosa. It is defined as "essentially an oral mucosal white lesion that cannot be considered as any other definable lesion." Oral leukoplakia is a white patch or plaque th ...

herpes simplex Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called col ...

and chelitis.

Teeth

Tooth condition indicates a person's general health. Teeth should be clean with no decay, white with shiny enamel and smooth surfaces and edges. Adults should have a total of 32 teeth (16 teeth in each arch). By the age of , children have a total of 20

deciduous In the fields of horticulture and Botany, the term ''deciduous'' () means "falling off at maturity" and "tending to fall off", in reference to trees and shrubs that seasonally shed leaves, usually in the autumn; to the shedding of petals, ...

teeth (10 in each arch). Abnormal findings are missing, loose, broken and misaligned teeth. Diseases of the teeth include baby-bottle tooth decay, epulis,

meth mouth Meth mouth is a colloquial term used to describe severe tooth decay and tooth loss, as well as tooth fracture, acid erosion, and other oral problems that are often symptomatic to extended use of the drug methamphetamine. The condition is though ...

and

Hutchinson's teeth Hutchinson's teeth is a sign of congenital syphilis. Affected people have teeth that are smaller and more widely spaced than normal and which have notches on their biting surfaces. It is named after Sir Jonathan Hutchinson, an English surgeon an ...

Gums

To assess the gums, a tongue depressor gently retracts the cheek to allow inspection of the upper and lower gums. They should appear symmetrical, moist and pinkish, with well-defined margins. Dark-skinned people may have a melanotic line along the gum margin. Abnormal findings include swelling, cyanosis, paleness, dryness, sponginess, bleeding or discoloration. Diseases include leukoplakia, epulis,

gingival hyperplasia Gingival enlargement is an increase in the size of the gingiva (gums). It is a common feature of gingival disease. Gingival enlargement can be caused by a number of factors, including inflammatory conditions and the side effects of certain medica ...

gingivitis Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attached ...

periodontitis Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cau ...

and

(canker sore).

Oral mucosa

To check the

oral mucosa The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed '' lamina propria''. The oral cavity has sometimes been des ...

, the patient's cheek is exposed with a tongue depressor and the tissues inspected with a penlight. Healthy tissue appears moist, smooth, shiny and pink. Stensen's duct is opposite the second molar. Abnormal findings include dryness, cyanosis, paleness and

Fordyce spots Fordyce spots (also termed Fordyce granules)James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. . are visible sebaceous glands that are present in most individuals ...

, and signs of disease include canker sores,

Koplik's spots Koplik's spots (also Koplik's sign) are a prodromic viral enanthem of measles manifesting two to three days before the measles rash itself. They are characterized as clustered, white lesions on the buccal mucosa (opposite the lower 1st & 2nd ...

(an early indication of measles),

candidiasis Candidiasis is a fungal infection due to any type of '' Candida'' (a type of yeast). When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth ...

and leukoplakia.

Hard palate

The patient tilts their head back and opens their mouth for the hard-palate assessment. Visual inspection with a penlight shows a healthy palate as whitish in color, with a firm texture and irregular transverse rugae. Abnormal findings include yellowness or extreme pallor, and diseases include

torus palatinus A torus palatinus (pl. tori palatini), or palatal torus (pl. palatal tori), is a bony protrusion on the palate. Palatal tori are usually present on the midline of the hard palate.Neville, B.W., D. Damm, C. Allen, J. Bouquot. ''Oral & Maxillofaci ...

cleft palate A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The ...

, submucous cleft palate,

High-arched palate A high-arched palate (also termed high-vaulted palate) is where the palate is unusually high and narrow. It is usually a congenital developmental feature that results from the failure of the palatal shelves to fuse correctly in development, the sa ...

Kaposi's sarcoma Kaposi's sarcoma (KS) is a type of cancer that can form masses in the skin, in lymph nodes, in the mouth, or in other organs. The skin lesions are usually painless, purple and may be flat or raised. Lesions can occur singly, multiply in a limit ...

and leukoplakia.

Soft palate and uvula

The soft palate is checked with a penlight. It should be light pink, smooth and upwardly movable. To check the uvula, a tongue blade is pressed down on the patient's tongue and the patient is asked to say "ah"; the

uvula The palatine uvula, usually referred to as simply the uvula, is a conic projection from the back edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers. It also conta ...

should look like a pendant in the midline and rise along the soft palate. Abnormal findings include deviation of the uvula from the midline, an asymmetrical rise of the soft palate or uvula and redness of either. Diseases include bifid uvula, cleft palate and carcinoma. If cranial nerve 10 is injured, the soft palate does not rise when the mouth is opened.

Tongue

All sides of the

tongue The tongue is a muscular organ in the mouth of a typical tetrapod. It manipulates food for mastication and swallowing as part of the digestive process, and is the primary organ of taste. The tongue's upper surface (dorsum) is covered by taste ...

are assessed. To inspect the dorsal side (top) of the tongue, a patient sticks out their tongue. A healthy dorsal tongue is symmetrical, pink, moist, slightly rough from the papillae, possibly with a thin, whitish coating. The sides of the tongue are inspected with a gloved hand holding a piece of gauze. The tongue is moved side to side and inspected; it should be pink, moist, smooth and glistening. Assessment of the ventral (bottom) surface of the tongue is done by having the patient touch the tip of their tongue against the roof of their mouth. If healthy, it should have prominent veins and be pink, smooth, moist, glistening and free of lesions. The

frenulum A frenulum (or frenum, plural: frenula or frena, from the Latin ''frēnulum'', "little bridle", the diminutive of ''frēnum'') is a small fold of tissue that secures the motion of a mobile organ in the body. In human anatomy Frenula on the h ...

should be centered under the tongue. Abnormal findings includes marked redness, cyanosis or extreme pallor. Diseases include

scrotal The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum co ...

fissured tongue Fissured tongue is a benign condition characterized by deep grooves (fissures) in the dorsum of the tongue. Although these grooves may look unsettling, the condition is usually painless. Some individuals may complain of an associated burning sen ...

, migratory glossitis (geographic tongue),

atrophic glossitis Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue (loss of the lingual papillae), leaving a smooth and erythematous (reddened) surface, (sometimes specifically termed atro ...

black hairy tongue Black hairy tongue syndrome (BHT) is a condition of the tongue in which the small bumps on the tongue elongate with black or brown discoloration, giving a black and hairy appearance. The appearance may be alarming, but it is a harmless condit ...

, caviar lesions, carcinoma,

macroglossia Macroglossia is the medical term for an unusually large tongue. Severe enlargement of the tongue can cause cosmetic and functional difficulties in speaking, eating, swallowing and sleeping. Macroglossia is uncommon, and usually occurs in children. ...

, aphthous ulcer and leukoplakia.

Tonsils (if present)

To assess the

tonsils The tonsils are a set of lymphoid organs facing into the aerodigestive tract, which is known as Waldeyer's tonsillar ring and consists of the adenoid tonsil, two tubal tonsils, two palatine tonsils, and the lingual tonsils. These organs play a ...

, a patient opens their mouth and a tongue blade is used to depress the tongue. A penlight is used to inspect the back of the patient's throat, looking for pink, symmetrical and normal-size tonsils. Tonsil size is graded as follows: *1+ Visible *2+ Halfway between the tonsillar pillars and the uvula *3+ Touching the uvula *4+ Touching each other Abnormal findings include bright-red, enlarged tonsils or white or yellow tonsillar exudate.

Tonsillitis Tonsillitis is inflammation of the tonsils in the upper part of the throat. It can be acute or chronic. Acute tonsillitis typically has a rapid onset. Symptoms may include sore throat, fever, enlargement of the tonsils, trouble swallowing, and en ...

is an inflammation of the tonsils.

Special populations

Patients with

Down syndrome Down syndrome or Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21. It is usually associated with physical growth delays, mild to moderate intellectual dis ...

and

cretinism Congenital iodine deficiency syndrome is a medical condition present at birth marked by impaired physical and mental development, due to insufficient thyroid hormone (hypothyroidism) often caused by insufficient dietary iodine during pregnancy. It ...

have delayed tooth eruption, and prolonged thumb-sucking may cause problems with mouth growth and tooth alignment. Gingivitis is one of the most prevalent oral problems associated with

pregnancy Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occur ...

, occurring in 60–75 percent of pregnant women.

References

External links

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Tooth eruption chart
{{Mouth anatomy Mouth