Oral Medicine and Oral Pathology/Oral examination

The ability to carry out an examination of the oral cavity and oropharynx is key to many dental specialties, including oral medicine, and is useful to other medical specialtists from family practitioners to gastroentologists. Whole chapters and even whole textbooks are written on the topic, and many different systems exist. Whatever system is used by a clinician, it must be systematic to ensure that no aspect of the examination is missed. It is also worth remembering how the oral examination fits in the overall diagnostic process:

History   Examination    Special investigations    Diagnosis    Treatment

The most fundamental concept in physical examination is the ability to distinguish normal anatomy from pathology, and to do this clinicians must have a sound understanding of what normal is.

Generally speaking, there are 2 types of examination: a screening examination in the absence of any specific complaint, as may occur during a dental check up; and an examination of a patient who has a specific complaint. The focus in the latter is mainly on the problem at hand, although a quick screening examination should also take place.

Physicial examination in medicine traditionally follows the sequence: Inspection (looking) Auscultation (listening with a stethoscope)  Palpation (feeling)  Percussion (tapping)

In the mouth, auscultation is rarely possible, although extra-orally it may sometimes be involved, e.g. listening to joint noises with the stethoscope over the TMJ. In oral examination, percussion generally applies only to teeth.

A common problem when looking into a dental mirror is that it becomes fogged with condensation every time the patient takes a breath. This can be most easily avoided by first gently pressing the face of the mirror against the buccal sulcus. The film of saliva that is imparted to the mirror face prevents any fogging. This of course requires that the patient has a normal coating of saliva on their mucous membranes. An alternative is to smear the face of the mirror with a very thin film of washing up detergent.

References and further reading

 * 1) -- A little dated now, but a truly excellent textbook. See Part 1 "GENERAL PRINCIPLES OF DIFFERENTIAL DIAGNOSIS"
 * 2) -- See Chapters 3, 4 and 5