Diagnostic Approach
to Oral Lesions
The first dental exam should begin at the time of tooth eruption
approximately at a year of age. As the individual ages, the primary objective
of the exam will be the same, the maintenance of the structure, function, and
cosmetics of the teeth and mouth. The specifics of the exam, however; will vary
over time. As in any evaluation of normal and diseased states, obtaining a
complete history is paramount and inclusive of both symptomatic and
asymptomatic conditions. Specific to the dental exam, symptoms of mucosal
bleeding, ear or jaw pain, mastication difficulties and signs of malocclusion,
or improper teeth alignment, and the presence of oral growth should be
elicited. Tobacco and alcohol have a significant negative impact on dental
health; therefore; eliciting information about their use is critical to the
completeness of the oral history.
The physical exam begins with
evaluation of the face for symmetry, masses, or skin lesions. An examination of
the mouth follows, with inspection of the teeth for alignment, mobility, color,
and adherent plaque and tartar. Teeth are gently tapped with the mirror handle
to assess percussion sensitivity and manually rocked to determine the presence
or absence of mobility. The lips are palpated, with an open mouth and a tongue
blade used to guide the examination and increase the visibility of the buccal
mucosa, vestibules, palate, uvula, and oropharynx. With the tongue extended,
the dorsum of the tongue is exposed and examined; side-to-side motion allows
for inspection of both posterolateral surfaces. The ventral surface of the
tongue and floor of the mouth is examined with an upward motion of the tongue.
Palpation of the vestibules, floor of the mouth, and sublingual and
submandibular glands is included in the oral examination. Opening and closing
of the jaw while palpating the head of the condyle anterior to the external
auditory meatus allows for assessment of the temporomandibular joint.
