You will remember some of what you hear,much of what you read, more of what you see,and almost all of what you experienceand fully understand.Moore & Dalley – Clinically Oriented Anatomy

Richard P Madden, DDS, MS Richard P Madden, DDS, MS RMadden@umn.eduRMadden@umn.edu

PHYSICAL EVALUATION I PHYSICAL EVALUATION I (Dent 5121)(Dent 5121)

IntraIntra--oral Examination:oral Examination:Normal AnatomyNormal Anatomy

Lecture ObjectivesLecture ObjectivesAfter todayAfter today’’s lecture, the student will be able to:s lecture, the student will be able to:

Describe how to examine periDescribe how to examine peri--oral and intraoral and intra--oral oral structuresstructures

Identify and describe normal periIdentify and describe normal peri--oral and intraoral and intra--oral oral topographic anatomytopographic anatomy

Identify and describe variations in normal Identify and describe variations in normal topographical anatomy and some of the more topographical anatomy and some of the more common pathological findingscommon pathological findings

See list of anatomic structures, variations of normal, and commoSee list of anatomic structures, variations of normal, and common pathological findings n pathological findings

““Oral and periOral and peri--oraloral““working definitionsworking definitions

IntraIntra--oraloral Oral cavityOral cavity

•• Oral cavity properOral cavity proper The area between the dental arches occupied by The area between the dental arches occupied by

the anterior portion of the tonguethe anterior portion of the tongue•• Oral vestibuleOral vestibule

The area between the teeth and cheeksThe area between the teeth and cheeks

OropharynxOropharynx•• The portion of the pharynx (throat) visualized through The portion of the pharynx (throat) visualized through

the oral cavitythe oral cavity

PeriPeri--oraloral The facial skin around the mouthThe facial skin around the mouth

Normal Lip Surface AnatomyNormal Lip Surface Anatomy

Perioroal and lip examination: Observation then palpation

Philtrum

Vermillion border / Mucocutaneous junction

Lip vermillion

Commisure of the mouth

Angular Cheilitis

Common pathological findings of lipsCommon pathological findings of lips

Actinic Cheilosis

Common pathological findings of lipsCommon pathological findings of lips

Actinic Cheilosis

Common pathological findings of lipsCommon pathological findings of lips

Actinic Cheilosis

Common pathological findings of lipsCommon pathological findings of lips

Recurrent Herpes Labialis

Common pathological findings of lipsCommon pathological findings of lips

Recurrent Herpes Labialis

Common pathological findings of lipsCommon pathological findings of lips

Recurrent Herpes Labialis

Labial MucosaLabial Mucosa

Labial mucosa examination: Observation then palpation

Labial MucosaLabial Mucosa

Labial MucosaLabial Mucosa

Palpation of Labial MucosaPalpation of Labial Mucosa

“Digital and Bi-digital palpation”

Variations of normal labial mucosaVariations of normal labial mucosa

Fordyce Granules

Variations of normal labial mucosaVariations of normal labial mucosa

Fordyce Granules

Morsicatio labiorum

Common pathological findings Common pathological findings of labial mucosaof labial mucosa

Apthous

Common pathological findings Common pathological findings of labial mucosaof labial mucosa

Mucocele

Common pathological findings Common pathological findings of labial mucosaof labial mucosa

Mucocele / Fibrosing mucocele

Buccal mucosaBuccal mucosa

Buccal mucosa examination: Observe then palpate

Parotid papilla

Salivary glandsSalivary glands

Parotidgland

Submandibulargland

Milking the Parotid GlandMilking the Parotid Gland

Palpation of Buccal MucosaPalpation of Buccal Mucosa

Pterygomandibular raphe

A tendinous band running from the pterygoid hamulus of the medial ptyergoid palte to the mylohyoid line of the mandible. The pterygomandibular rapheseparates and gives rise to the superior constrictor of the pharynx and the buccinator muscle.

Pterygomandibular RaphePterygomandibular Raphe

Variations of normal buccal mucosaVariations of normal buccal mucosa

Linea alba

Variations of normal buccal mucosaVariations of normal buccal mucosa

Linea alba

Variations of normal buccalVariations of normal buccal mucosamucosa

Leukoedema

Leukoedema is a diffuse grey-white, milky, opaque appearance of the buccal mucosa mostly disappears upon stretching.

Variations of normal buccal mucosaVariations of normal buccal mucosa

Leukoedema

Variations of normal buccal mucosaVariations of normal buccal mucosa

Fordyce granules

Variations of normal buccal mucosaVariations of normal buccal mucosa

Morsicatio buccarum

Variations of normal buccal mucosaVariations of normal buccal mucosa

Morsicatio buccarum or traumatic hyperkeratosis

Lichenoid Lichenoid mucositismucositis

Lichen planus versus Contact allergy to a dental material

ADDEDADDEDDentifrice stomatitis Variations of normal Variations of normal

buccal mucosabuccal mucosa

Common pathological findings Common pathological findings of the buccal mucosaof the buccal mucosa

Fibroma

Hard PalateHard Palate

Anterior palateAnterior palate

Incisive papilla

Palatal rugae

Median palatal raphe

Hard PalateHard Palate

Incisive papilla

Median palatal raphe

Palatal rugae

Fovea palatine

Palatal rugae

Fovea palatine

Variations of a normal hard palateVariations of a normal hard palate

Torus palatinus

Nicotinic Stomatitis

Common pathological findings of the hard palateCommon pathological findings of the hard palate

Soft palate Soft palate and and

OropharynxOropharynx

Foveapalatine

Examination of the oropharynxAnd palate is accomplished mostly by observation. The soft palate should be gently palpated. Beware of the gag reflex.

OropharynxOropharynx

Anterior tonsillar pillar = glossopalatine arch

Uvula

Posterior tonsillar pillar = glossopharyngeal arch

Posterior pharyngeal wall

OropharynxOropharynx

Soft PalateSoft Palate

Common pathological findings Common pathological findings of the of the oropharynxoropharynx

Tonsillitis

Common pathological findings Common pathological findings of the of the oropharynxoropharynx

Tonsillitis

Gingival Gingival AnatomyAnatomy

Gingiva and Alveolar MucosaGingiva and Alveolar Mucosa

Mucogingival junction

GingivaGingiva

Gingiva and Alveolar MucosaGingiva and Alveolar Mucosa

Gingiva and Alveolar MucosaGingiva and Alveolar Mucosa

Retromolar pad

Variations of normal Variations of normal gingivagingiva

Racial / Physiologic pigmentation

Common pathological findings of the Common pathological findings of the gingivagingiva and alveolar mucosaand alveolar mucosa

Gingivitis

Common pathological findings of Common pathological findings of the the gingivagingiva and alveolar mucosaand alveolar mucosa

Periodontitis

Common pathological findings of Common pathological findings of the the gingivagingiva and alveolar mucosaand alveolar mucosa

Pericoronitis

Common pathological findings of Common pathological findings of the the gingivagingiva and alveolar mucosaand alveolar mucosa

Amalgam tattoo

Common pathological findings of Common pathological findings of the the gingivagingiva and alveolar mucosaand alveolar mucosa

Amalgam tattoo

Common pathological findings of Common pathological findings of the the gingivagingiva and alveolar mucosaand alveolar mucosa

Dorsal TongueDorsal Tongue

Retraction of TongueRetraction of Tongue

Palpate TonguePalpate Tongue

Fungiform and Filiform papillaeFungiform and Filiform papillae

Circumvallate PapillaeCircumvallate Papillae

Foliate Papilla and Lingual TonsilsFoliate Papilla and Lingual Tonsils

Lingual TonsilsLingual Tonsils

Foliate papilla

Ventral TongueVentral Tongue

TongueTongue

Plica fimbriata

TongueTongue

Lingual frenulum

Variations of a normal tongueVariations of a normal tongue

Lingual varicosities

Lingual veinsLingual veins

Lingual veinsLingual veins

Variations of a normal tongueVariations of a normal tongue

Scalloped tongue

Variations of a normal tongueVariations of a normal tongue

Hairy tongue

Variations of a normal tongueVariations of a normal tongue

Fissured tongue

Geographic tongue (erythema migrans)Variation of normal

Geographic tongue (erythema migrans)Variation of normal

Unusual findings of the tongueUnusual findings of the tongue

“Forked” tongue

Floor of MouthFloor of Mouth

Floor of mouth examination: Observe then palpate

Floor of MouthFloor of Mouth

Bi-manual palpation

Floor of MouthFloor of Mouth

Variations of a normal Variations of a normal floor of mouthfloor of mouth

Mandibular tori