Oral Mech Exam - Willis Exam 2

gloves, flashlight, tongue depressor, mirror (optional), stopwatch/clock, food/drink items (optional), Orofacial Examination and Hearing Screen Protocol

List the 7 materials required for the Oral Mech Exam:

face and mouth, eye level

When performing the oral mech exam, you want to position the child so that his/her ____ and _____ are at your ___ _____.

symmetry, eyes, nose, mouth, ears, hair/hairline, jaw, eyebrows, forehead, chin

Observe general facial _______ and appearance of structures: (9); note and irregularities

neurological involvement, unilateral facial paresis (weakness), or paralysis

Asymmetry indicated by drooping of one eye, cheek, or corner of mouth could indicate: (3)

eye, cheek, mouth

Asymmetry of the face could be indicated by drooping of one ___, _____, or corner of the _____, all of which could indicate neurological involvement, unilateral facial paresis (weakness) or paralysis.

craniofacial anomalies, syndromes, medical conditions

Structures that appear unusual, out of alignment with each other, or asymmetric may indicate __________ ________ or be characteristic of certain _________ or _______ _________.

prosody, vocal quality

When observing the client’s breathing, irregular breathing patterns or inadequate respiration may affect speech _______ or have a negative effect on ______ _______.

mouth breathing

often associated with open mouth posture and forward tongue carriage

nasal patency, to be sure nasal breathing is possible

If mouth breathing is observed on the client, what should you check for? Why?

child should be referred for a medical evaluation to determine the cause

If the client cannot breathe through their nose or has difficulty doing so and their speech is hyponasal, what should the next step be?

scars, discolorations

When observing the lips at rest, note any irregularities such as _____ or _____________

labial strength and ROM

The following tasks help the clinician assess the client’s…?

• round/pucker lips

• elongate lips —> smile, showing teeth

• alternate pucker-smile-pucker-smile

• open lips wide

• close lips tightly and puff up cheeks —> sustain intraoral pressure

• bite lower lip as if making /f/ sound

• say “puh-puh-puh”

labial weakness

indicated by the inability to round/pucker lips tightly, elongate lips symmetrically, or close lips tightly to sustain intraoral pressure

round/pucker, elongate, intraoral, neurologic involvement

Labial Weakness: indicated by the inability to _____/______ lips tightly, ________ lips symmetrically, or close lips tightly to sustain ________ pressure. All of this could indicate a _________ __________.

stronger, weaker

If lips pull to the side during elongation, the pull will be to the _______ side (this suggests a _______ opposite side)

labial weakness

client cannot sustain intraoral pressure because air escapes through the lips = ??

velopharyngeal insufficiency or incompetence

If air escapes through the nose, along with hyper-nasality or nasal emission this would possibly indicate…?

Resonance and Velopharyngeal Function Assessment Protocol

if velopharyngeal insufficiency/incompetence was thought to be observed, what would you then administer?

labial weakness/incorrdination

Inability/difficulty to produce /p/ would possibly indicate what?

apraxia

Sequencing/motor planning difficulties such as searching/groping behaviors, difficulty alternating pucker-smile, or difficulty coordinating movements needed to puff up the cheeks or bite lower lip could indicate that the client has…?

groping, pucker-smile, puff up the cheeks, lower lip

Apraxia is indicated by sequencing/motor planning difficulties such as: searching/_______ behaviors, difficulty alternating __________, or difficulty coordinating movements needed to ____ ___ ___ _____ or bite _____ ___.

scars, discolorations

When observing the surface of the tongue, note any irregularities such as…? (2)

lingual strength and ROM

The following tasks assess the client’s?

• stick tongue out as far as possible

• push against tongue blade

• elevate tongue tip as if trying to touch nose

• move tip down as if trying to touch chin

• move tip R & L

• move tongue to R & L sides

• put tongue inside cheek on R & L sides and push cheek out —> clinician can push against cheek

  • place tongue tip behind teeth (alveolar ridge), then slide back along roof of mouth (hard palate)

protrude, push, lowering, side-to-side, cheek, slow

The following indicate labial weakness or incoordination:

• inability to _______ tongue/____ against tongue blade

• difficulty ________ tongue tip

• difficulty moving tongue ______ or pushing against _____

• ____ tongue movement, possibly accompanies by tremor and reduced ROM

weak, strong

If lingual weakness is unilateral, the tongue will deviate toward the ____ side upon protrusion and the child will have trouble moving the tongue to the ______ side.

short lingual frenuIum

inability to protrude tongue beyond lips and/or a heart shaped tongue when protruded are both indicative of a…?

True

T/F: ankyloglossia or “tongue tie” may or may not affect articulation

elevation, t, d, n, k

To determine if a child has a tongue tie, have them attempt to produce sounds that require tongue _________ such as: (4)

frenulum clip

If a child cannot produce sounds that require tongue elevation such as /t/, /d/, /n/, and /k/, they may require a _______ ____ by a physician.

dental appliances, protheses

When observing the general condition of the teeth and gums, note any… (2)

wide, teeth, together, 1st molars, repeat

Observe alignment/dental occlusion:

• have child open their mouth ____

• place tongue depressor alongside _____ on one side and gently pull cheek to observe them on that side

• have child bite down so upper and lower teeth are _________

• compare alignment of upper and lower _________

• ______ on other side

neutrocclusion

Class I occlusion:

distocclusion

Class II occlusion:

mesiocclusion

Class III occlusion:

normal occlusion

lower 1st molar is one-half-tooth ahead of upper 1st molar

Class I - Neutrocclusion

maxilla and mandible are in correct alignment, but individual teeth are misaligned, rotated, or jumbled

Class II - Distocclusion

mandible is too far back in comparison to maxilla (will appear as if jaw is underdeveloped or chin is receding)

Class III - Mesiocclusion

mandible is too far forward in relation to maxilla (midface may appear underdeveloped or jaw may appear overdeveloped)

dental, front

To observe bite, have the child bite down and observe ______ alignment from the _____

open bite

open (vertical) space remains between upper and lower teeth; could be anterior or lateral

overbite

upper anterior teeth overlap the bottom teeth excessively; more than 1/3 of lower teeth are covered by upper teeth

overjet

horizontal projection of upper incisors in front of lower incisors; “buck teeth”

overjet

Which bite type is associated with class II malocclusion?

underbite

upper incisors rest behind lower incisors

underbite

Which bite type is associated with class III malocclusion?

dental hygiene, nutrition, medical conditions

Discoloration or caress of teeth could be an indicator of poor _____ _______, _________, medications, or other _______ __________.

craniofacial, syndromes

Poorly developed or misshapen teeth is often associated with various __________ anomalies or ________.

articulation

Severe malocclusion or dental alignment problems may interfere with ____________.

tongue thrust or forward tongue carriage

Tongue in mouth for open bite or overjet:

color, scarring, vault height/width

What to observe on the hard palate: (3)

palatal fistula or a repaired, un-repaired, or submucosal cleft

Discoloration/scaring on the hard palate could indicate: (2 ish)

bifid uvula, white/blueish line near border of hard/soft palates, and a “notch” near posterior nasal spine

Diagnostic triad for sub-mucous cleft:

articulatory contacts

the shape of the palatal arch whether it is significantly high, narror, or low may make ___________ ________ more difficult for some sound productions

forward, fronting

Extremely high, narrow palates may be associated with _______ tongue carriage and ________ of speech sounds.

pronounced ridge

Associated with tongue thrust or forward tongue carriage; often co-occur with a high, narrow, or low palate or large tongue in relation to the palate

soft palate, uvula, faucial arches, tonsils, pharyngeal area

Observe the following components of the velopharyngeal mechanism: (5)

velopharyngeal mechanism

What is assessed during completion of the following tasks?

• have child sustain “ah” for as long as possible

• have child say “ah-ah-ah” forcefully

  • have child say /u/ while you alternately occlude and open nostrils —> alternate nose holding technique

uvula, faucial arches

When having the child sustain “ah” during assessment of the velopharyngeal mechanism, you are observing the symmetric elevation of the _____ and medial movement of the ________ ______ upon phonation.

up and down, phonation

When having the child say “ah-ah-ah” forcefully during the assessment of the velopharyngeal mechanism, you are observing the uvula move ___________ symmetrically with ________.

False; voice quality should NOT change as you occlude and release the nose

T/F: During the alternate nose holding technique, the quality of voice should change as you occlude and release the nose

hypernasality

Any change in the quality of voice during the alternate nose holding technique is an indication of _____________.

submucous cleft or velopharyngeal insufficiency (VPI)

a bifid uvula is sometimes indicative of: (2)

diagnostic triad

What should help you identify a submucous cleft?

neurologic involvement

Asymmetry of faucial arches or deviation of the uvula to one side is indicative of:

weak, strong

In the case of asymmetry of the faucial arches, the arches will tend to “droop” to the ____ side and the uvula will deviate to the ______ side upon elevation

True

T/F: enlarged tonsils are often observed and usually have no adverse effect on a child’s speech but at times are associated with general health, resonance, hearing problems, and forward tongue carriage which in turn could affect speech production

velopharyngeal weakness, neurologic involvement

Weak or absent gag reflex could indicate: (2)

True

T/F: absent gag reflex is normal for some individuals

hypersensitivity

hyperactive gag reflect is indicative of ____________ and may require the clinician to desensitize the child or may prohibit the use of tongue blade in mouth.

oral

Children with ____ hypersensitivity may have trouble using a tooth brush or be extremely picky eaters.