Unit 5A.8: MOUTH & PHARYNX Assessment | Eyes, Ears, Nose & Sinuses, Mouth & Pharynx, Neck

1. Lips

2. Teeth and gums

3. Buccal mucosa

4. Inspect and palpate the tongue

5. Inspect hard (anterior) and soft (posterior) palates and uvula

6. Note odor.

7. Assess uvula.

8. Inspect Tonsils.

9. Test gag reflex.

9 Steps for Mouth & Pharynx Assessment

1. Lips

First Step for Mouth & Pharynx Assessment

Lips are smooth and moist without lesions or swelling

Normal Finding for 1. LIps

1. Circumoral Pallor

2. Cyanotic Lips

3. Reddish Lips

4. Edema

Abnormal findings for 1. Lips

Circumoral Pallor

Abnormal findings for 1. Lips

• Pallor around the lips

• Seen in anemia and shock

• Anemia

• Shock

What conditions cause circumoral pallor?

Bluish/Cyanotic Lips

Abnormal findings for 1. Lips

• May result from cold or hypoxia

• Oxygenation; cardiac arrest

• Cold

• Hypoxia

What conditions cause cyanotic lips?

Reddish Lips

Abnormal findings for 1. Lips

• Seen in clients with ketoacidosis, carbon monoxide poisoning, COPD with polycythemia, liver problems

• Ketoacidosis

• Carbon Monoxide Poisoning

• Chronic Obstructive Pulmonary Disease (COPD) with polycythemia

What conditions cause Reddish Lips?

Edema/Swelling of the Lips

Abnormal findings for 1. Lips

• Common in local or systemic allergic or anaphylactic reactions

1. Herpes Simplex Type 1

2. Cheilosis of the Lip

3. Carcinoma of the Lip

4. Leukoplakia (Ventral Surface)

5. Hair Leukoplakia (Lateral Surface)

6. Candida Albicans Infection (Thrush)

7. Smooth, reddish, shiny tongue without papillae due to Vitamin B12 deficiency

8. Black hairy tongue

9. Carcinoma od tongue

10. Cankersore

10 Common Abnormalities of the Mouth

Herpes Simplex Type I

One of the 10 Common Abnormalities of the Mouth

• Crust

• Commonly known as oral herpes or cold sores

• Viral infection that manifests as small, painful, fluid-filled blisters or ulcers, usually around the lips or mouth

• Often recur, especially during stress, illness, or weakened immunity

Cheilosis of the Lips/Angular Cheilitis

One of the 10 Common Abnormalities of the Mouth

• Inflammatory condition that causes cracking, crusting, and scaling of the corners of the mouth

• Painful, red, inflamed fissures or cracks at corners of the mouth

• Can be caused by fungal or bacterial infections, vitamin deficiencies, (especially Vitamin B2 or riboflavin), or drooling

• May also occur in people with poorly fitted dentures or those who frequently lick their lips

• Vitamin B2

• Riboflavin

Deficiencies in what vitamins may cause Cheilitis?

• Fungal or bacterial infections

• Vitamin B2 Deficiency

• Riboflavin Deficiency

• Drooling

• Poorly fitted dentures

• Frequent lip lickers

What is Cheilitis caused by?

Carcinoma of the Lip

One of the 10 Common Abnormalities of the Mouth

• Malignant tumor, typically a squamous cell carcinoma that develops on the lip, most commonly the lower lip

• May appear as a persistent sore, ulcer, or lump that does not heal

Leukoplakia (Ventral Surface)

One of the 10 Common Abnormalities of the Mouth

• Development of thickened, white patches on the mucous membranes of the mouth, particularly on the ventral (underside) surface of the tongue or inner cheeks

• Patches cannot be scraped off and signal a pre-cancerous condition, especially individuals who smoke or use alcohol excessively

Those that smoke or use alcohol excessively.

What individuals usually have leukoplakia?

Hairy Leukoplakia

One of the 10 Common Abnormalities of the Mouth

• Viral infection of the mouth often seen in individuals with compromised immune systems, particularly those with HIV/AIDS

• Appears as white, hairy-looking patches on the lateral sides of the tongue

HIV/AIDS

What condition causes Hairy Leukoplakia?

Candida Albicans

One of the 10 Common Abnormalities of the Mouth

• Fungal infection caused by an overgrowth of Candida albicans in the mouth

• Presents as creamy white, curd-like patches on the tongue, inner cheeks, gums, or throat, which may be painful or cause a burning sensation
  patches can be scraped off, leaving a red or bleeding surface

Smooth, reddish, shiny tongue without papillae due to vitamin B12 deficiency

One of the 10 Common Abnormalities of the Mouth

• Often indicative of glossitis caused by vitamin B12 deficiency

• Results from atrophic glossitis, loss of tongue papillae, making tongue appear smooth and inflamed

• Commonly associated with pernicious anemia and can cause a burning sensation or discomfort when eating

Vitamin B12

Deficiency in what vitamin causes a smooth, reddish, shiny tongue?

Black Hairy Tongue

One of the 10 Common Abnormalities of the Mouth

• Papillae on surface of tongue become elongated and darkened, giving appearance of black hair

• Caused by an overgrowth of bacteria or yeast, often due to poor oral hygiene, smoking, certain mediations (like antibiotics), or excessive use of mouthwashes

• Poor oral hygiene

• Smoking

• Certain medications (like antibiotics)

• Excessive mouthwash use

What may cause bacteria or yeast overgrowth that causes a Black Hairy Tongue?

Carcinoma of Tongue

One of the 10 Common Abnormalities of the Mouth

• Usually squamous cell carcinoma

• Type of oral cancer that manifests as a non-healing sore or lesion on the tongue

• May appear as a red or white patch an ulcer, or a lump on the tongue’s surface

Cankersore

One of the 10 Common Abnormalities of the Mouth

• Small, painful, round or oval ulcer that forms inside the mouth, typically on the inner cheeks, gums, or tongue

• Ulcer has a white or yellowish center with a red, inflamed border

• Triggers may include stress, minor mouth injuries, food allergies, and certain vitamin deficiencies

2. Teeth & Gums

Second Step of Mouth & Pharynx Assessment

1. Ask client to open mouth. Note number of teeth, color, and condition.

2. Ask client to bite down and note alignment of lower and upper jaws.

3. Put on gloves and retract client’s lips and cheeks to check gums for color and consistency.

How to assess 2. Teeth & Gums?

• 32 pearly whitish teeth with smooth surfaces and edges

• No decayed areas; no missing teeth

• Gums are pink, moist, and firm with tight margins to the tooth. No lesions or masses.

Normal Findings for 2. Teeth & Gums

1. Yellow or Brownish Teeth

2. Caries

3. Missing Teeth

4. Chalky White Area

5. Malocclusion

6. Brown or yellow stains or white spots

7. Red, swollen gums

8. Receding Gums with loss of teeth

9. Hyperplasia

10. Bluish-Black or Grey-White Line

Abnormal findings for 2. Teeth & Gums

Malocclusion

Abnormal findings for 2. Teeth & Gums

• Seen when upper and lower incisors protrude

Red, Swollen Gums

Abnormal findings for 2. Teeth & Gums

• Seen in gingivitis, scurvy (Vitamin C deficiency) and leukemia

• Gingivitis

• Scurvy (Vitamin C deficiency)

• Leukemia

What cause red, swollen gums?

Hyperplasia

Abnormal findings for 2. Teeth & Gums

• Enlarged reddened gums that may cover some of the normally exposed teeth

• May be seen in pregnancy, puberty, leukemia, and use of some medications, such as phenytoin

• Pregnancy

• Puberty

• Leukemia

• Medications (Phenytoin)

What may hyperplasia be seen in?

Periodontitis

Where are receding red gums with loss of teeth seen in?

Lead Poisoning

When are bluish-black or grey-white line along the gum line seen in?

3. Buccal Mucosa

Third Step of Mouth & Pharynx Assessment

1. Use penlight and tongue depressor to retract lips and cheeks to check color and consistency

2. Note Stenson’s Ducts

How to assess 3. Buccal Mucosa?

• Buccal mucosa should appear pink in light-skinned clients

• Tissue is smooth and moist without lesions

• Stenson’s ducts are visible with flow of saliva and with no redness, swelling, pain or moistness

• Fordyce spots

Normal Findings for 3. Buccal Mucosa

Fordyce Spots

Normal Finding for 3. Buccal Mucosa

• Yellowish-whitish raised spots

• Normal ectopic sebaceous glands

Leukoplakia

Abnormal Findings for 3. Buccal Mucosa

• May be seen in chronic irritation and smoking

• ‭Precancerous ‬‭lesion,‬ ‭whitish patch and painless‬

Yellow Brown Coating

Other than leukoplakia, what may be seen on smoker's tongues?

4. Inspect & palpate the tongue

Fourth Step of the Mouth & Pharynx Assessment

• Tongue pink, moist, moderate size with papillae present

• No lesions

Normal Findings for 4. Inspect & palpate the tongue

1. Deep longitudinal fissures

2. Black tongue

3. Smooth, reddish, shiny tongue

4. Enlarged tongue

5. Small tongue

6. Atrophied tongue

Abnormal Findings for 4. Inspect & palpate the tongue

Deep longitudinal fissures

Abnormal Findings for 4. Inspect & palpate the tongue

• Seen in dehydration

Dehydration

When are deep longitudinal fissures seen?

Black Tongue

Abnormal Findings for 4. Inspect & palpate the tongue

• Indicative of bismuth (Pepto-Bismol) toxicity

Bismuth (Pepto-Bismol) toxicity

When is black tongue seen?

Enlarged Tongue

Abnormal Findings for 4. Inspect & palpate the tongue

• Suggest hypothyroidism, acromegaly, or Down’s Syndrome, and angioneurotic edema of anaphylaxis

• Niacin/Vitamin B12 Deficiency

• Anemia

• Antineoplastic Therapy

What does a smooth, reddish shiny tongue without papillae indicate?

1. Hypothyroidism

2. Acromegaly

3. Down’s Syndrome

4. Angioneurotic Edema of Anaphylaxis

What does an enlarged tongue suggest?

Small Tongue

Abnormal Findings for 4. Inspect & palpate the tongue

• Suggests malnutrition

Malnutrition

What does a small tongue suggest?

Atrophied Tongue/Fasciculations

Abnormal Findings for 4. Inspect & palpate the tongue

• Point to cranial nerve damage: Hypoglossal, CN 12

Hypoglossal, CN XI

Damage of what nerve does an atrophied tongue/fasciculations indicate?

5. Hard (anterior) and soft (posterior) palates and width

Fifth Step for Mouth & Pharynx Assessment

• Hard palate is pale or whitish with firm, transverse rugae

• Torus Palatinus

• Soft palate pinkish, movable, spongy and smooth

Normal Findings for 5. Hard (anterior) and soft (posterior) palates and width

Torus Palatinus

Normal Finding for 5. Hard (anterior) and soft (posterior) palates and width

• Bony protuberance in the midline of the hard palate

• More often in females, Native Americans, and Asians

1. Thick white plaques on hard palate

2. Kaposi’s Sarcoma

3. Yellow Tint

4. Cleft Palate

Abnormal Findings for 5. Hard (anterior) and soft (posterior) palates and width

Thick white plaques

Abnormal Findings for 5. Hard (anterior) and soft (posterior) palates and width

• Candidal infection

Karposi’s Sarcoma

Abnormal Findings for 5. Hard (anterior) and soft (posterior) palates and width

• Deep purple, raised, or flat lesions

Yellow Tint

Abnormal Findings for 5. Hard (anterior) and soft (posterior) palates and width

• May indicate jaundice since bilirubin adheres to elastic tissue (collagen)

Cleft Lip/Palate

Abnormal Findings for 5. Hard (anterior) and soft (posterior) palates and width

• Congenital

• Opening in the hard palate

6. Note odor

Sixth Step of Mouth & Pharynx Assessment

No unusual or foul odor noted

Normal finding for 6. Note Odor

1. Fruity/Acetone Breath

2. Ammonia

3. Foul Odors

4. Fecal Breath Odor

5. Sulfur Odor (Fetor Hepaticus)

Abnormal findings for 6. Note Odor

Fruity/Acetone Breath

Abnormal findings for 6. Note Odor

• Associated with diabetic ketoacidosis

Diabetic Ketoacidosis

What is a fruity/acetone breath indicative of?

Ammonia Odor

Abnormal findings for 6. Note Odor

• Associated with Kidney Disease

Kidney Disease

What is an ammonia breath indicative of?

Foul Odors

Abnormal findings for 6. Note Odor

• Indicate oral or respiratory infection, or tooth decay

• Oral or respiratory infection

• Tooth decay

What is a foul breath indicative of?

Fecal Breath Odor

Abnormal findings for 6. Note Odor

• Occurs in bowel obstruction

Bowl Obstruction

What is a fecal breath indicative of?

Sulfur Odor (Fetor Hepaticus)

Abnormal findings for 6. Note Odor

• Occurs in endstage liver disease

Enstage liver disease

What is a Sulfur Odor (Fetor Hepaticus) indicative of?

7. Uvula

Seventh Step of Mouth & Pharynx Assessment

1. Apply tongue depressor to tongue and shine penlight into client’s wide-open mouth

2. Ask client to say “aaah” snd watch for uvula and soft palate to move

How to assess 7. Uvula?

• No redness of or exudate form uvula or soft palate

• Midline elevation of uvula and symmetric elevation of the soft palate

• Bifid Uvula

Normal findings for 7. Uvula

Bifid Uvula

Normal findings for 7. Uvula

• Common in Native Americans

• Looks like uvula is split in two or partially severed

1. Asymmetric movement or loss after stroke

2. Palate fails to rise and uvula deviates to normal side

Abnormal findings for 7. Uvula

Cerebrovascular (Stroke)

When does asymmetric movement or loss of movement of the uvula occur?

Vagus CN X

Paralysis of what cranial nerve causes the palate to fail to rise and the uvula to deviate to the normal side?

8. Tonsils

Eighth Step for Mouth & Pharynx Assessment

• Tonsils pink and symmetric and may be enlarged to +1 for healthy clients

• No exudate, swelling, or lesions

Normal Findings for 8. Tonsils

+1

Tonsil Grade

• Tonsils occupy less than 25% of the oropharyngeal width

+2

Tonsil Grade

• Tonsils occupy 26-50% of the oropharyngeal width

+3

Tonsil Grade

• Tonsils occupy 51-75% of the oropharyngeal width

+4

Tonsil Grade

• Tonsils occupy more than 75% of the oropharyngeal width

9. Gag reflex

Ninth Step of Mouth & Pharynx Assessment

Gag reflex intact

Normal Finding for 9. Gag Reflex

• Glossopharyngeal (CN IX)

• Vagus (CN X)

Lesions in what cranial nerves cause an absent gag reflex?

Aphthous Ulcer

Cankersore

Koplik Spots

Peculiar spots present on buccal mucosa, whitish spots and be scrapped off

Measles

Receding Gums

Gums atrophy

Tonsillitis

Inflammation of tonsil (palatine) with yellowish exudate