Week 6, Tuesday

Mouth and Throat ppt

Key components of the Mouth and Pharynx Examination:

  • Inspect (color, symmetry, lumps, ulcerations/lesions):

    • lips

    • oral mucosa

    • gingiva

    • gums

    • teeth

    • roof and floor of the mouth

    • tongue

    • soft palate

    • anterior and posterior pillars

    • uvula

    • tonsils

    • pharynx

  • Palpate (if lesions or thickening):

    • Oral mucosa

    • Tongue

  • Test (for symmetry):

    • The Hypoglossal nerve (CN XII)

    • The Vagus Nerve (CN X)

32 teeth in an adult mouth (including wisdom teeth)

Papillae cover the tongue’s dorsal surface, but are absent on the underside

  • Submandibular Ducts = Wharton’s Duts

    • Under the tongue

  • Torus Mandibularis = bony prominence where the Submandibular Duct runs

Illnesses and their Risk Factors:

  • Oral CA:

    • 2-3:1 Male:Female

    • Tobacco use

    • Alcohol use

    • 75% HPV

    • Men age >50, smokers and heavy users of chewing tobacco and alcohol use are at highest risk for cancers of the tongue and oral cavity

      • usually squamous cell carcinomas on the side or base of the tongue

      • Any persistent nodule or ulcer, red or white, is suspect, especially if induration occurs

        • These discolored lesions represent erythroplakia and leukoplakia, respectively, and should be biospied

          • If you scrape white induration and it leaves little blood spots, definitely biopsy that because it is leukoplakia

  • Oral Candidiasis

    • Thrush

    • C. Albicans, mc

    • Common in children, nursing home residents, denture wearers, and (HIV, Db) immunocompromised

    • May follow antibiotic or immunosuppressant therapy

    • Pain may decrease appetite

    • Iron deficiency (ferritin- antifungal)

    • “Cottage cheese” -like

  • Asymmetric protrusion of tongue

    • suggests a lesion of CN XII

    • Tongue points toward the side of the lesion

  • Geographic Tongue:

    • Benign

    • White varying sections on tongue

  • Black Hairy Tongue

    • Candida

    • Bacteria

    • Antibiotics

    • Spontaneous

  • Smooth Tongue

    • B vitamin or Iron deficiency

  • Streptococcal Pharyngitis:

    • Use rapid antigen testing or culture and Sensitivity

    • Exudate

    • Patechiae

  • Koplik’s Spots

    • Measles is a viral infection caused by Paramyxovirus

    • Measles is predominantly the disease of children, which appear in winter and spring following incubation period of 7-10 days

    • Koplik’s spots have been reported in 97% of children

      • After 1-2 days follow prodromal symptoms and 2-3 days before the developments of skin lesion (cutaneous rash of measles)

      • Spots begin to exist

  • Gingivitis

    • Red, swollen gums

  • Dental Caries/ Cavities

    • Transitions:

      • Enamel caries

      • Dentin caries

      • Pulpitis

      • Periodontitis

  • Attrition of Teeth, Recession of Gums

    • Wearing down of dental enamel and receding of gingiva

    • “Long in the tooth”

  • Erosion in Bulima exposes the darker dentin

  • Hutchinson Teeth

    • Congenital syphilis

    • Permanent teeth are notched and have a tapered contour

    • Central incisors are mc affected

Pharynx

  • visible posterior to the Uvula

  • Back of the throat

Parotid Ducts

  • “Stenson’s Ducts”

  • In cheek

Recording your findings:

  • throat (or mouth)

    • Oral mucosa pink dentition good, tongue midline, tonsils absent bilaterally, pharynx without exudates or erythema

  • OR

    • Oral mucosa pink, dental caries in lower molars, tongue midline, pharynx erythematous, bilateral tonsils enlarged, no exudates