ORAL EXAM

1. Before you touch the patient

First, review the patient’s medical history completely and make sure they are formally checked into the clinical system. Pull up the electronic oral examination sheet so you can follow it in order.

Then approach the patient:

“I’m going to complete your oral examination today. I’ll start by feeling around your head, face, and neck, and then I’ll take a look inside your mouth. The outside portion is basically a gentle palpation—it may feel a little like a massage. If anything feels tender or uncomfortable, just let me know.”

Recline the patient into your normal supine treatment position.

Give them protective eyewear.

“I’m going to have you put these glasses on for eye protection while you’re reclined.”

Then position yourself appropriately for your dominant hand.

EXTRAORAL EXAM

2. TMJ / preauricular area

Stand or sit behind/beside the patient.

Place your fingers directly in front of both ears, over the TMJs.

Say:

“I’m going to feel your jaw joints now. Open… close… open… close.”

While they move, feel for:

smooth movement
popping
clicking
crepitus
deviation left or right

If you feel something:

“Do you have any pain or discomfort when your jaw does that?”

Mental checklist:

TMJ = movement + sound + deviation + pain

Document anything abnormal and specify right, left, or bilateral.

3. Occipital region

Move your hands behind their head.

Palpate along the occipital bone/base of the skull, then slightly down the posterior neck.

Say:

“I’m going to feel along the back of your head and neck. Let me know if anything feels tender.”

Feel for:

tenderness
swelling
asymmetry
enlarged nodes or unusual masses

4. Parotid region

Move your fingers around the cheek area just anterior/inferior to the ears.

Gently palpate the parotid gland region bilaterally.

Look and feel for:

enlargement
tenderness
asymmetry

5. Facial landmarks

Visually observe the nasion, at the bridge of the nose.

Then move down toward the chin and palpate the mentalis/mental region.

You’re also casually scanning the face for:

moles
macules
scars
lesions
asymmetry

If you notice a significant skin lesion:

“Has your doctor or dermatologist looked at this area before?”

LYMPH NODES

6. Submandibular nodes

Place your fingers underneath the mandible.

Palpate inferior and medial to the mandibular border, moving systematically from one side to the other.

Think:

Under the jaw = submandibular.

Feel for:

tenderness
enlargement
firmness
mobility

7. SCM and cervical chain

Say:

“Turn your head all the way to the left for me.”

This makes the opposite SCM easier to palpate.

Palpate:

anterior to SCM
along SCM
posterior to SCM
deeper cervical region

Work downward toward the clavicle.

Then:

“Now turn your head all the way to the right.”

Repeat on the other side.

Your hands are basically tracing the cervical lymph node chain.

THYROID

8. Thyroid examination

Say:

“Now face straight ahead for me.”

Locate the region around the larynx and trachea.

Gently palpate both sides of the thyroid.

Then say:

“Go ahead and swallow for me.”

Feel the thyroid move while the patient swallows.

Assess:

symmetry
smoothness
enlargement
nodules
abnormal movement

Now you’ve completed the major extraoral examination.

Document your findings before moving on if needed.

INTRAORAL EXAM

9. Initial mouth scan

Say:

“Go ahead and open nice and wide.”

Before immediately touching anything, perform a quick overall inspection.

You’re asking yourself:

Is there anything acute that changes what I do today?

Look for:

open sores
active infection
major swelling
ulcerations
obvious suspicious lesions

LIPS + LABIAL MUCOSA

10. External lips

Look at the lips first.

Check for:

chapping
cold sores/herpes
trauma
bruising
lesions

Then gently pull the lower lip outward/downward.

Say:

“I’m going to pull your lip down so I can look at the tissue.”

Inspect:

lower labial mucosa
mandibular vestibule
mandibular labial frenum

Then retract the upper lip.

Inspect:

upper labial mucosa
maxillary vestibule
maxillary labial frenum

BUCCAL MUCOSA

11. Cheeks

Use your mirror to retract one cheek.

Inspect the entire buccal mucosa.

Then repeat on the other side.

You’re looking for things like:

Fordyce granules
trauma
ulcerations
linea alba
color changes

If you see the horizontal white line at the biting plane:

Linea alba.

Document:

“Bilateral linea alba.”

Not just “linea alba.” You need the location.

FLOOR OF MOUTH + LINGUAL MANDIBLE

12. Floor of the mouth

Have the patient lift their tongue.

Say:

“Lift your tongue up toward the roof of your mouth for me.”

Use your fingers/mirror to inspect and palpate the floor of the mouth bilaterally.

Then inspect along the lingual mandibular alveolar process.

If you feel hard bony bumps:

Mandibular tori.

You could explain:

“Those are called tori. They’re just benign areas of extra bone and are a normal anatomical variation.”

Document:

“Bilateral mandibular tori, lingual alveolar process.”

PALATE

13. Hard palate

Say:

“Open wide for me.”

Use your mirror and inspect the entire hard palate.

Look for:

palatal torus
trauma
burns
ulcers
pigmentation
smoking-related tissue changes

Think especially about the classic “pizza burn.”

14. Soft palate

Move your visualization posteriorly.

Inspect the soft palate.

Remember: it may naturally have a slightly more yellowish hue than the hard palate.

Look for symmetry, lesions, redness, or unusual tissue changes.

TONGUE

15. Dorsal tongue

Say:

“Stick your tongue straight out for me.”

Inspect the top.

Identify:

filiform papillae
fungiform papillae
fissures
coating
abnormal lesions

Filiform

Hair-like and most numerous.

Fungiform

Scattered, mushroom-like papillae.

16. Lateral borders

This is a big one.

Use gauze if needed to gently hold the tongue.

Move it to one side.

Inspect the entire lateral border.

Then switch sides.

You’re especially looking for:

ulcers
red areas
white areas
masses
induration
asymmetry

Remember:

Lateral tongue = extremely important oral cancer screening area.

Posteriorly, identify the foliate papillae as the vertical folds on the sides.

17. Posterior tongue / circumvallate papillae

Say:

“Stick your tongue out as far as you can and say ‘ahhh.’”

Look toward the posterior dorsum.

Identify the larger circumvallate papillae arranged in a V-shaped pattern.

OROPHARYNX + TONSILS

18. Tonsils

Continue:

“Keep your mouth open and give me a nice deep ‘ahhh.’”

Inspect the oropharynx and palatine tonsils.

Assess:

presence
symmetry
enlargement
erythema

Normal documentation might be:

Tonsils present, symmetrical, non-erythemic.

IF YOU FIND A LESION

19. Measure it

If you find any lesion, ulcer, or growth, don’t just write “lesion.”

Grab your periodontal probe.

Measure:

length × width in millimeters

Example:

“3 mm × 3 mm ulceration on right buccal mucosa.”

You want a baseline so at the next appointment you know whether it:

resolved
stayed the same
enlarged

OCCLUSION

20. Have the patient bite

Say:

“Go ahead and bite together on your back teeth.”

Get them into maximum intercuspation.

Now examine each side.

Think:

CANINE + MOLAR.

21. Canine relationship

Look at where the maxillary canine falls relative to the mandibular teeth.

Normal canine relationship:

Maxillary canine should sit in the embrasure between the:

mandibular canine + first premolar.

Record left and right separately.

22. Molar relationship

Find the mesiobuccal cusp of the maxillary first molar.

Then see where it lands.

For Class I:

MB cusp of maxillary 1st molar → buccal groove of mandibular 1st molar.

Again, record:

right
left

If canine and molar classifications disagree, follow your program’s charting rule and use the molar relationship for the overall side classification.

OVERBITE

23. Measure vertical overlap

Keep the patient biting.

Think:

Overbite = vertical.

Place your probe so you can mark where the maxillary central incisor overlaps the mandibular central incisor.

Then say:

“Open for me.”

Measure from the mandibular incisal edge to your marked point.

Example:

Overbite = 4 mm.

Memory trick:

Bite = up/down.

OVERJET

24. Measure horizontal projection

Have them bite again.

Think:

Overjet = horizontal.

Place your probe horizontally from the facial surface of the mandibular central incisor toward the maxillary incisor.

Example:

Overjet = 3 mm.

Memory trick:

Jet shoots forward.

CROSSBITE

25. Look around the arch

While the patient is biting, look for any maxillary teeth positioned lingual to the mandibular teeth.

If none:

“Crossbite: N/A.”

GINGIVAL ASSESSMENT

Now mentally divide the mouth into areas.

26. Mandibular anterior

Inspect facial and lingual.

Look at:

color
contour
edema
stippling
papilla shape
recession
bleeding

Healthy tissue should generally appear:

pink + firm + knife-edged + stippled + papilla fills embrasure

27. Mandibular posterior

Inspect buccal and lingual on both sides.

Again assess:

color
contour
stippling
recession
papillae
inflammation

If there’s a little recession:

“Slight recession mandibular posterior.”

28. Maxillary anterior

Check facial and lingual.

Pay attention to stippling here.

Think:

Orange peel = stippling = healthy attached gingiva.

29. Maxillary posterior

Inspect buccal and lingual bilaterally.

Then record any bleeding points.

If none:

Bleeding = 0.

HARD TISSUE CHECK

30. Scan the teeth

Now examine for hard tissue abnormalities.

Attrition

Tooth against tooth.

Think:

Grinding.

Abrasion

Outside object mechanically wears the tooth.

Think:

Toothbrush.

Erosion

Chemical loss.

Think:

Acid.

Decalcification

Chalky white demineralized enamel.

Think:

White spot lesion.

Fluorosis

Developmental fluoride-related mottling.

Also look for developmental defects such as:

enamel hypoplasia
amelogenesis imperfecta

STAIN

31. Identify stain

Look at whether stain is on or inside the tooth.

Extrinsic

Outside surface.

Examples:

coffee
tobacco
brown
black
green
orange

So your patient might be documented:

“Slight brown extrinsic stain associated with coffee consumption.”

Intrinsic

Inside the tooth.

Examples:

tetracycline
non-vital tooth
root canal-related discoloration
developmental discoloration
some restorative changes

FINAL DOCUMENTATION

32. Finish your charting

Before leaving the exam, mentally run through:

Did I document every abnormal finding?

For every lesion or finding, think:

WHAT + WHERE + SIDE + SIZE

Example:

Bilateral mandibular tori on lingual alveolar process.

3 × 3 mm ulceration, right buccal mucosa.

Bilateral linea alba.

If everything is normal:

WNL — Within Normal Limits

And if something significant is abnormal, make sure it appears in the proper oral exam section and in your broader clinical note according to your program protocol.

Your super-short “performance order”

When you’re nervous, memorize this sequence:

History → explain → glasses → TMJ → head/neck → glands/nodes → thyroid → lips → cheeks → floor → palate → tongue → tonsils → occlusion → OB/OJ → gingiva → teeth/stain → document.

Or even shorter:

OUTSIDE → INSIDE → BITE → GUMS → TEETH → CHART.