The mouth is the beginning of the passageway to the digestive tract, but it also functions in the entry or exit of air. The major structure of the exterior of the mouth is the lips. The doctor should note the presence of painful, inflamed and dried cracks or fissures of the lips, called cheilitis. These may be caused by exposure to harsh climatic conditions, habitual licking or biting of the lips, particularly with fever in systemic disease. Cheilitis, or angular stomatitis, is fissuring at the angles or corners of the lips and may indicate vitamin deficiencies of riboflavin or niacin.
Any lesions on the lips are noted. The herpes simplex virus produces singular or clusters of vesicular eruptions on the lip, which are often called “cold sores”. The lip may also be the site of a primary syphilitic chancre, which appears as a firm nodule that ulcerates and crusts. If one suspects a chancre, it is examined with a gloved hand for the doctor’s protection.
The mouth and throat are divided into three areas
- the oral cavity, which extends from the lips to the palatopharyngeal arches
- the oropharynx, which extends from the epiglottis to the lower edge of the adenoids
- the nasopharynx, which extends from above the lower edge of the adenoids to the nasal cavity.
The major structures that are visible on examination within the oral cavity and oropharynx are the mucosal lining of the lips and cheeks, gums or gingival, teeth, tongue, palate, uvula, tonsils and posterior oropharynx. Other pharyngeal structure that are not visible one examination are the epiglottis, lingual tonsils, and pharyngeal tonsils or adenoids.
Infants and toddlers, however, usually resist attempts to keep the mouth open. This is because it is an upsetting part of the examination, it is reserved until last (wit examination of the ears) or performed during episodes of crying. However, the use of a tongue blade to depress the tongue is necessary. The tongue blade is placed along the side of the tongue, not the center back area where the gag reflex is elicited. If the child resists in opening his mouth, pinching the nostrils closed forces the child to breathe by mouth and, therefore, open the mouth.
All areas lined with mucous membranes (inside the lips and cheeks, gigiva, underside of tongue, palate, back of pharynx) are inspected, noting color, any areas of white patches or ulceration, bleeding, sensitivity, and moisture. The membranes should be bright pink, smooth, glistering, uniform, and moist. Any deviations are noted. For example, reddened areas with white ulcerated centers may be canker sores (aphthae), which may be caused by trauma to the gums during toothbrushing or chewing.
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