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| Te invitamos a visitar la sección de Cirugía Bucal,
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oral diseases
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Oral
examination
The
exam of the oral structures must be performed in all patients in a
complete and orderly fashion, under good illumination, whether natural or
artificial, providing oneself with gauze and a tongue depressor, and
making sure one one inspects and palpates:
lips, buccal mucosa, hard and soft palate, oropharynx, floor of the
mouth, tongue, gingivae and teeth. This
serves to evaluate the state of health of these structures and serves to
“see” if there are any incipient primary or secondary lesions which
characterize any condition or illness which the patient has, as well as to
interpret and correctly diagnose such lesions.
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The lips are the anteriormost
part of the mouth;
the skin surrounding them ends at a slightly raised
line which contorns them and is called the mucocutaneous
or vermillion border, from there to the mucosal union we
have a red zone also known as the labial semimucosa, a trait
characteristic of humans.
The union of upper and lower lips at the sides are
the labial commisures. |
| Lips
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Intraorally the lips
are covered by a rose-colored, smooth, glossy, wet and thin
mucosa. It
extends to the bottom of the sulcus and at the midline we
encounter a band of tissue which extends from the lips to
the gingivae and is called the labial frenum |
| Upper
lip, labial sulcus and frenum
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It is easy to visualize
the venous, arterious and capillary arborization as well
as multiple prominences corresponding to the minor salivary
glands through the lower labial mucosa |
| Lower lip, sulcus and
frenum |
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The cheeks are externally
covered by skin and intraorally
by a rose, smooth, glossy, wet, thin mucosa; buccal to the maxillary second molar we have the the opening
to Stensen´s or parotid duct, its point of exit marked by
an elevation or mucosal papilla |
| Buccal mucosa (left
side) |
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Certain
yellowish spots may be seen with relative frequency which
are situated underneath the mucosa: these are Fordyce’s
granules and correspond to intraoral sebaceous glands.
At the level of the occlusal plane we notice a whitish
line known as the “linea alba”. |
| Buccal mucosa (right side) |
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The
hard palate is covered by a pale rose mucosa, sometimes slighly bluish,
thick, firm and adherent to underlying bone; behind the incisors one
encounters the “incisal papilla”; extending distally along the
midline we have the “palatine raphe”; in the anterior third of the
palate we have the palatine “rugae”.
Frequently we can observe a hard, firm protuberance along the
midline which corresponds to a bony exostosis known as “torus
palatinus”.
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| Hard
palate
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The
soft palate is a thick fold of rosy, smooth, glossy, wet
mucosa whose free border is concave and at the midline becomes
the palatine “uvula”.
Laterally this border
divides into two folds or pillars, one anterior (glossopalatine
muscle) and the other posterior (pharyngopalatine muscle),
together making up an amygdaline fossa where we find the
palatine amygdalae. |
| Soft
palate
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The
dorsal side of the tongue is covered by a specialized mucosa containing
filiform, fungiform and circumvallate papillae; the first ones being
more numerous and covering a great extension of the dorsum; the second
ones are distributed amongst the filiform papillae and are more abundant
and noticeable at the borders and the tip of the tongue;
the circumvallate papillae are more prominent and are only 8 to
12 in number, conforming a lingual “V”.
The lateral borders of the tongue have characteristics of both
dorsal and ventral sides of the tongue, in their most posterior part we
find the folliate papillae which are more reddish in color and have some
parallel folds in between them. |
| Tongue
(dorsal surface)
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The inferior or
ventral side of the tongue is covered by a rosy, smooth, glossy, wet,
thin mucosa through which we can see the deep lingual veins; on each
side of the lingual frenulum we find the fimbriated folds.
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| Tongue
(ventral surface)
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At
the end of the lateral border (posteriorly) one appreciates the folds
of the folliate papillae. To
be able to examine this part of the tongue it is necessary to grab the
tongue with some gauze and pull it outwards and to the opposite side.
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| Right
lateral border
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The same procedure
must be followed with the other side of the tongue. |
| Left
lateral border
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The
floor of the mouth is covered by a rosy, smooth, shiny, wet and thin
mucosa; being visible and accessible in a horseshoe-shaped area
surrounding the base of the tongue. The midline is composed by the
“lingual frenulum”, being flanked laterally by certain prominences
named “sublingual caruncles” which are the openings to the
submaxillary salivary glands. Posteriorly
the floor is more elevated due to the protuberance of the sublingual
salivary glands, a mucosal fold containing Wharton’s ducts is visible over them.
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| Floor
of the mouth
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The
gingiva is made up by a mucosa which is salmon-colored, rough, orange-peel
texture, wet, thick, and firmly adhering to underlying bone; the
interdental papillae fill in the triangular spaces in between the teeth.
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| Gingiva
(gums)
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(continue)
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