Transcription
Evaluate the lip area and labial commissures. Visually check the maxillary and mandibular anterior and posterior vestibule areas.
This is a great time to check each of the frenum and attached gingival areas. Visually assess the buccal and labial mucosa. Then palpate bidigitally the labial mucosa and then bimanually palpate the buccal mucosa using the middle and ring finger, so as not to smear saliva across the cheek.
Examine the ventral tongue and floor of the mouth. Examine the dorsal tongue and then the lateral borders of the tongue by wrapping gauze around the end of the tongue and pulling it left to right. Be sure to take your mirror back there for illumination and indirect vision of that hard-to-see area. While I have my mirror, I will check the maxillary tuberosity and retromolar pads. Then have the patient protrude the tongue and digitally palpate the tongue. Then reach back far under the tongue and bimanually palpate the left and right side. Once again, using the middle and ring finger under the mandible, as not to smear saliva.
You can test the function of the submandibular gland by wiping Wharton's duct with gauze and compressing next to it with a cotton-tipped applicator. Note how long it took for the saliva to appear. You can do this as well to the parotid papilla on Stensen's duct. Then assess the hard and soft palate structures; then have the patient say “ah” to relax and lower the posterior portion of the tongue and evaluate the uvula, anterior and posterior faucial pillars, tonsils in the oropharynx area. Then palpate the anterior hard palate without going too far back to stimulate the gag reflex. Then document any abnormalities.