Examination of the Oral Cavity and Pharynx

Examination algorithm and methodology

The examination requires minimal instrumentation — a medical tongue depressor (which can be replaced by an ordinary clean spoon at home or in the field) and a good light source. The primary examination method is visual inspection, though thorough patient questioning and history-taking provide important additional diagnostic information.

Examination of anatomical structures is performed in a strict sequence to avoid missing any single structure:

1. Vestibule of the mouth: the physician examines the inner surface of the lips, visualizes the teeth and gums from all sides, and assesses the condition of the buccal mucosa.
2. Oral cavity: the tongue (including its dorsum, lateral and inferior surfaces) and the hard palate are examined in detail.
3. Fauces and pharynx: the palatine arches, tonsils, soft palate (velum palatinum), palatine uvula (uvula), and posterior pharyngeal wall are assessed.

When examining deep structures of the fauces, the patient should open their mouth wide without protruding the tongue and pronounce the sound "ah-ah". If visualization is difficult, the physician may gently press the root of the tongue with a depressor. The key diagnostic sign at this stage is the symmetry of all anatomical structures. Any deviation of the uvula to the side is pathological and may indicate soft palateparesis or the formation of a peritonsillar abscess.

Lip examination: normal and pathological findings

External inspection of the lips assesses their color, level of moisture, and the presence of pathological elements such as nodules, fissures, or ulcers. Several characteristic pathological conditions are distinguished:

• Herpes simplex (Herpes labialis): a viral disease manifesting as vesicular rashes — pinhead-sized vesicles with clear contents. Localized on the lips, at the base of the nose, and more rarely on the forehead. It frequently acts as a marker of transient or permanent immunodeficiency, and also accompanies severe illnesses (e.g., lobar pneumonia).
• Angular cheilitis (angular stomatitis): begins with softening of the skin at the corners of the mouth, followed by the formation of fissures turning into weeping erosions or ulcers. Causes are divided into alimentary (malnutrition, riboflavin/vitamin B₂ deficiency) and dental (missing teeth or incorrect dentures leading to a decreased bite height).
• Angioedema (Quincke's edema): a type I hypersensitivity allergic reaction, most commonly to oral allergens (food or medications). Manifests as rapidly developing, diffuse, dense edema of the dermis and underlying tissues, which resolves within hours or days.

Within the framework of differential diagnosis, one should remember the risk of lip cancer (more commonly affecting the lower lip as a plaque, nodule, or ulcer) and primary syphilis (chancre). A hard chancre appears as a painless superficial ulcer on a firm base and can have extragenital localization, including the lips, oral cavity, and pharynx, which is especially relevant due to rising incidence rates.

Assessment of teeth and gums

Tooth examination records their quantity, color, shape, arrangement, and the presence of carious cavities. The number of teeth directly affects chewing efficiency; the absence of molars makes this process inadequate. Changes in enamel color often serve as a marker of smoking or poor hygiene. If caries is suspected, the patient is referred to a dentist. If progressive caries is combined with pronounced dry mouth (xerostomia), Sjögren's syndrome ("dry syndrome") must be ruled out.

Gum examination aims to detect periodontitis, which manifests as inflammation of the free gingival margin, bleeding, and the accumulation of pus between the teeth as it progresses.

Important cardiac risk: periodontitis can cause transient bacteremia — the entry of Streptococcus viridans into the bloodstream. For patients with heart defects, this poses a serious threat of developing infective endocarditis, requiring mandatory prophylaxis.

Gum bleeding requires differential diagnosis. It can be caused by both local factors (gingivitis, trauma from teeth brushing) and systemic pathologies (hematological diseases, systemic vasculitis).

The tongue as an indicator of health

The condition of the tongue has high diagnostic value as it reflects the functioning of the gastrointestinal tract, blood system, and nervous system. Normally, the tongue is pink or red, and its papillae are well-defined. The color may temporarily change due to food colorings.

• Neurological disorders: motor disorders or asymmetry of the tongue when protruded are a classic sign of hypoglossal nerve lesion.
• Surface changes: coating of the tongue with a thick plaque is typical of various digestive disorders. Smoothing of the pattern (papillary atrophy) is diagnostically significant in blood and gastrointestinal diseases.
• Macroglossia (enlargement of the tongue): a pathological condition in which the tongue increases in volume, impairing chewing and swallowing. One of the visual signs of macroglossia is dental impressions along the lateral margins of the tongue. A possible cause of such enlargement is amyloidosis.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Pathogenesis of the type I hypersensitivity allergic reaction in Quincke's edema
• The connection between herpes simplex virus and severe pneumonias and immunodeficiency states
• Differential diagnosis of systemic causes of gum bleeding (vasculitis and hematology)
• Sjögren's syndrome: mechanisms of xerostomia and multiple dental caries development
• Amyloidosis as a systemic cause of macroglossia development

Other topics in the "Digestive System" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.