This article provides a guide to performing an examination of the oral cavity in an OSCE setting.

Check out our oral cavity examination OSCE mark scheme here.


Preparation

Ensure you have the correct equipment available:

  • Gloves
  • Headlight
  • Tongue depressors (x2)

Introduction

  • Wash hands
  • Introduce yourself to the patient
  • Confirm the patient’s details (name/DOB)
  • Explain the examination
  • Gain verbal consent
  • Ask if the patient currently has any pain
  • Ask the patient if they have any dentures/implants that should be removed
  • Put on headlight (if available)

General inspection

Ask the patient to open their mouth and say “AHHHH”:

  • Perform general inspection of the oral cavity
  • Assess mouth opening for pain and trismus
Oral cavity anatomy OSCE

Anatomy of the oral cavity 1


Closer inspection

Using one tongue depressor to gently depress the tongue, examine the:

  • Lips: colour, ulceration, swelling, angular stomatitis
  • Tongue: candida, glossitis, ulceration, swelling, rarer conditions (black hairy tongue, Kaposi’s sarcoma)
  • Soft palate, hard palate, uvula: swelling, ulceration, papillomas
  • Tonsils and pillars: enlargement, asymmetry, peritonsillar swelling, ulceration, inflammation and tonsillar stones

Using one tongue depressor move the tongue to either side and examine:

  • Buccal mucosa: ulceration, leucoplakia and trauma
  • Stensen’s duct: stones and discharge

Using two tongue depressors examine the:

  • Teeth, gums and alveolar margins
  • Look for missing teeth, nicotine staining, swelling, leucoplakia, tooth decay, gingivitis and periodontal disease
Gingivitis

Gingivitis

Ask the patient to lift their tongue to the roof of their mouth:

  • Inspect the opening of the submandibular ducts and the floor of mouth
  • Look for ulceration, stones and swellings
Salivary stone in submandibular salivary duct

Salivary stone in submandibular salivary duct 2


Palpation

If permitted by the patient and examiner, proceed to bimanual palpation of the mouth.

Bimanual palpation of the mouth

Bimanual palpation technique

  • Don gloves
  • With one finger palpating the neck externally and the other gloved finger in the oral cavity, gently palpate any identified lumps from both sides
  • Palpate the lateral wall of the mouth: parotid gland and duct
  • Palpate the floor of the mouth: submandibular gland and sublingual gland
  • Any intraoral swelling should be described according to site, size, thickness, colour, texture, consistency and tenderness

To complete the examination…

  • Thank the patient
  • Dispose of gloves and tongue depressors
  • Wash your hands
  • Summarise your findings to the examiner

Other examinations and investigations to suggest:

  • A full examination of the neck, ears and temporomandibular joint
  • Flexible nasal endoscopy
  • Orthopantomogram if any poor dentition
  • Ultrasound neck +/- fine needle aspiration (FNA) for neck and salivary gland lumps
  • CT and MRI for any suspected oropharyngeal cancer

Example summary

“Today I performed an examination of the oral cavity on Mr Smith, a 30-year-old man who presented with a submandibular swelling. The most obvious finding on inspection was a small, erythematous swelling in the floor of his mouth. On bimanual palpation, the lump was hard, non-tender and immobile. To complete my assessment I would like to do a full examination of the neck and arrange an ultrasound scan of the lesion.”


References

1. Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons

2. James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0, from Wikimedia Commons

3. Klaus D. Peter, Gummersbach, Germany [CC BY 3.0 de (https://creativecommons.org/licenses/by/3.0/de/deed.en)], from Wikimedia Commons

4. Clara Polo Sabat [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

5. GalliasM [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

6. DRosenbach [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0, from Wikimedia Commons


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