A. General examination
The general examination begins as soon as the patient enters the dental office. The patient’s general appearance may give information that relates to his or her medical condition. The clinician will observe the patient’s gait, mobility, facial asymmetries, lesions or scars.

B. Extraoral head and neck examination
The extraoral head and neck soft tissue examination includes checking for asymmetries, a lymph node examination and a brief temporomandibular joint examination.

1. Asymmetries
In order to check for asymmetries, the clinician will stand in front of the patient to observe the head and neck, focusing on the area around the jaws. If a significant asymmetry exists, the clinician will ask the patient for any known causes, such as previous surgeries, scars, tumours, and infections.

2. Lymph node examination
To examine the head and neck lymph nodes and other soft tissue of the oral region, the clinician will palpate, (which means feel) the area gently to look for tenderness or enlargements. Normal lymph nodes are either not palpable, or may feel like a pea or lentil, and are not tender when touched. Abnormal lymph nodes are generally larger, may be tender, and can be an indication of an inflammation or that drainage of infection has occurred. A non-tender enlargement may indicate cancer or lymphoma.

The lymph node examination may include the areas around the ear, the base of the skull, under the jaw and chin, the neck and the area above the collar bone.

3. TMJ examination
A limited examination of the jaw joints or temporomandibular joints may also be performed at the initial dental appointment. This is done by placing the fingertips over the joints with gentle pressure. The clinician will note any tenderness, swelling or redness. Then the patient will be asked to open and close his or her mouth slowly, several times. He or she may also be asked to slowly move the lower jaw from side to side. If an abnormality is noted, further examination may be needed.

C. Intraoral soft tissue examination
The intraoral soft tissue examination includes checking the soft tissues of the mouth, the throat, the tongue and the gums.

Lips and labial mucosa

The clinician will begin by examining the lips and the mucosa inside the lips called the labial mucosa. The labial mucosa will be examined by gently turning the lip out. The labial mucosa should appear wet and shiny. Scars inside the lower lip are seen frequently as a result of trauma as a child.

Buccal mucosa and vestibular mucosa

The clinician will then examine the inside of the cheeks, called the buccal mucosa, using two mirrors to retract the buccal mucosa to one side. This examination will be performed in a thorough and stepwise manner, moving from one side to the other. The mucosa should be smooth, moist and shiny. If the mirror sticks to the mucosa, xerostomia or dry mouth may be present.

Hard and soft palate

Next, the clinician will examine the hard palate, which is the firm area of the roof of the mouth and then the soft palate, which is the soft area behind the hard palate. He or she will then briefly look at the throat. This is easier if the patient says “Ahhh”.

Tongue

The next step is to examine the tongue. The top of the tongue will be examined first, followed by the sides of the tongue, which may stretch the tongue slightly. The tip of the tongue will be held with a piece of gauze and the tongue moved from one side to the other. If there is any swelling or ulcers, then the area will be palpated. The tissue in this area should be soft. The underside of the tongue will also be examined. Particular attention should be paid to the sides of the tongue and the floor of the mouth, as cancers develop in these areas more frequently than on the top of the tongue or the palate. Oral cancers may have the appearance of ulcers, masses, red areas, or white areas.

Floor of mouth

Now the clinician will examine the floor of the mouth. He or she may feel the saliva glands, which usually feels ropey or lobulated. A salivary stone in this area would feel hard. This examination is not painful, but it is a slightly odd feeling.

Gingiva and alveolar mucosa

Finally, the clinician will examine the gums, which are called the gingiva. Healthy gingiva is pink, and regular. Some abnormalities include generalized or localized swelling, redness, ulceration or bleeding.

The clinician may also palpate the area over the jaws to check for lumps and bumps. This examination may also reveal tenderness that could be the result of infection or inflammation.