# Mouth & Throat Assessment --- A **mouth and throat assessment**, or sometimes called an **oral assessment** is an [[assessment]] of the [[mouth]] and [[pharynx|throat]], usually done as part of an HEENT assessment. It is important to the patient because the health of the mouth is often a sign of the health of the rest of the person. A poor oral health status can also lead to other problems, such as bacterial infections that can enter the bloodstream. Doing a thorough oral assessment can also help prevent tooth loss if you catch a potential problem early enough. >[!tip]- Considerations of the Older Adult > - A lot of medications can cause dry mouth. Sometimes tooth loss happens. Are they able to care for their own teeth or dentures? > - Have there been any changes in taste of smell? This can be normal from aging, but also [[COVID-19]]. > - Teeth may look slightly yellowed, but color should be uniform. > - Surface of incisors may show vertical cracks from a lifetime of exposure to extreme temperatures. > - Teeth may look longer as gum margins recede. > - Old dental work deteriorates, teeth loosen with bone resorption. > - Tongue looks smoother as a result of papillary atrophy. > - Aging buccal mucosa is thinned and may look shiner. > - Diminished taste and smell > - Problems with mastication ## Subjective Questions In addition to the standard subjective questions... - any bleeding when you brush your teeth? - sores or lesions - sore throat - toothaches - hoarseness - dysphagia - altered taste - do they smoke, drink alcohol - dental care patterns - brush and floss? - how often do they see the dentist - dentures/appliances - dry mouth? - especially with older adults, a lot of meds cause dry mouth ## Objective You want a penlight. Position the person sitting up with their head at your eye level. If they wear dentures, offer a paper towel and ask them to remove the dentures. ### Inspection Begin with the anterior structures and move posteriorly. Use a tongue blade to retract structures (be careful not to trigger a gag reflex), and the penlight. Observe for color, moisture, cracking lesions. #### Mouth Dark skinned people might have bluish lips and a dark line on the gingival margin. - teeth - the condition of the teeth are a good index of a person's general health - are there any diseased teeth, loose teeth, abnormally positioned - any missing teeth - do they rest together when closed? - Talon cusps on incisors and circular cusps on molars in Asian, Pacific Islanders, and Native Americans - **Torus palatinus** in female Inuit, Native Americans, and Asians - gums - are the margins tight to the teeth? - swelling - bleeding - mucosa - If the mouth is moist, that usually means the salivary glands are working. - palate - look at the anterior hard palate - should look white with an irregular transferse rugae - posterior palates - pinker, smooth and upwardly movable (you see the palate rise when you say "ahhh") - tongue - color - smokers may have yellowish-brown color - texture - moisture - any lesions - superior, posterior, ventral - veins visable on ventral side - stick tongue and move side to side (tests cranial nerve) - if they can't really move it so you can see the sides, you can do it with a gloved hand - pharyngeal wall - uvula - should remain midline when you say "ahhh" - Someitmes you find a bifid uvula in Native Americans and Asians. #### Throat Some people can open their mouth wide enough, but you may need to press down with a tongue blade They may have bad breath, and this can be from a lot of different reasons, from garlic to sickness - nasopharynx - oropharynx - laryngopharynx ## Cranial Nerves of the Mouth and Throat [[cranial nerves|CN V]] influences clenching and lateral jaw movement [[cranial nerves|CN VII]] taste on the anterior 2/3 of the tongue. Stimulates [[salivary glands]] [[cranial nerves|CN IX]] posterior 1.2 of the tongue and the gag reflex. [[vagus nerve|CN X]] promotes swallowing and talking [[cranial nerves|CN XI]] promotes movement of the larynx [[cranial nerves|CN XII]] innervates tongue, moving the tongue side to side and up and down ___