How to Conduct an Intraoral Dental Screening

An intraoral dental screening should be a routine part of any dental assessment: checking and recording the presence or absence of any abnormalities. The importance of regular dental examinations has been emphasized by the many studies which show positive outcomes for patients as a result of an effective examination

Above you will find a video that explains how to conduct an intraoral dental screening and below is a transcript of the video.

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Hi, everybody! My name is Lisa Hou and today I’m going to be talking to you about intraoral dental screening, especially for our geriatric patients.

First things first, what exactly are we looking for? And this is just kind of a brief overview of the anatomy of our oral cavity, in addition to the teeth and gingiva. We’re also looking at the soft tissue, so we’re talking about the lips, the labial mucosa the buccal mucosa, basically the lip and the cheek lining, and the floor of the mouth, as well as a hard and soft palette.

For the lip and the labial mucosa, we’re looking at the surfaces, the frenum, the vermilion borders, the commissures and the vestibules of the mouth, and the major and minor salivary glands.

When you’re first looking at it on inspection, we’re looking at the color of the lips and the labial mucosa, morphology, function, and texture. You’re going to be pressing on in a little bit. If there’s anything abnormal, any weird lesions, such as ulceration, atomic or developmental abnormality, such as cleft lip, double lip, lip pit, or even a short lip. You’re going to be looking for consistency and pliability. If there are any indurated lesions, as well as um glandular involvement, the texture of the lip, and the size and shape of the lip must also be examined.

Some of the more common lesions you’ll be seeing are your herpes labialis, erythema multiform, smoker’s patch of lip, and sometimes lichen planus as well.

The top picture is angular colitis, which is inflammation at the corner of your mouth and usually can be caused by irritation or infection, or allergies, and a lot of times in older adults it’s caused by ill-fitted dentures, and could be caused also by licking the lips and drooling mouth, and mouth-breathing, which could result in dry mouth. Also, exposure to sun and overclosure in the mouth, and sometimes even smoking and trauma. The bottom picture is herpes, your common cold sore, and then the last vertical picture is a smoker’s patch.

On your buccal mucosa, the first thing you’re going to do is look for any potential abnormalities. You’re going to feel around to see if there’s any inconsistency in the texture, and then some of the more pathological conditions could be leucodermia, leukoplakia, white spongy nevus, smoker keratosis, and some indurated ulcers. You’re looking for the salivary duct openings as well if there are any ulcerations and abnormal pigmentation.

Here are some pictures, you see leukoplakia, leucodermia, and on the bottom left is oral squamous cell carcinoma, so any abnormal lump, some bumps.

You’re also gonna be looking at the consistency of the tongue, especially if you see any tongue lesions, the resilience and the texture of the tongue, and if there’s any presence of any induration, scars, or lesions. Ask your patient to move the tongue around if they can, and make sure you’re also checking the floor of the mouth as well.

In this picture, we show how you want to conduct the exam. Make sure you’re touching the floor of the mouth using a piece of gauze, ask the patient to stick out their tongue, and then check the lateral borders of the tongue as well as underneath it. And basically also doing your oral cancer screening at the same time.

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Here are all pictures of oral squamous cell carcinoma that have been found in some of the patients. You could see that doing a tongue exam is really important. Any abnormal ulceration lumps and bumps. Patients could also be really helpful in providing information during this time because you can ask if they’ve noticed any of these lumps and bumps, or how long it’s been there.

Now, moving on to the hard and soft palette. By using direct or indirect light, conduct a visual exam, and you can take a look at the contour, the height, the area, the size of the papillae, and the width of the arch to look for any weird lumps and bumps.

Here in the picture on the top right you see thermal burning, if you drink hot soup and absolutely burn yourself. In the top left you see candidiasis, after wiping the white spots away. Bottom left, you see herpes zoster, and bottom right denture stomatitis.

The floor of the mouth can be inspected by asking a patient to raise the tongue to reveal the structure and the different landmarks. The color of the mucosa covering the floor of the mouth should also be observed for any pathological lesions like ranula, mucocele, ulcerations and swelling.

Here on the floor of a mouth, bottom picture, you see an aphthous ulcer or your common canker sore. Bottom right you see squamous cell carcinoma.

On the right you see mucus seal, when they’re on the floor of the mouth they’re a little bit bigger, it’s called ranula, basically mucus cysts, and generally caused by the minor salivary gland. Sometimes it could be also caused by lip-biting as well as trauma.

Of course, after we check out the soft tissue, we want to look at the gums and the teeth. For the gums you want to take a look at the color, the contour, and the gingiva size, so make sure it’s normal, with no large or gingival recession. For the contour make sure the marginal and papillary are normal rounded color, pink, red, blueish, red, or any other color variation.

Here’s a picture of a healthy versus a flame. You can see that it’s red. It’s bulbous, whereas in the healthy it looks pink.

This is also a progression from healthy gums to gingivitis, periodontitis, and advanced periodontitis, which you could see a lot in some of your geriatric patients.

Here we have the pictures of some gingival cancerous cells, so squamous cell carcinoma again, and there’s also a pyogenic granuloma. Usually, it arises in response to various stimuli, such as low-grade local irritation, traumatic injury, hormonal factors, or some kind of drug, so that is on the um right-hand side. So when you see anywhere lumps and bumps again ask the patients about it, because chances are it may have been there for a while now.

So the next thing we’re going to look at is the number of teeth, caries, attrition, abrasion, erosion, any discoloration or staining mobility, fractured or broken teeth, and discoloration. If there’s any dental plaque forming, food pigment or food debris, tobacco, smoking, or potentially could be caused by medications.

Here are some pictures that um we typically see by looking at the teeth. These are all geriatric patients of ours. 70 and older. You see, some are wearing RPDs [removable partial dentures.] Some have a lot of recession with some inflame gingiva. There are some incomplete dentures, we do want to remove them and then take a look at the soft tissue area as well.

The next thing I’m gonna talk about is a Brief Oral Health Status Examination, or the “BOHSE” exam. This is typically something that we give community-dwelling elders to take. It could be performed by a spouse or a caregiver. It assesses the oral health, and the elderly individual covers the patient’s, current oral health status, including factors that could contribute to the risk of oral diseases and the need for referral. So it covers 10 oral hygiene categories. It’s looking at the lymph, nodes the lips, the tongue, the cheek, and the roof of the mouth, the gum saliva, natural teeth, artificial teeth, chewing position, and general oral cleanliness um of the mouth. So we usually recommend the caregiver, or whoever’s doing the exam to take a pen-light or something that you can shine so you could see a little bit better inside the oral cavity. Use a tongue depressor, so you can kind of press the tongue down or move it to the side, use gauze as needed. And then you’re taking a look at the conditions around the oral cave, and there is a rubric.

So each category is rated by the examiner on a three-point scale, 0, 1, or 2. 0 indicates the healthy end, and 2 is unhealthy. The final score is the sum of all the scores from the ten categories ranging from zero, which is very healthy, to twenty, which is very unhealthy, and the tool reflects the oral status of the individual. The higher score means that there are more problems that have been identified, although it should just be noted that if the higher the score, if there are some abnormal lumps and bumps and abnormal things noted in the oral cavity, we should refer to the dentist immediately. Now for the caregiver, usually the time it takes to minister this exam is approximately 5 – 10 minutes with a reported average of about 7.8 minutes.

So the next slide you’ll see the categories. The lymph nodes talks about how to do the measurements, and then there’s a score at the end of it. It also talks about whether or not the patient has dentures down here, and if it feels comfortable inside the mouth, the resident’s name. Usually, this is conducted in long-term care, facilities and facilities where there are nurses going around the examiner’s name, and the total score, and the date that it is scored.

I think the rubric is really helpful, especially for somebody who may not know as well how to conduct the oral exam. So I really like this picture because it really shows the different areas that we should be looking and focusing on when we’re conducting these intraoral screenings for our older adults. So here is my email. Thank you very much. Please feel free to email me if you have any questions, comments, or concerns. Thank you.

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Posted: November 9, 2022
<a href="https://ostrowon.usc.edu/author/lisahou/" target="_self">Lisa Hou, DDS, MS</a>

Lisa Hou, DDS, MS

Lisa Hou, ‘08, DDS ‘12, MS ‘17, is the Director of USC’s Mobile Dental Clinic at Hollenbeck Palms, a nonprofit retirement community. Hou provides specialized care for elderly patients and prepares the next generation of dental professionals to treat this growing, and often under-served population. Her approach allows student to get the full breadth to adult care.

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