Chapter 9 Consequences of Poor Oral Health BOX 9.4 Head and Neck Examination

Face Observe position, profile, symmetry Facial expressions, taste (changes?), swallow (CNVII, IX) Smell (changes?) (CNI)

Skin Observe color, inspect texture

Eyes Inspect eyeballs, eyelids, sclera, pupils Peripheral vision, pupillary light reaction (CNII) “H” or “box” test (CNIII, IV, VI)

Ears Observe skin

Temporal mandibular joint Ask about joint sounds Palpate for tenderness Measure for three-finger opening Muscles of mastication—tenderness? Jaw movement; dull, sharp, and soft sensations to three divisions (CNV)

Neck Observe color, inspect texture Carotid pulse Thyroid ROM, strength (CNXI)

Lymph nodes: Inspect for palpable, tender, or movable lymph nodes Suboccipital Pre- and postauricular Submandibular Submental Cervical Supraclavicular

Cranial nerves

Note: Some of these may have already been tested during the extraoral examination, and some can be incorporated into the intraoral examination.

CNI (Olfactory) Smell (present? changes?); distinguish scents

CNII (Optic) Peripheral vision Pupillary light reaction

CNIII, CNIV, CNVI (Oculomotor, trochlear, abducens) H” or “box” test

CNV (Trigeminal) Jaw movement and strength Sensation to sharp/dull objects to three divisions

CNVII (Facial) Facial expression (smile, frown), wrinkle forehead, purse lips Taste—ask about changes

CNVIII (Acoustic) Rub hair or fingers by ears

CNIX (Glossopharyngeal) Taste/changes (ask) Gag reflex Swallow

CNX (Vagus) Gag reflex Swallow

CNXI (Spinal accessory) Neck ROM Strength (shrug shoulders) Push head against pressure

CNXII (Hypoglossal) Tongue ROM Strength (push against finger or tongue blade)

Intraoral examination Labial mucosa—evert lips for color, texture, moisture Buccal mucosa—observe color, texture, moisture, Stensen’s duct, bidigital palpation Floor of mouth—observe color, texture, Wharton’s duct, palpitate bidigitally Oropharynx—say “aah,” observe uvula, soft palate, tonsils (CNIX, X) Gag reflex, swallow Tongue—inspect dorsal, ventral, lateral borders (CNXII) Tongue movement Gingiva—observe color and texture Hard palate—observe color and texture Dentition—observe missing teeth, obvious caries, fractures

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Source: Radler DR, Touger-Decker R. Nutrition screening in oral health. Topics in Clinical Nutrition. 2005;20(3):181-188.