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Part II Nutrition Assessment, Consequences, and Implications

Figure 9.1 How to Conduct a Nutrition-Focused Physical Examination of the Head, Neck, and Oral Cavity

STEP 1: INTERVIEW YOUR PATIENT. IMPORTANT POINTS TO COVER IN YOUR ORAL HEALTH INTERVIEW:

Polypharmacy (use of medications associated with risk of dysphagia; chronic use of medications [three or more]) Xerostomia (dry mouth) Questions for patients: V, VII

● Do you ever feel your mouth is dry? If so, when? Can you consume a meal without a drink? Can you consume a snack without a drink?

● Has there been any change in your medication(s), both prescription and over the counter?

Dysgeusia (distorted taste) or ageusia (loss of/absent taste) or hypogeusia (diminished taste) Oral pain:

● Where/when/how often? ● Does anything relieve this pain? ● If so, what?

Eating and drinking patterns: ● When during the day and what do you typically eat and drink? ● Are you on a special diet?

STEP 2: EXTRAORAL EXAM. LOOK AT THE FACE AND OVERALL APPEARANCE OF YOUR PATIENT: opening STEP 3: CRANIAL NERVES : TEST KEY CRANIAL NERVES RELATED TO ORAL HEALTH:

Trigeminal nerve V: ● Assess jaw movement and strength; sensation to the face (sharp, dull, and light touch to three branches)

Facial nerve VII: ● Assess facial expressions—raise eyebrows, frown/smile, purse lips, nasolabial fold; changes in taste

Glossopharyngeal/vagus nerve IX, X: ● Taste (changes) and swallow

Hypoglossal nerve XII: ●

STEP 4: INTRAORAL. AFTER YOUR EXTRAORAL EXAM IS COMPLETE, INSPECT THE INTRAORAL CAVITY:

● Buccal mucosa: Stenson’s duct; saliva production ● Floor of mouth: Wharton’s duct; saliva production

Soft palate: Say “aah.” Is uvula midline? Does soft palate elevate? Visual assessment: Food debris around teeth, abscesses, lesions, red, swollen, receding, or bleeding gingiva Dentition: Observe shifting/separation of teeth, obvious caries ● Edentulism: Assess for tooth loss (where?)

● Occlusion: Assess the pattern in which teeth come together—labial mucosa, buccal mucosa, hard palate, floor of mouth (beneath the tongue)

● Denture use? Partial/full/maxillary (upper) or mandibular (lower) or both ● Any complaints of difficulty chewing food? Difficulty with only certain type or textures of foods? Tongue: Inspect color, appearance: dorsal (back), ventral (front), lateral (left/right) borders and movement