While research into specific cause-and-effect relationships continues, there are still plenty of reasons to encourage patients to take care of their mouth.
Some say the mouth is the body's mirror. And while associations between oral and systemic health can be made and research is on the rise, specific cause-and-effect relationships remain elusive. Life—and certainly health—are not so easily defined, packaged, and distributed.
Links have been made between oral health and cardiovascular disease, diabetes, respiratory disease, and osteoarthritis. But establishing cause and effect can be a complex and confusing process, confounded by a myriad of variables. Wherever the quest eventually leads, the basic oral health assessment is a good starting point. Remember that all clinical contacts should include protection for both your patient and yourself. This means using examination gloves, face mask, and a mirror or tongue depressor. These simple devices along with a good light source will facilitate a thorough examination.
Extraoral assessment
The examination should begin with an evaluation of the face and neck. Symmetry of the face is expected; asymmetry could be a sign of an intraoral infection or tumor manifested extraorally. Engage the patient in conversation to assess speech production and muscular function in the perioral structures. Palpate the neck for any masses or irregularities. To assess the temporomandibular joints, ask the patient to open and close his or her mandible. Pain, deviation to one side, and popping or clicking noises may all be signs and symptoms of degenerative joint disease.
A close look at the skin is particularly important during extraoral assessment. The skin should be free of ulcerated, cratered, crusted, or pigmented lesions (painful or not). Light-skinned individuals living in geographic areas of intense sun exposure and high altitude are particularly susceptible to basal cell carcinoma (BCC). The most common sites are the lower lip, top of the ear, and tip or side of the nose. Traditionally, these neoplasms have been considered slow-growing and noninvasive, but recent reports indicate that approximately 11% of BCCs are aggressive and feature deep-tissue invasion and metastasis.1 Evaluate the degree of skin hydration for clues to underlying dehydration, and investigate any bruises or discolorations by inquiring into the patient's medical and/or personal history. Last, the lips should be examined for lesions, palpated for lumps or bumps, and checked for signs of dehydration or infection.