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Physical Examination of Teeth, Gum, Tongue and Tonsils in Children

12 Nov, 2015

Physical Examination of Teeth, Gum, Tongue and Tonsils in Children

The teeth
The teeth are inspected for number in each dental arch, hygiene, and occlusion or bite. The general rule for estimating the number of temporary teeth in children who are 2 years of age or younger is; the child's age in months- 6 months= the number of teeth. Dislocation of tooth enamel with obvious plaque (whitish coating on the surface of the surface of the teeth) is a sign of poor dental hygiene and indicates a need for dental counseling, Brown spots in the crevices of the crown of the tooth or between the teeth may be caries. Teeth that appear greenish black may be stained from oral ingestion of supplemental iron. Although unsightly, this disappears after the iron is no longer given. Malocclusion or poor biting relationship of the teeth is evaluated in terms of
• How the jaws relate to each other in vertical, transverse, and anteroposterior directions, for example, the "bucktoothed" appearance that results when the maxilla is forward in relations to the mandible.
• How the teeth are aligned and
• How the teeth interdigitate when in occlusion. Although parents frequently express concern regarding thumb-sucking and the development of orthodontic problems, thumb-sucking that ceases before the age of 6 years probably does little harm.
The gums
The gums surrounding the teeth are examined. The color is normally coral pink, and surface texture is stripped, similar to the appearance of orange peel. In dark-skinned children the gums are more deeply colored and a brownish area is often observes along the gumline.
The tongue
The tongue is inspected for the presence of papillae, small projections that contain several taste buds each and give the tongue its characteristic rough appearance. Changes in the surface texture are noted, such as the "geographical tongue", unusual pasterns of papillae formation and denuded areas; coated tongue such as in thrush, an exceptionally beefy red swollen tongue, which is a sign of various systemic disease.
The doctor also notes the size and mobility of the tongue, especially protrusion, which is frequently seen in children with mental retardation. Normally the tip of the tongue should extend to the lips. If the child is unable to move the tongue forward to this point, the frenulum, or central band of mucous membrane, which attached the tongue to the floor of the mouth, may be too short. "tongue-tie" can result in speech problems.
Other parts of the mouth
The roof of the mouth consists of the hard palate, near the front of the cavity, and the soft palate, toward the back of the pharynx, which has a small midline protrusion called the Uvula. Both are carefully inspected to be sure that they are intact. Sometimes there is a pinpoint cleft in the soft palate, which may go undetected unless carefully inspected. Such a cleft is exotically important if the uvula is bifid or separated into two appendages. A submucosal cleft may result in speech problems later on, since air cannot be effectively trapped for vocalization. The arch of the palate affects the placement of the tongue and can cause feeding and speech problems. Movements of the uvula is tested by eliciting a gag reflex. It moves upward to close off the nasopharynx from the oropharynx.
As the recesses of the oropharynx are inspected, the size and color of the palatine tonsils are also noted. They are normally the same color as the surrounding mucosa, glandular, rather than smooth in appearance, and barely visible over the edge of the palatoglossal arches. Enlargement, redness, and white patched on the tonsils and surrounding area are recorded. Such signs are indicative of suppurative tonsillitis or pharyngitis.

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