The intraoral examination
For the intraoral examination, use a headlamp to provide a good source of bright light. "Prior to the speculum's placement,
I look at the incisors and canines, since once you put in the speculum you can't see those any more," says Gregory. "Before
rinsing, I see where there might be food within the mouth—food stasis on one side or the other—impacted between the teeth.
After rinsing, I look again, noting if there's a diastema—spacing between teeth—or a cavity. With rinsing, food usually washes
out but might stick in those places. Such food residues might be indicative of a particular problem."
Gregory says he starts with the arcades: 2, 3, 4, 1. With a dental explorer, he takes a good look at every tooth. He then
uses a dental mirror and an oral endoscope to take a better look at problem areas. Next, he puts his hand in the mouth and
palpates all the teeth, since, he says, about 25 percent of problems are invisible to the naked eye but might be felt. He
begins palpation from the back of the mouth and moves forward. He checks the cheek teeth, bars, diastemata of the cheek teeth,
canines in males and incisors in females.
Menzies adds that it's important to count the teeth to assess either supernumerary or missing teeth in the dental arcade.
Once the mouth is rinsed, use a dental mirror to get a cursory look throughout the mouth. Then use a rigid endoscope to further
examine and record.
"The endoscope is 45 to 50 cm long with a 30- to 90-degree bevel on the end," Menzies says. "The advantage of it is several-fold:
The picture comes up on a monitor, so with the clients there to observe, it's a great educational tool to help them understand
what the problems are as you go through. And you can examine the most rostral premolar teeth and the most caudal molar teeth
with the same degree of accuracy. This is a great advantage, since most of the pathoses are in the more caudal region of the
mouth. Diagnostic tests, diagnoses and treatments all get harder to perform as you go more caudally."