Examination Of The Oral Cavity

MATTHEW GRUNDY-BOWERS

INTRODUCTION

In most sexual health settings examination of the oral cavity is often forgotten, and when it is made it is often brief. However, examination of the mouth can yield important clinical information, which can be essential in making a diagnosis. It can aid the diagnosis of many conditions from syphilis to HIV and AIDS (Toghill, 1994).

WHEN YOU SHOULD UNDERTAKE AN EXAMINATION

An examination should be undertaken in patients who present with oral symptoms or if it is indicated by the history, as in patients with Lichen planus or syphilis. Patients often present to the clinic with a sore throat following oral sex, concerned that they have contracted a sexually transmitted infection (STI) - especially, for example, if they have performed oral sex for the first time, had sexual contact outside an established relationship or had sexual contact with a sex worker. These symptoms are rarely caused by an STI, and antibiotics are hardly ever indicated. Note that most infections of gonorrhoea are asymptomatic in the throat (BASHH, 2005b), and it is often missed on culture because of poor swabbing technique. It is important to remember that a trivial symptom occasionally heralds a serious problem (Hopcroft & Forte, 2003), and symptoms reported in the mouth should not be taken in isolation, as they may be a feature of generalised disease (Toghill, 1994). Therefore, once an STI is excluded further investigation with a dental practitioner and/or general practitioner may be prudent. Some patients, however, can appear deflated because a sexual cause cannot be found; these patients may need gentle encouragement to seek further medical advice to ensure that a more serious condition is not missed.

THE EXAMINATION

There are four aspects to examination: inspection, palpitation, auscultation and percussion. During the examination of the mouth, oral cavity and throat in sexual health, only inspection and palpation are used (Barkauskas, 2002). During the consultation you may have already picked up on hoarseness and bad breath. Examine the patient sitting down in a chair or on a couch (Swash, 2001), and have a good light source, gloves and a tongue depressor handy. Take a few moments to observe the patient to see if there are any obvious signs such as jaundice, asymmetry or ulceration of the lips (Barkauskas, 2002).

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