Chapter 16

I. Developmental Considerations

a. Infants and Children

i. Salivation starts at 3 months,

ii. 20 deciduous teeth (temporary) and they should appear by 2 ½ ; lost by 6-12

iii. Nose develops during adolescents, full growth at 16 in F and 18 in M

b. Aging Adult

i. Nasal hairs grow coarser and stiffer and may not filter the air well, sense of smell diminish, decrease

sensations

ii. Decrease in salivation secretion that is needed to dissolve flavoring agents

iii. Gums begin to recede and teeth begin to erode at the gum line.

iv. If tooth loss occurs the rest of the teeth shift causing malocclusion

v. Over 250 medications cause dry mouth

II. Transcultural considerations

a. Bifid Uvula

i. Condition in which uvula is split either completely or partially occurs in Native Americans (18%) and Asians

(10%)

b. Cleft Lip

i. Common in Native Americans and least common in blacks

c. Whites have more tooth decay

III. Subjective Data

a. Discharge

b. Frequent colds

c. Sinus pain

d. Trauma

e. Epistaxis (nosebleeds)

f. Allergies

g. Altered Smell

h. Sores or Lesions

i. Sore throat

j. Bleeding Gums

k. Toothache

l. Hoarseness

m. Dysphagia

n. Altered Taste

o. Smoking, Alcohol Consumption

IV. Objective Data

a. Inspect and Palpate Nose

i. External Nose

1. symmetric, midline, in proportion to facial features

2. test patency of nostrils, reveals obstruction

ii. Nasal Cavity

1. lift tip of nose before inserting nasal speculum; inspect nasal mucosa

2. Rhinitis

a. Nasal mucosa is swollen and bright red with an upper resp. infection

b. Discharge is common, varying from watery and copious to thick, purulent and green – yellow

c. With chronic allergies, mucosa looks swollen, boggy, pale, and gray

b. Palpate the sinus areas

i. Chronic Allergies and acute infection

1. tender

ii. Transillumination

1. note a dull glow inside mouth on hard palate and

2. Healthy sinuses contain air and may light up symmetrically

c. Inspect Mouth

i. Lips

1. white ppl: circumoral palor occurs with shock and anemia,

2. cyanosis with hypoxemia and chilling

3. cherry red lips with carbon monoxide poisoning

4. acidosis/ ketoacidosis (diabetes) from aspirin poisoning

5. Chelilitis

a. Cracking corners

6. Herpes Simplex other lesions

ii. Teeth and Gums

1. gums look pink with stippled (dotted) surface

a. excessive fluoride use causes brown discolored teeth

b. yellow teeth with tobacco use

iii. Tongue

1. Enlarged Tongue occurs with mental retardation, hypothyroidism, Acromegaly

2. Small Tongue – malnutrition

3. Dry Mouth occurs with dehydration, fever, Tongue has deep vertical fissures

4. Any lesions or ulcer persisting for more than 2 weeks must be investigated

5. indurated area may be a mass or lymphadenopathy, and must be investigated

iv. Buccal Mucosa

1. pink, smooth, and moist

2. leukoedema

a. benign grayish opaque area, more common in blacks

v. Palate

1. Anterior hard palate : white with irregular transverse rugae

2. Posterior Palate: pinker, smooth, and upwardly movable

3. Uvula : any deviation to the side or absent movement indicates nerve damage

d. Inspect Throat

i. Tonsils: graded ( + 1 – visible +2 halfway between tonsillar pillars and uvula +3 touching Uvula +4 touching

each other)

ii. White membrane covering tonsils may accompany infections mononucleosis, leukemia, and diphtheria

iii. Press slightly off center to test gag reflex

iv. Notice breath odor

1. Diabetic Ketoacidosis

a. Sweet fruity breath odor

2. Ammonia Breath

a. Uremia

3. Musty Odor

a. Liver disease

4. foul, fetid odor

a. dental or respiratory infections

5. Alcohol Odor

a. Alcohol ingestion

6. Mouse – like Smell

a. Diphtheria

V. Developmental Considerations

a. Infants and Children

i. During crying episodes inspect mouth and oropharnyx

ii. Newborns may have milia across nose, obbligate nose breathers, test nares immediately

1. inability to pass catheter through nasal cavity indicates choanal atresia

iii. with a toddler be alert for the possibility of foreign objects in nose

iv. Mouth and Thoat

1. Sucking Tubercle

a. Normal finding, a small pad in the middle of upper lip from friction of breast/ bottle feeding

2. Abnormal : no teeth by age 1

a. Trauma may indicate child abuse due to force feeding or bottle or spoon

3. Epstein Pearls

a. Normal finding, small white glistening pearly papules along median raphe of hard palate and

on the gums

4. Tonsils are not visible in newborn,

5. sucking reflex can be elicited in infants up to 12 months

b. The Aging Adult

i. In the edentulous person the mouth and lips fold in giving “purse lip”

ii. Yellowing results from dentin visible through worn enamel

iii. Tongue looks smoother due to papillary atrophy

VI. Abnormal Findings

a. Perforated Septum: Hole in septum

b. Furuncle : small nosebleeds

c. Gingivitis: gum margins are red, swollen, and bleed easily. Exposes roots of teeth in extreme cases; condition may

occur in pregnant women and puberty b/c of changing hormone balance

d. Aphthous Ulcers: canker sore

e. Leukoplakia : chalky white, thick, raised patch on tongue; lesions are precancerous

f. Candidiasis : white, cheesy, on buccal mucosa and tongue, scrapes off leaving red surface and bleeds easily

i. Thrush in newborn

g. Fissured or Scrotal Tongue: Deep furrows

h. Oral Kaposi’s Sarcoma : bruiselike, dark red or violet confluent macule, usually on hard palate

i. Acute Tonsilitis and Pharyngitis : white or yellow exudate on tonsils and pharynx, swollen uvula, and enlarged tender

anterior cervical and tonsillar nodes

j.