At-a-Glance

Instructor’s Notes

Materials provided in the Instructor’s Guide.

• Instructor’s Notes
• Handouts for participants:
  • The Oral Examination Skills Checklist
  • Workshop 1 Evaluation Form

Additional materials needed.

• Smiles for Life Course 7 PowerPoint slides
• Computer, projector, screen
• Surgical mask, examination gloves, 2×2 inch gauze square, and protective eyewear for each participant
• Intraoral mirror and tongue depressor for each participant (optional)

Participant preparation. Participants should review Smiles for Life Course 7: The Oral Examination prior to the workshop. Registration for Course 7 is not required to attend the workshop, but it is required to earn continuing education credit.

• Introduction (5 minutes)
• Live demonstration and slide presentation (25 minutes)
• Peer-to-peer examination (30 minutes)
• Follow-up and documentation (5 minutes)
• Evaluation (5 minutes)

Note: Times may vary depending on the number of participants.

Instructor’s Notes

Introduction (5 minutes). Welcome participants and review the workshop objectives. Explain that participants will develop the skills needed to perform an adult oral examination and oral cancer screening by practicing on each other. Review and distribute protective eyewear, surgical masks, gauze, and examination gloves. Let participants know that following the demonstration, they will be working with a partner to conduct an oral examination and will need to remove any intraoral prosthetics before they begin.

Live demonstration and slide presentation (25 minutes). Ask for a volunteer to be the subject of an oral examination. You will work with the volunteer to demonstrate how to perform both an intraoral and an extraoral examination. As you move through each category (e.g. face, lips), explain what is being visually and manually inspected.

The notes below and the Oral Examination Skills Checklist in this toolkit have been broken into sections to match the presentation slides in Smiles for Life Course 7. Each slide will serve as a prompt for the next step of the oral examination.

• Slide 27, Exam Components. Introduce the components of an oral examination.
• Slide 28, Face and Lips. Instruct the provider to observe the face, ears, and neck of the patient, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, or color variations. The provider should observe the lips with the patient’s mouth both open and closed.
• Slide 29, Common Lip Abnormalities. Review the photographs on this slide.
• Slide 30, Inside Lips. Instruct the provider to observe the inside of the lips with the patient’s mouth partially open. The provider should use gloved fingers to gently lift the upper lip and pull down the lower lip to observe color and texture as well as to note any swelling or other abnormalities of the lip mucosa.
• Slide 31, Buccal Mucosa. The provider should retract the buccal mucosa (cheek) with a gloved finger and examine the right then the left buccal mucosa from the corner of the lip to the back of the throat. Note changes in color and texture, or any other abnormalities.
• Slide 32, Common Mucosal Abnormalities. Review the slide.
• Slide 33, Gums. Instruct the providers to systematically inspect the gums. They should begin at the top right of the mouth and move across the upper teeth to the top left of the mouth before proceeding to the lower left and across the lower arch to the lower right. The lips should be moved up and down and the cheeks retracted to allow a full view of the gums. Providers should look at the color of the gums and note the presence of plaque along the gum line. Pink gums indicate health, and red or erythemic gums indicate inflammation.
• Slide 34, Common Gum Abnormalities. Review the slide.
• Slide 35, Anterior Teeth. Ask providers to briefly examine the anterior or front surface of each tooth looking for signs of tooth decay (discoloration), trauma (chips or breaks), and plaque.
  
  Note: This step can be practiced separately, but once providers become familiar with the process, they should complete this step while examining the gums.
• Slide 36, Lingual Teeth. Providers should ask their patients to tilt their heads back so providers can inspect the lingual (tongue-side or inward-facing) surface of the upper teeth and molars. Then providers should ask patients to tilt their heads down so providers can inspect the inward-facing surface of the lower teeth and molars.
• Slide 37, Common Tooth Abnormalities. Review the slide.
• Slide 38, Hard and Soft Palate. Providers should ask their patients to tilt their heads back so providers can examine the hard and soft palate. The hard palate is the region behind the upper teeth shown in the slide photo. The soft palate, which sits between the hard palate and the throat, should be examined closely as it is a high-risk area for oral cancer.
• Slide 39, Abnormalities of the Palate. Review the slide, then alert participants that another common abnormality of the palate is the presence of bony growths along the inside of the lower jaw or along the cheek side of the upper jaw. These typically benign, hard, bony protrusions are called exostoses. Instruct providers to feel along the gum on the inside of the lower teeth and along the gum on the cheek side of the upper teeth to detect the presence of exostoses.
• Slide 40, Tongue. Instruct each provider to use gauze to grasp the patient’s tongue and inspect the dorsal (top), ventral (bottom), and lateral borders (sides). Emphasize that the lateral borders of the tongue are common areas for oral cancer.
• Slide 41, Video Tongue Exam. Show the video to demonstrate how to inspect the tongue.
• Slide 42, Oral Cancer Screening. Explain that an oral cancer screening should be a routine part of each patient’s general medical examination, especially for those who use tobacco or alcohol excessively. Discuss statistics and review the visual diagram identifying common areas for cancerous lesions.
• Slide 43, Common Tongue Abnormalities. Review the slide.
• Slide 44, Posterior Pharynx. Review the slide. Ask providers to locate the pictured structures on their partners.
• Slide 45, Floor of Mouth. Show the video and explain that the provider should palpate or gently press on the floor of the patient’s mouth.
• Slide 46, TMJ. Instruct providers to remove their gloves and disinfect their hands before performing the temporomandibular joint (TMJ) examination. Show the video.
• Slide 47, Neck Anatomy. Review the slide (optional).
• Slide 48, Neck Palpation. Instruct the provider to palpate the patient’s anterior and posterior triangle and the submandibular area as indicated in the photographs on the slide.
• Slide 27, Exam Components. Return this slide to the screen and leave it there to guide participants as they begin the peer-to-peer examination.

Peer-to-peer examination (30 minutes). After you complete the presentation, ask participants to select a partner. Determine who will act as the provider and who will act as the patient during the first practice oral examination. The provider should wear protective eyewear, a surgical mask, and gloves. The patient should sit down and remove any intraoral prosthetics before the examination begins.

Instruct providers to stand or sit directly in front of their patients. Providers should perform the oral examination using the Oral Examination Skills Checklist as a guide.

When the first examination is complete, ask the participants to switch places so each has a chance to perform the examination. While the oral examinations progress, the instructor should move about the room to answer questions as needed.

Follow-up and documentation (5 minutes). After all participants have performed an oral examination and completed the skills checklist, explain that if a suspicious lesion is found during the oral examination, the provider should take the following steps.

1. Show the lesion to the patient using a hand-held mirror.
2. Ask the patient if he or she is aware of the lesion and if so, how long it has been present. Note: Any lesion that lasts longer than two weeks could indicate a serious condition such as oral cancer. The patient should be referred for evaluation and possible biopsy.
3. Ask the patient if there has been any pain associated with the lesion. Pain or soreness could indicate a cancerous growth.
4. Document the lesion by describing the location, color, size, and presence or absence of pain to the best of your ability (e.g., 2×2 mm white patch on upper right lip, asymptomatic, patient is unsure of how long the lesion has been present).
5. Schedule a follow-up appointment.

Evaluation (5 minutes). Ask participants to evaluate the workshop. You can use the Workshop 1 Evaluation Form provided in this toolkit. If applicable, explain to participants that the next workshop will cover oral health risk assessment and dental referral.