Mouth and pharynx examination !

Exam technique

How lips, gums, teeth, tongue, palate, tonsils and throat are checked, and which findings get reported.

Updated 2026-11-01

See it in 3D: Tongue · Palatine tonsils · Soft palate · Pharynx · Gums (gingiva) · Hypoglossal nerve (XII) · Glossopharyngeal nerve (IX) · Vagus nerve · Parotid gland · Submandibular gland

What it is

The mouth and pharynx are examined with light, gloves and a tongue depressor, going in order through lips, mucosa, gums, teeth, tongue, floor of the mouth, palate, tonsils and posterior pharyngeal wall. The exam reveals infections (pharyngitis, peritonsillar abscess), systemic signs (central cyanosis, anaemia, dehydration) and premalignant lesions or oral cancer. It also tests cranial nerves IX, X and XII.

Landmark anatomy

The hypoglossal nerve (XII) moves the tongue; on protrusion it deviates towards the side of the damaged nerve.
The vagus (X) raises the soft palate: with a one-sided lesion the uvula deviates towards the healthy side.
The glossopharyngeal nerve (IX) carries pharyngeal sensation (afferent limb of the gag reflex) and the vagus its motor limb.
The palatine tonsils sit between the anterior and posterior pillars; behind them is the posterior oropharyngeal wall.
The submandibular duct opens in the floor of the mouth on each side of the lingual frenulum.

Technique, step by step

Explain the exam, wear gloves and use a good head light; ask the patient to remove dentures.
Inspect and feel the lips: colour, cracks, lesions at the corners and ulcers.
With the depressor, pull the cheeks aside to see the buccal mucosa, the parotid duct opening opposite the upper second molar, the gums and the teeth.
Ask the patient to stick out the tongue: dorsum, midline or not, wasting or fasciculations; then side to side to see the lateral borders.
Ask the patient to touch the palate with the tongue tip to see the underside and the floor of the mouth, common sites of oral cancer.
With a gloved hand, feel the floor of the mouth and any lesion, one hand inside and the other under the jaw.
With the tongue pressed down at its middle third, ask the patient to say 'aah': the soft palate and uvula should rise symmetrically in the midline.
Look at the tonsils (size, colour, exudate) and the posterior pharyngeal wall.
Test the gag reflex only if a lesion of nerves IX and X is suspected, by gently touching each side of the pharynx.
Finish by feeling the cervical nodes and record any lesion with its size and site.

Abnormal findings

Tonsillar exudate, fever, tender anterior cervical nodes and no cough suggest streptococcal pharyngitis; a rapid test or culture confirms it.
Tonsillar exudate with posterior cervical nodes, fatigue and splenomegaly suggests infectious mononucleosis.
A bulging tonsil with the uvula pushed to the opposite side, trouble opening the mouth and a muffled voice: peritonsillar abscess, an emergency.
A white patch that does not rub off (leukoplakia) or a persistent red patch (erythroplakia), especially on the lateral tongue or floor of mouth: biopsy for cancer risk.
White plaques that wipe off leaving red mucosa: oral candidiasis; in adults without a local cause, think of immunosuppression or HIV.
Bluish tongue: central cyanosis. Smooth red tongue: iron, vitamin B12 or folate deficiency. Dry mucosa: dehydration.
White spots on the buccal mucosa with fever and coryza (Koplik spots) come before the measles rash.

Common errors

Pressing on the back of the tongue with the depressor: it triggers gagging; rest it on the middle third.
Not removing dentures: they hide ulcers and premalignant lesions.
Looking without feeling: the induration of oral cancer is felt before it is seen.
Forgetting the floor of the mouth and the lateral borders of the tongue, the most common sites of oral carcinoma.

Test yourself

Think of the answer, then tap the question to see it.

On protrusion the tongue deviates to the left. Which nerve is damaged?

The left hypoglossal (XII): the tongue deviates towards the side of the lesion because the healthy genioglossus pushes it over.

Which findings suggest a peritonsillar abscess?

A bulging tonsil, uvula pushed to the opposite side, trismus, a muffled voice, severe pain on swallowing and fever.

Which nerves make up the gag reflex?

The glossopharyngeal (IX) is the afferent limb (sensation) and the vagus (X) the efferent limb (pharyngeal contraction).

Which sites in the mouth are most common for oral carcinoma?

The lateral border and underside of the tongue and the floor of the mouth.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Evaluation of the Dental Patient - Dentistry - Merck Manual Professional Edition (Merck Manuals, 2026); Pharyngitis - sore throat: MedlinePlus Medical Encyclopedia (MedlinePlus, U.S. National Library of Medicine, 2026).

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Representative model, for educational purposes only.