3.2 Oral Examination

Oral Reflexes and Oral Sensitivity

Assess for oral hypersensitivity, excessive gagging, swallowing difficulties, or oral hypotonicity. Any of these factors can interfere with optimal feeding, toothbrushing, and in-office preventive oral health care. Food adherence and retention in the mouth due to food consistency, inadequate oral hygiene, or abnormal muscle control are risk factors for oral disease.

Oral Trauma and Injury

Children who experience some types of seizure disorders, abnormal protective reflexes, muscle incoordination, behavioral disorders, or attention deficit disorders are at high risk for facial and intraoral trauma, some of which may be self-inflicted. Children may engage in self-injurious behaviors such as face or mouth banging; picking or scratching the skin or gum tissue; biting the tongue, cheek, or lip; or placing sharp or hot objects in the mouth. Look in the mouth for any fractured, intruded, extruded, missing, or mobile teeth; lacerated frenums; and scar tissue. Lip and facial lacerations are common and can easily become infected. (See section 3.4, Anticipatory Guidance, Oral Trauma and Injury.)

Dental trauma may be an important marker for child abuse because craniofacial, head, face, and neck injuries occur in more than half of the cases of child abuse. (See section 3.3, Child Abuse and Dental Neglect.)