A comprehensive clinical examination is the basis for selecting further diagnostic and therapeutic steps.
Extraoral examination
- Inspection
- Facial asymmetries
- Soft tissue swelling
- Parafunctions (lip/cheek sucking or biting, etc.) [morsicatio (habitual cheek chewing)]
- Palpation
- Bimanual (symmetry comparison)
- Lymph node
- [accompanying inflammatory reactions; tumor activity]
Intraoral examination
- Mucosa – changes on lips, cheeks, tongue, tongue edge, palate, floor of mouth:
- Predominantly white, uniformly flat, thin, shallow furrows if any, surface smooth, wrinkled or wavy, texture largely consistent [homogeneous leukoplakia].
- Predominantly white or white and red [erythroleukoplakia] with loss of surface integrity, irregularly flat, nodular/nodular [inhomogeneous leukoplakia]
- Exophytic [verrucous leukoplakia]
- Multifocal, extended, initially homogeneous, later exophytic [proliferative verrucous leukoplakia].
- Erosions (superficial substance defects confined to the epidermis, without scarring) [erythroplakia (sharply circumscribed, red lesion of the mucosa); carcinoma in situ]
- Ulceration (ulceration) [carcinoma in situ]
- Induration indurations) [accompanying inflammatory reaction; carcinoma in situ]
- Oral candidiasis [Candida-infected leukoplakia]
- Dental findings (general dental findings).
- Check for causes of mechanical irritation:
- Sharp-edged teeth or restorations [mechanical-irritation-induced leukoplakia].
- Oral hygiene situation:
- Plaque infestation
- Tartar supra- and subgingival (“above and below the gingival margin”).
- Bleeding gums
- Check for causes of mechanical irritation:
Square brackets [ ] indicate possible pathological (pathological) physical findings.