Clinical anatomy of the oral cavity organs of a healthy person. Examination and examination of the oral cavity organs

Date: 08.03.2020

Stomatoscopy It is used for a detailed examination of individual sections of the mucous membrane for the purpose of differential diagnosis of lesion elements, studying the bottom of erosion, ulcers, the surface of verrucous growths, papules, plaques, etc. blue (1%).

Photostomatoscopy provides for photographing lesions using special devices.

Vital staining. One of these methods is staining the discolored tooth surface with a 2% aqueous solution of methylene blue. After thorough cleaning of the tooth from plaque (a 3% solution of hydrogen peroxide can be used), drying and isolation from saliva, a tampon with a 2% aqueous solution of methylene blue is applied to the surface of the tooth. After 2-3 minutes, the tampon is removed, and the excess paint is removed, the oral cavity is rinsed with water. Intact enamel does not stain, and the demineralization area changes color depending on the degree of damage. To assess the intensity of staining of dental tissues, a standard scale is used, which provides various shades of blue from 10 to 100%. The scale is produced by the printing industry.

Schiller-Pisarev test involves lubricating the mucous membrane with a 2% aqueous solution of Lugol. Normally, there is a dark brown coloration of the lips, cheeks, transitional fold, sublingual region. The remaining areas of iodine are negative, since they are covered with keratinizing epithelium. Para- and hyperkeratosis of the epithelium, normally non-keratinizing, also causes a negative reaction.

Hematoxylin test consists in varying degrees of staining of the mucous membrane, depending on its condition. Normal epithelial cells become pale purple, atypical ones become dark purple. Areas of hyperkeratosis do not absorb the dye, and therefore do not change their appearance. The highest color intensity is characteristic of cancer cells due to the hyperchromicity of the nuclei.

Toluidine blue assay is produced in a similar way: normal cells of the epithelium after treatment of the mucous membrane with 1% solution look blue, atypical ones become dark blue.

Luminescent methods provide for the use of the effect of fluorescence - the secondary luminescence of tissues when exposed to ultraviolet rays (Wood).

Healthy mucosa gives a pale bluish-violet glow; keratosis has a dull yellow tint; a bluish-violet glow is characteristic of hyperkeratosis; bluish-violet - for inflammation; erosions and ulcers look dark brown. A spot with lupus erythematosus differs with a snow-white glow.

Luminescent research is widely used in the diagnosis of hyperkeratosis, since it has a high degree of reliability. It should be remembered that many topical medications also have the ability to emit Wood's rays, which can provide false information.

Cytological methods research is widely used in the diagnosis of diseases of the mucous membrane. The collection of material can be done in various ways. Yasinovsky test, studying the migration of leukocytes, involves a series of sequential washings followed by counting living and dead blood cells - leukocytes. Smear performed more often from the mucous membrane of the posterior parts of the cavity, allows you to assess the microflora of the pharynx and other areas. From the surface of the lesion, including from the bottom of the ulcer, cytological material is taken using smear prints.

If necessary, the study of deeper layers can be carried out scraping... Puncture allows you to study cells obtained from deep sections of cavitary lesions.

Laboratory research requires special preparation of cytological material (fixation, staining) and subsequent study using technology: from ordinary optical devices to sophisticated electron microscopes.

Histological examinations in their methods are close to cytological. Tissue sampling is performed by biopsy, extended biopsy. The preparations are obtained by the method of thin and ultrathin sections after fixation, followed by staining of the elements of the cell structure. The study of preparations by microscopic methods is a reliable source of data on morphological changes in the mucous membrane.

Histochemical samples with biopsy material are based on the ability of various structural elements of cells, enzyme systems, metabolic products to respond to certain dyes. This ability formed the basis for detecting the activity of enzymes (for example, alkaline phosphatase), nucleic acids (RNA, DNA), minerals (calcium), etc.

Bacteriological methods studies involve the analysis of microbial and fungal flora obtained from the affected area. Most often, the fingerprint smear method is used to collect material, but scraping, smear and other methods can be used. After fixation and staining, a bacterioscopy is performed, i.e., the microflora is visually identified by a characteristic color pattern. It is also possible to study the activity of bacterial growth, their sensitivity to drugs. Infection of animals in the experiment is used in the study of pathogenic activity, contagiousness and other properties of microorganisms.

Virological research based on serological reactions, properties of infected cells to agglutination, ability to fluorescence (immunofluorescence reaction), the possibility of infection of chicken embryos.

Detection of lesion elements on the oral mucosa often requires a general examination of the patient. In this regard, the most often assigned clinical blood test(expanded formula, sugar content),urine... Diagnostic information can be obtained by biochemical blood tests (saturation with vitamins, characteristics of mineral components, etc.), saliva (enzymatic activity of lysozyme, calcium, phosphorus content).

Allergic research are carried out in case of violation of the immune status ( in vivo application tests, blood cell counting, tests with a standard set of allergens). Provocative and parenteral tests are excluded from the arsenal of examination methods, since they differ in the potential risk of complications.

A mandatory assessment of the patient's individual response to the drug should be made during the initial use of medications (most often anesthetics), especially for parenteral administration. Sensitivity test it is also placed if the patient has a history of allergic reactions to other medications. In addition, with the appearance of subjective sensations or objective changes on the part of the oral mucosa in wearers of prostheses, it is determined the level of metals in the blood, electric currents in the oral cavity, reactions to components of plastics and other materials.

Currently, to provide qualified dental care, doctors need knowledge in related fields of medicine. First of all, this concerns the field of neurology.

The dentist should be aware of symptoms of allodynia and hyperalgesia found in many dental diseases.

At allodynia Pain sensations arise in conditions of application of non-nociceptive stimuli, that is, those that, in natural conditions, are not capable of causing pain sensations.

At hyperalgesia pain sensations increase in conditions of application of nociceptive stimuli. Irradiation of pain occurs, synesthesia (when irritations are felt not only at the place of their application, but also in other areas), polyesthesia (when the idea of several irritations arises, although in fact one was applied), etc.

Term<ноцицептор>introduced by C. Sherrington to designate receptors that respond exclusively to damaging stimuli. The pulp of the tooth is extremely rich in such receptors. The variety of pain manifestations under the action of damaging stimuli is one of the reasons for their designation as<ноцицептивные>rather than painful. The simplest response to a nociceptive stimulus is reflexive. With a certain ratio of the strength of the damaging stimulus (for example, an inflammatory process in the oral cavity) and the excitability of the nociceptive system, sensory signals entering the brain lead to the formation of pain.

During the initial examination of the patient in the dental office, a careful external examination can give the doctor a lot. A number of pathological phenomena, for example, contractures, facial muscle atrophy, are already noticeable during external examination and must be registered in the outpatient card (from a legal point of view, this is important, for example, to avoid a conflict situation in the event of patient dissatisfaction with the medical reception provided).

With a special neurological examination, first of all, it is necessary to pay attention to the shape and size of the pupils... Deformation of the pupils deserves special attention in the sense of suspicion of organic damage to the nervous system. When examining the pupils, it is necessary to assess the movement of the eyeballs, especially the presence of nystagmus (twitching of the eyeballs). External examination of the facial muscles is insufficient. It is advisable to ask the patient to wrinkle his forehead, nose, open his mouth wide, show his teeth. With paralysis of the facial nerve, there are teak twitching of the affected facial muscles, change in the width of the palpebral fissure, increased mechanical excitability of muscles. After peripheral paralysis of the lingual muscles, fibrillar twitching with tongue atrophy(this may be a symptom of syringobulbia or amyotrophic lateral sclerosis). Bilateral paresis of the tongue causes a speech disorder of the type dysarthria. Defects of articulation, chanted speech are revealed in the process of conversation and questioning of the patient.

The outlined volume of a brief neurological examination is time-consuming and uncomplicated. Compliance with the examination plan will help the dentist to competently provide assistance to a patient with an intact or affected nervous system.

Intraoral X-ray Reading Technique

I Assessment of the quality of the radiograph: contrast, sharpness, projection distortions - lengthening, shortening of the tooth, completeness of coverage of the studied area. II Determination of the scope of the study: which jaw, group of teeth. III Analysis of the tooth shadow: 1. The state of the crown (presence of a carious cavity, filling, filling defect, the ratio of the bottom of the carious cavity to the tooth cavity); 2. Characteristics of the tooth cavity (the presence of filling material, denticles); 3. Condition of roots (number, shape, size, contours); 4. Characteristics of root canals (width, direction, degree of filling); 5. Evaluation of the periodontal gap (uniformity, width), the condition of the compact plate of the socket (preserved, destroyed, thinned, thickened). IV Assessment of the surrounding bone tissue: 1. The condition of the interdental septa (shape, height, condition of the endplate); 2. The presence of restructuring of the intraosseous structure, analysis of the pathological shadow (area of destruction or osteosclerosis), includes the determination of localization, shape, size, nature of the contours, intensity, structure.

Diagnostic method in dentistry: profilometry

A group of scientists from the University of Toronto, led by Andreas Mandelis, used for their experiments the most common semiconductor infrared laser with a wavelength of less than 1 micrometer. The examined tooth is heated by a laser beam and begins to emit light in the infrared range itself, which allows using a computer to obtain images of the internal structure of the tooth to a depth of 5 mm. The method, called "profilometry", also provides for the possibility of changing the intensity of the laser beam. With pulsations with a high frequency (about 700 hertz), the method is optimal for detecting superficial cracks in the tooth enamel, while lower frequencies - less than 10 hertz - make it possible to effectively detect cavities inside the dental tissue. As the researchers believe, their development will soon find wide application in clinical practice for the early diagnosis of caries.

Form start

What causes the pain?	From sour, sweet, cold, hot (may not be)
From everything
From cold, hot
When tapping on a tooth
No pain
Does a tooth hurt without irritation?	No never
yes, especially at night
yes / no, sometimes it hurts at night
Yes, it hurts all the time
Not if you rinse regularly
Does it hurt badly at the moment of irritation?	So-so
Very badly, in fits
Not very good, but the hot one is rather unpleasant
Strong
It may not hurt
How long does the pain last?	Few seconds
"I walk on the ceiling all day and night"
It hurts, it doesn't hurt
Hurts for hours
Not really, but I remember from time to time
Where does it hurt?	Specific tooth
I can't say for sure, but the whole jaw hurts and even the opposite teeth.
A specific tooth, and it seems to me that it "grew"
Such a pain?	aching, dull
Like a needle stuck
Blunt pain
Sharp, throbbing pain
Virtually no
When does it hurt or get worse?	Only in a moment of irritation
Intensifies at night
Doesn't depend on the time of day
What has changed in my face?	Nothing
There is swelling of soft tissues from the side of a diseased tooth
Possibly slight swelling of soft tissues on the part of the diseased tooth
Are there any changes in the gum?	No
The gums are red and swollen in the area of the aching tooth
Slight redness of the gums, in the area of the root of the diseased tooth on the gum available fistula (a small white blister from which pus periodically flows out)
How is my tooth different from neighboring healthy ones?	Brown spot, enamel defect, "hole", pigmentation around the filling
Brown spot, enamel defect, "hole", pigmentation around the filling. Perhaps they recently had a filling and a tooth ached.
Enamel defect, "hole", pigmentation around the filling. Perhaps a filling was recently placed and the tooth ached.
Large cavity or filling. It is possible that earlier the tooth was "pulped" (picking it with needles)
Large cavity or filling. Tooth color can be changed. It is possible that earlier the tooth was "pulped" (picking it with needles)
Does the tooth swing?	No
Yes
Does it hurt to bite on it?	No
Maybe a little
It hurts so much it's scary to think

Methods for the study of OSS

The study of the oral cavity is carried out in order to determine the state of the mucous membrane, tongue, teeth, salivary glands, changes in which may indicate both local pathology and diseases of other organs and systems.

The survey reveals complaints of pain in the mouth when talking, eating, swallowing, which is often associated with the pathology of the trigeminal, glossopharyngeal or upper laryngeal nerves, pterygopalatine node, tongue, with the presence of aphthae, erosions, ulcers on the mucous membrane. Possible impairment of diction, due to defects in the mucous membrane, cleft palate, macroglossia, errors in the manufacture of dentures. Dry mouth (xerostomia) may indicate dysfunction of the salivary glands. Bad breath is characteristic of necrotizing ulcerative gingivitis, periodontitis, periodontitis. Complaints of burning, paresthesia, changes in taste are observed with stomalgia, glossalgia. A feeling of soreness may appear in connection with a pathology caused by occupational hazards - acid necrosis, cervical necrosis of hard tissues.

On examination, attention is paid to the color, shine, relief of the mucous membrane, the presence of aft, erosions, ulcers, fistulas in it. Normally pink mucous membrane acquires a bright red color in acute infectious processes, blood diseases, as well as in smokers, its pale or bluish coloration is a sign of a number of diseases of the cardiovascular system, a yellow tint is often associated with liver pathology.

Loss of gloss of the mucous membrane and the appearance of whitish spots are observed with hyperkeratosis, such as leukoplakia. The presence of edema of the mucous membrane, which can be noted both in the pathology of the R. of the item, and be a symptom of other diseases, is judged by the imprints of the teeth, which are often determined on the lateral surface of the tongue or along the line of closing of the teeth. In order to detect latent edema under the epithelium of the mucous membrane, 0.2 ml isotonic sodium chloride solution (blister test). The resulting bubble normally dissolves after 50-60 min; with edema, the resorption time increases.

To identify diseases of the mucous membrane, especially those accompanied by increased keratinization, examination of the R. of the item is carried out in the rays of Wood's lamp (luminescent diagnostics).

In order to establish the causes of a number of mucosal lesions, additional examination is necessary, including the setting of allergic tests with bacterial and non-bacterial antigens, cytological (for the diagnosis of pemphigus, viral infections, cancer, precancerous diseases), bacteriological (for detecting fungal lesions and ulcerative necrotic processes) , immunological (if syphilis is suspected - Wasserman's reaction, for brucellosis - Wright's reaction, etc.) studies. All patients with pathology of the oral mucosa undergo a clinical blood test.

Pathology oral cavity includes malformations, injuries, diseases, tumors. It includes pathology teeth , salivary glands , jaws , language , lips, palate and oral mucosa.

Developmental defects... A significant place among developmental defects is occupied by congenital cleft lips, caused by both hereditary factors and intrauterine developmental disorders. The formation of a cleft may be associated with impaired fusion of the mandibular processes (median cleft of the lower lip), maxillary and median nasal processes (the so-called cleft lip). The size of the clefts ranges from an insignificant notch in the area of the red border to its complete communication with the opening of the nose. When the cleavage of tissue is limited to the muscle layer, a hidden cleft occurs in the form of a retraction of the skin or mucous membrane. Clefts of the upper lip can be unilateral or bilateral; in about half of the cases, they are combined with clefts of the alveolar ridge of the upper jaw and palate. Complete clefts are accompanied by difficulty in sucking, as well as breathing disorders (frequent, superficial), which often leads to pneumonia.

Possible absence of lips (acheilia), fusion of lips in the lateral regions (syncheilia), shortening of the middle part of the upper lip (brachycheilia), thickening and shortening of the frenum, limiting the mobility of the upper lip. Hypertrophy of the mucous glands and tissue leads to the formation of a fold of the mucous membrane (the so-called double lip). Treatment for malformations of the lips is operational. For clefts and other tissue defects, various types of plastic surgery are used using local tissues, free skin transplantation, Filatov stem, etc. The operations are performed in the first three days after birth or in the third month of a child's life (after immunological restructuring of the body). With deformation of the frenum, it is excised, with a double lip, excess tissue is removed.

The most common malformations of the palate are congenital clefts (the so-called cleft palate), often associated with cleft lips. They can be through (pass through the alveolar process of the upper jaw, hard and soft palate) and non-through, in which the alveolar process has a normal structure. Through clefts of the palate can be unilateral and bilateral; blind clefts - complete (passes through the entire hard and soft palate) and partial (affects only part of the hard and soft palate). There are hidden crevices, in which the defect of the palate is covered by an unchanged mucous membrane. Cleft palates, especially through ones, sharply disrupt the function of breathing and sucking in newborns (when sucking, milk enters the nasal passages, as a result of which it is aspirated). With age, speech disorders develop, nasalness appears, the shape of individual parts of the face changes. Treatment of cleft palates is prompt, however, unlike cleft lips, it should be carried out at the age of 4-7 years. Until this age, obturators are used to ensure normal breathing and nutrition - special devices that separate the mouth and nose.

There is also a narrow high palate, in which orthodontic or (if ineffective) surgical treatment is performed; underdevelopment of the soft palate, requiring plastic surgery.

Damage... Damage to both the oral mucosa and deep-lying tissues is possible. Isolated damage to the mucous membrane is more often associated with mechanical, thermal or chemical injury. Long-term injury to it can lead to the formation of erosion, ulceration, the development of precancerous diseases and cancer. Damage to the lips occurs as a result of blows, wounds. Wounds (bruised, cut, gunshot) can be superficial, deep, through, lacerated, with or without tissue defect. They are accompanied by the rapid development of edema, significant bleeding. The characteristic gaping of the wound often gives the impression of a larger defect than in reality. Damage to the palate can occur when it is injured by a sharp object, as a result of gunshot wounds. The latter are usually accompanied by simultaneous damage to the nasal cavity, maxillary sinus, and upper jaw.

Start with inspection vestibule with closed jaws and relaxed lips, lifting the upper lip and lowering the lower lip or pulling the cheek with a dental mirror. First of all, the red border of the lips and the corners of the mouth are examined. Pay attention to the color, the formation of scales, crusts. On the inner surface of the lip, as a rule, an insignificant bumpy surface is determined, due to the localization of small salivary glands in the mucous layer. In addition, you can see the pinpoint holes - the excretory ducts of these glands. At these holes, when the mouth is fixed in the open position, an accumulation of secretion droplets can be observed.

Then using the mirror inspect the inner surface of the cheeks. Pay attention to the color and moisture content of the buccal mucosa. Sebaceous glands (Fordyce's glands) are located along the line of teeth closing in the posterior part, which should not be mistaken for pathology. These are pale yellow nodules with a diameter of 1-2 mm, which do not rise above the mucous membrane, and sometimes are visible only when it is pulled. At the level of the upper second large molars (molars) there are papillae, on which the excretory ducts of the parotid salivary glands open. (They are sometimes mistaken for signs of disease.) There may be dental imprints on the mucous membrane.

It is important to determine the ratio of the dentition - bite. According to the modern classification, all existing types of bite are divided into physiological and pathological (Fig. 4.1).

Following the examination of the oral cavity, gum examination... Normally, it is pale pink, tightly covering the neck of the tooth. The gingival papillae are pale pink, occupying the interdental spaces. A groove is formed at the site of the periodontal junction (previously it was called the periodontal pocket). With the development of the pathological process, the gum epithelium begins to grow along the root, forming a clinical, or periodontal (pathological), periodontal pocket. The condition of the pockets formed, their depth, and the presence of tartar are determined using an angular button-like probe or a probe with notches applied every 2-3 mm. Examination of the gums allows you to determine the type of inflammation (catarrhal, ulcerative necrotic, hyperplastic), the nature of its course (acute, chronic, in the acute stage), prevalence (localized, generalized), severity (mild, moderate, severe gingivitis or periodontitis). The papillae may be enlarged due to their swelling, while they cover a significant part of the tooth.

For determining CPITN (index of need for treatment of periodontal disease), proposed by WHO, it is necessary to examine the surrounding tissues in the area of 10 teeth: 17, 16, 11, 26, 27, which corresponds to teeth 7, 6, 1, 6, 7 on the upper jaw, and 27, 36, 31, 46, 47, which corresponds to 7, 6, 1, 6, 7 teeth on the lower jaw. The results of the examination of this group of teeth make it possible to obtain a complete picture of the state of the periodontal tissues of both jaws. The formula for this group of teeth:

In a special card, the state of only 6 teeth is recorded in the corresponding cells. When examining teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is found in the area of tooth 17, and tartar is found in the area of tooth 16, then code 2 is entered into the cell, indicating tartar. If any of these teeth is missing, then the tooth next to it in the dentition is examined. In the absence of this tooth, the cell is crossed out diagonally and this indicator is not taken into account in the summary results.

Periodontal tissues are examined by probing with a special (bulbous) probe (Fig. 4.2) to detect bleeding, supra- and subgingival calculus and pathological pocket. The load on the periodontal probe during examination should be no more than 25 g. Practical test to establish this force - pressure with a periodontal probe under the thumbnail without causing pain or discomfort.

Probing force can be divided into two components: working (for determining the depth of the pocket) and sensitive (for detecting subgingival calculus). The pain experienced by the patient during the probing is an indicator of the use of too much force. The number of probes depends on the condition of the tissues surrounding the tooth; however, probing more than 4 times in the area of one tooth is unlikely to be required. Bleeding can appear both immediately after probing and after 30-40 seconds. Subgingival calculus is determined not only when it is clearly present, but also with a barely perceptible roughness, which is revealed when the probe moves along the tooth root along its anatomical configuration.

CPITN is assessed using the following codes:

0 - no signs of illness;
1 - bleeding gums after probing;
2 - the presence of supra- and subgingival calculus;
3 - pathological pocket with a depth of 4-5 mm;
4 - pathological pocket with a depth of 6 mm or more.

Assessment of the hygienic state of the oral cavity- an important indicator of the occurrence and course of pathological processes in it. At the same time, it is important to have not only a qualitative indicator that would make it possible to judge the presence of dental plaque. Many indices have now been proposed to quantify the various components of oral hygiene.

Green and Vermillion (1964) proposed a simplified oral hygiene index (IHI) - determining the presence of plaque and calculus on the buccal surface of the first upper molars, the lingual surface of the first lower molars and the labial surface of the upper incisors: 16, 11, 21, 26, 36 , 46.

In this case, estimates are used in points:

0 - no dental plaque;
1 - plaque covers no more at the surface of the tooth;
2 - plaque covers from Y to at the surface of the tooth;
3 - Plaque covers more at the surface of the tooth.

Plaque Index (PLA) calculated by the formula:

Indicator 3 indicates unsatisfactory, and 0 - good oral hygiene.

Tartar Index (TCI) assessed in the same way as IZN:

0 - no stone;
1 - supragingival calculus at the surface of the tooth;
2 - supragingival stone on 2/3 of the surface of the crown or in certain areas;
3 - the supragingival calculus covers more at the surface of the tooth, the subgingival calculus encircles the neck of the tooth.

In determining oral hygiene index according to Fedorov-Volodkina(Fig. 4.3) with a solution of iodine and potassium iodide (crystalline iodine 1 g, potassium iodide 2 g, distilled water 40 ml) lubricate the vestibular surfaces of the six anterior (frontal) teeth of the lower jaw. The quantitative assessment is given on a five-point scale:

staining the entire surface of the crown - 5 points;
3/4 of the surface - 4 points;
1/2 surface - 3 points;
1/4 of the surface - 2 points;
lack of staining - 1 point.

The average value of the index is calculated by the formula:

Values 1 - 1.5 reflect good, and values 2-5 - poor oral hygiene.

Podshadley and Haley (1968) suggested oral hygiene efficiency index (IH)... After applying dyes and rinsing the mouth with water, 6 teeth are visually examined: buccal surfaces 16 and 26, lip surfaces 11 and 31, lingual surfaces 36 and 46.

The surface of the teeth is conventionally divided into 5 sections: 1 - medial, 2 - distal, 3 - mid-occlusal, 4 - central, 5 - mid-cervical. At each site, codes are determined:

0 - no staining;
1 - painting any surface.

The calculation is made according to the formula:

where ZN is the sum of codes for all teeth; n is the number of examined teeth. A score of 0 indicates excellent, and 1.7 or more indicates an unsatisfactory hygienic state of the oral cavity.

Tumors and swellings of various shapes and consistencies can form on the gums. The most common abscesses are a sharply hyperemic area of the gums with an accumulation of purulent exudate in the center. After opening the abscess, a fistulous tract occurs. It can also form in the presence of a focus of inflammation at the apex of the root. Depending on the localization of the fistulous tract, its origin can be determined. If the fistulous passage is located closer to the gingival margin, then its formation is associated with an exacerbation of parodontitis, and if it is closer to the transitional fold, then its occurrence is due to a change in the periodontal tissues. It should be remembered that X-ray examination is of decisive importance.

Oral examination

Begin by examining the vestibule of the mouth with closed jaws and relaxed lips, raising the upper and lowering the lower lip or pulling the cheek with a dental mirror. First of all, the red border of the lips and the corners of the mouth are examined. Pay attention to the color, the formation of scales, crusts. On the inner surface of the lip, as a rule, an insignificant bumpy surface is determined, due to the localization of small salivary glands in the mucous layer. In addition, you can see the pinpoint holes - the excretory ducts of these glands. At these holes, when the mouth is fixed in the open position, an accumulation of secretion droplets can be observed.
Then, using a mirror, examine the inner surface of the cheeks. Pay attention to its color, moisture content. Sebaceous glands (Fordyce's glands) are located along the line of teeth closing in the posterior part, which should not be mistaken for pathology. These are pale yellow nodules with a diameter of 1 - 2 mm, sometimes visible only when the mucous membrane is pulled. At the level of the upper second large molars (molars) there are papillae, on which the excretory ducts of the parotid salivary glands open. They are sometimes mistaken for signs of disease. There may be dental imprints on the mucous membrane. Following the examination of the oral cavity, the gums are examined. Normally, it is pale pink, tightly covering the neck of the tooth. The gingival papillae are pale pink, occupying the interdental spaces. A groove is formed at the site of the periodontal junction (previously it was called the periodontal pocket). Due to the development of the pathological process, the gum epithelium begins to grow along the root, forming a clinical, or periodontal, periodontal pocket. The condition of the pockets formed, their depth, the presence of tartar are determined using an angular button-like probe or a probe with notches applied every 2 - 3 mm. Examination of the gums allows you to determine the type of inflammation (catarrhal, ulcerative necrotic, hyperplastic), the nature of the course (acute, chronic, in the stage of exacerbation), prevalence (localized, generalized), severity (mild, moderate, severe gingivitis or periodontitis) of inflammation. There may be an increase in the size of the papillae due to their edema, when a significant part of the tooth is covered.
Then proceed to the study of the actual oral cavity. First of all, a general examination is performed, paying attention to the color and moisture content of the mucous membrane. Normally, it is pale pink, but it can become hyperemic, edematous, and sometimes acquires a whitish tint, which indicates the phenomenon of para or hyperkeratosis.
Examination of the tongue begins with determining the condition of the papillae, especially if there are complaints of changes in sensitivity or burning and soreness in any areas. There may be a lining of the tongue due to a slowdown in the rejection of the outer layers of the epithelium. This phenomenon may be the result of disruption of the gastrointestinal tract, and possibly pathological changes in the oral cavity with candidiasis. Sometimes there is an increased desquamation of the papillae of the tongue in some area (more often at the tip and lateral surface). This condition may not bother the patient, but pain from irritants, especially chemical ones, may occur. With atrophy of the papillae of the tongue, its surface becomes smooth, as if polished, and as a result of hyposalivation, it becomes sticky. Individual areas, and sometimes the entire mucous membrane, can be bright red or crimson. This state of the tongue is observed in malignant anemia and is called Gunther's glossitis (after the name of the author who described it for the first time). Hypertrophy of the papillae may also be noted, which, as a rule, does not cause concern to the patient.
Hypertrophy of the papillae of the tongue is often combined with hyperacid gastritis.

When examining the tongue, it should be remembered that at the root of the tongue on the right and left there is a pink or bluish-pink lymphoid tissue. Often this formation is sick, and sometimes even doctors take it for pathological. In the same place, a pattern of veins is sometimes clearly visible due to their varicose expansion, but this symptom has no clinical significance.
When examining the tongue, pay attention to its size, relief. With an increase in size, the time of manifestation of this symptom (congenital or acquired) should be determined. It is necessary to distinguish macroglossia from edema. The tongue can be folded in the presence of a significant number of longitudinal folds, but patients may not be aware of this, since in most cases it does not bother them. Folding appears when the tongue is spread. Patients mistake them for cracks. The difference is that with a crack, the integrity of the epithelial layer is broken, and with a fold, the epithelium is not damaged.
Examination of the mucous membrane of the floor of the mouth. A feature of the mucous membrane here is its pliability, the presence of folds, frenulum of the tongue and excretory ducts of the salivary glands, and sometimes droplets of accumulated secretions. In smokers, the mucous membrane may turn dull.
In the presence of keratinization, which manifests itself in patches of grayish-white color, their density, size, adhesion with the underlying tissues, the level of elevation of the focus above the mucous membrane, and soreness are determined.
The importance of identifying these signs is that sometimes they serve as the basis for active intervention, since foci of hyperkeratosis of the oral mucosa are considered precancerous conditions. If any changes are detected on the oral mucosa (ulcer, erosion, hyperkeratosis, etc.) exclude or confirm the possibility of a traumatic factor. This is necessary for diagnosis and treatment.
Palpation examines the alveolar process of the upper jaw from the vestibular, lingual and palatal sides, the color of the mucous membrane above these areas. When a fistulous passage is detected, pus is released from it, granulation swelling with a probe, the course is examined, its connection with the jaw bone, the presence of usuria in the bone and further (to the tooth or teeth) is clarified. Palpating the arch of the vestibule of the mouth, mark the cord along the transitional fold. Such symptoms are characteristic of chronic granulating periodontitis. With this process, there may be a protrusion of the bone.
However, bone swelling can be observed with a radicular cyst, tumor-like and tumor lesions of the jaw.
If palpation in the area of the vestibular fornix of the vestibule of the mouth or on the lower jaw on the lingual side shows a swelling in the form of a painful infiltrate or in the palate in the form of a rounded infiltrate, one can assume the presence of acute periostitis. Periosteal inflammatory tissue infiltration along the surface of the alveolar processes from the vestibular, lingual and palatal sides,
painful percussion of several teeth, suppuration from gingival pockets, fistulas characterize acute, subacute osteomyelitis of the jaw. In the lower jaw at the level of molars and premolars, this may be accompanied by a violation of the sensitivity of the tissues innervated by the lower alveolar and chin nerves (Vincent's symptom). Periosteal dense thickening of the jaw, fistulas on the skin of the face and in the oral cavity are typical for chronic forms of odontogenic osteomyelitis, as well as specific inflammatory lesions. At the same time

with mobility of the teeth accompanying such clinical symptoms, it is necessary to show oncological vigilance.
The focus of inflammatory changes in the peri-maxillary soft tissues requires clarification of the localization and boundaries of the infiltrate from the side of the mouth. Bimanual palpation is usually used. They reveal a violation of the function of opening the mouth, swallowing, breathing, speech impairment. Particular attention is paid to the root of the tongue, the sublingual, pterygo-mandibular and periopharyngeal spaces.
When massaging the salivary glands, one should pay attention to possible characteristic changes: thick saliva consistency, cloudy color, the presence of flakes, clots, salivary blood clots in it.
In diseases of the salivary glands, probing of the ducts is carried out, which makes it possible to establish their direction, the presence of stenosis, stricture or its complete obliteration, calculus in the duct.
Examination of teeth
When examining the oral cavity, it is necessary to examine all the teeth, and not only the one that, in the patient's opinion, is the cause of pain or discomfort. Violation of this rule may lead to the fact that the cause of the patient's anxiety at the first visit may not be found, because,
as discussed earlier, pain can be radiating. In addition, an examination of all teeth at the first visit is also necessary in order to outline a treatment plan, which ends with a sanitation of the oral cavity.
It is important that during the examination, all changes in the tooth tissues are detected. For this purpose, it is recommended to develop a specific inspection system. For example, the examination should always be done from right to left, starting with the teeth of the upper jaw (molars), and then from left to right, the teeth of the lower jaw should be examined.
Examination of the teeth is performed using a set of instruments; the most often used is a dental mirror and probe (always sharp). The mirror allows you to inspect poorly accessible areas and direct a beam of light to the desired area, and the probe is used to check all depressions, pigmented areas, etc. If the integrity of the enamel is not violated, then the probe glides freely over the surface of the tooth, without lingering in the depressions and folds of the enamel. In the presence of a carious cavity in a tooth (invisible to the eye), a sharp probe lingers in it. Especially carefully you should inspect the contact surfaces of the teeth (contact), since it is not easy to find an existing cavity with an intact chewing surface, while probing can detect such a cavity. Currently, the technique of transillumination of tooth tissues is used by supplying light through special light guides. Probing helps to determine the presence of softened dentin, the depth of the carious cavity, communication with the tooth cavity, the location of the canal orifices, and the presence of pulp in them.
Tooth color can make a difference in the diagnosis. Teeth are usually white with many shades (from yellow to bluish). However, regardless of the shade, the enamel of healthy teeth is characterized by a special transparency - "live enamel shine". In a number of conditions, the enamel loses its characteristic shine, becomes dull.
So, the beginning of the carious process is a change in the color of the enamel, the appearance of opacity at first, and then a white carious spot. Pulped teeth lose their usual enamel shine, they acquire a grayish tint. A similar discoloration, and sometimes more intense, is observed in teeth in which pulp necrosis has occurred. After necrosis of the pulp, the color of the tooth can change dramatically.

Tooth color can also change under the influence of external factors: smoking
(dark brown color), metal fillings (staining the tooth in a dark color), chemical treatment of canals (orange color after the resorcinol-formalin method).
Pay attention to the shape and size of the teeth. Deviation from normal shape is due to treatment or abnormality. It is known that some forms of dental anomalies (Hutchinson's teeth, Fournier's teeth) are characteristic of certain diseases.
Percussion - tapping on the tooth - is used to determine the state of the periodontium.
With tweezers or the handle of the probe, tap on the incisal edge or chewing surface of the tooth. If there is no focus of inflammation in the periodontium, percussion is painless. In the presence of an inflammatory process in the periodontium, a painful sensation arises from blows that do not cause discomfort in healthy teeth. When performing percussion, the beats should be light and even. Percussion should be started with obviously healthy teeth, so as not to cause severe pain and to enable the patient to compare the sensation in a healthy and affected tooth.
Distinguish between vertical percussion, when the direction of the blows coincides with the axis of the tooth, and horizontal, when the blows have a lateral direction.
The mobility of the teeth is determined with tweezers by swinging. The tooth has physiological mobility, which is normally almost invisible. However, with damage to the periodontium and the presence of exudate, pronounced tooth mobility arises in it.
There are three degrees of mobility: I degree - displacement in the vestibular-oral direction; II degree - displacement in the vestibular-oral and lateral directions; III degree - displacement and along the axis of the tooth (in the vertical direction).
Examination of the teeth is carried out regardless of the patient's specific complaints and their condition is recorded from right to left, first on the upper, then on the lower jaw.
A mirror and a sharp probe are used, which allows you to establish the integrity of the enamel or detect a cavity, mark its depth and dimensions, as well as communication with the tooth cavity. Attention should be paid to the color of the teeth. A grayish and cloudy color of the tooth enamel may indicate pulp necrosis. The shape and size of the teeth are also important, including dental anomalies: the teeth of Hutchinson, Fournier, which may indicate common diseases and hereditary signs of pathology.
Examining the teeth, percussion them, determine mobility with tweezers, note the presence of supernumerary or milk teeth in a permanent bite, eruption of the lower wisdom teeth, determine the nature of teeth closing.
Examine the gingival tubercles, determine the state of the periodontium. The instrument is tapped on the cutting or chewing surface of the tooth (vertical percussion) and on the vestibular surface of the tooth (horizontal percussion). If pain is noted during percussion, this indicates the presence of a peri-apical or marginal focus in the periodontium. They also perform palpation of the teeth - feeling, which makes it possible to establish their mobility and soreness. Grasping the crown of the tooth with dental tweezers, mark the degrees of mobility - I, II and III.
Using a dental probe, gingival pockets, their depth, bleeding during probing, discharge from the pockets and their character are determined.
With the mobility of the teeth, it is necessary to clarify whether there is a localized process or diffuse lesion of the periodontium, as well as to show an oncological

alertness. Pathological mobility of a number of teeth, combined with painful percussion, can be one of the symptoms of osteomyelitis of the jaw.
It is imperative to assess the hygiene of the oral cavity. If urgent surgical operations are required, simple hygienic procedures are performed to reduce the amount of dental plaque. During planned operations, the whole complex of medical procedures is carried out and the hygienic state is assessed according to the Green-Vermillion or Fedorov index.
Volodkina, and only with a high hygiene index, surgery is performed.
The results of the examination of the teeth are recorded in a special scheme (dental formula), where milk teeth are designated by Roman numerals, permanent ones - by Arabic numerals. Currently, it is customary to designate the tooth number according to the international classification.
The clinical examination of the patient should include b a number of diagnostic methods and studies. The type and volume of them depend on the nature of the disease or injury to the maxillofacial region and on the conditions of the examination (in a polyclinic or hospital), as well as on the level of equipment of the medical institution.
X-ray studies are important for the diagnosis of pathology of the teeth, jaws and other bones of the face and cranial vault, maxillary and frontal sinuses, temporomandibular joints, glands of the oral cavity. Contact intraoral radiography of the teeth, alveolar and palatal processes, the floor of the oral cavity is performed, which makes it possible to clarify the localization and nature of changes in the periodontium, bone, to note the presence of calculus. There are 4 methods of intraoral radiography: radiography of periapical tissues according to the rule of isometric projection; interproximal; bite or occlusal photography; radiography from an increased focal length with a parallel beam of rays.
Isometric surveys are used to assess the periapical tissues, however, they give distortions in magnitude, which can lead to hyper or underdiagnosis.
Interproximal radiographs show teeth, periapical tissues, margins of both jaws. Occlusal radiography allows you to take a snapshot of the alveolar ridge area. Most often, this projection gives an idea of the cortical plate of the alveolar process from the vestibular and lingual sides, including the thickness of the periosteum. In another plane, one can judge more accurately about the pathology: cysts, impacted teeth, jaw fracture lines, the presence of a foreign body (calculus) in the submandibular and sublingual salivary glands. Occlusal images are taken in addition to the previous ones.
Long-focus radiography is performed on devices with a more powerful X-ray tube and a long cone localizer. The method is used mainly to display the marginal sections of the alveolar processes, the structure of bone tissue, the shape of the roots and the presence of destructive changes around them.
X-ray examination of teeth, jaws and other bones of the facial skeleton is of fundamental importance for judging the presence of carious tooth cavities, the shape of the roots, the degree of filling them with a filling mass, the state of the periodontium, bone, etc.

Tooth enamel gives a denser shade, while dentin and cementum gives a less dense enamel.
The cavity of the tooth is recognized by the outline of the contour of the alveoli and the cement of the root - it is determined by the projection of the root of the tooth and the compact plate of the alveoli, which looks like a uniform darker strip 0.2 - 0.25 mm wide.
Bone structure is clearly visible on well-taken radiographs. The bone pattern is due to the presence of bone trabeculae in the cancellous substance and in the cortical layer, or trabeculae, between which the bone marrow is located.
The bone beams of the upper jaw have a vertical direction, which corresponds to the force load exerted on it. The maxillary sinus, nasal passages, orbit, and frontal sinus appear as clearly defined cavities. Filling materials due to different density on the film have unequal contrast. So, phosphate cement gives a good image, and silicate cement gives a bad image. Plastic, composite filling materials poorly trap X-rays, and, therefore, a fuzzy image is obtained in the picture.
Radiography allows you to determine the condition of the hard tissues of the teeth (hidden carious cavities on the contact surfaces of the teeth, under the artificial crown), impacted teeth (their position and relationship with the tissues of the jaw, the degree of formation of roots and canals), erupted teeth
(fracture, perforation, narrowing, curvature, degree of formation and resorption), foreign bodies in the root canals (pins, broken burs, needles). The radiograph can also assess the degree of patency of the canal (a needle is inserted into the canal and an x-ray is taken), the degree of filling the canals and the correctness of the filling, the state of the periapical tissues
(expansion of the periodontal gap, rarefaction of bone tissue), the degree of atrophy of the bone tissue of the interdental septa, the correct manufacture of artificial crowns (metal), the presence of neoplasms, sequesters, the state of the temporomandibular joint.
The x-ray can be used to measure the length of the root canal. To do this, an instrument is inserted into the root canal with a limiter set at the estimated length of the canal. An x-ray is then taken. The length of the tooth canal is calculated by the formula: where i is the actual length of the instrument; K1 is the radiologically determined length of the canal; i1 is the radiologically determined length of the instrument.
It is effective to use images on a radiovisiograph during resection of the apex of the tooth root, extraction of teeth (especially impacted ones), and implantation.
Radiovisiography gives an image of residual roots, foreign bodies, the position of the implant in relation to adjacent teeth, the bottom of the maxillary sinus, nose, the canal of the lower jaw, and the chin foramen. New generations of visiographs provide volumetric, color, and digital data, which make it possible to more accurately judge the amount and structure of the bone, the effect of surgical interventions. Extraoral radiography is used to study the upper and lower jaws, zygomatic, frontal, nasal, temporal and other bones of the skull, maxillary and frontal sinuses, temporomandibular joints. The following projections are used for radiography: direct, lateral, semi-axial, axial, as well as oblique contact and tangential.
Orthopantomography is a promising method of X-ray examination, which allows you to obtain an overview of the teeth and jaws.

Panoramic radiographs have a definite advantage over intraoral images, since with minimal radiation exposure they give an overview image of the jaw, teeth, periapical tissues and adjacent sinuses. However, on panoramic radiographs, distortions of the structure of the roots of the teeth, the structure of the bone, the location of individual anatomical formations are possible; the central teeth and the surrounding bone tissue are poorly formed.
Lateral panoramic images give less distortion. Orthopantomography is most effective for the primary diagnosis of inflammation, trauma, tumor, deformity.
When diagnosing pathological processes in the jaws and nasal cavities, orthopantomography, orthopantomography is supplemented with longitudinal tomography and zonography, using direct, lateral, posterior and anterior axial projections. To reduce radiation exposure, zonograms are also produced with small angles of tube rotation, giving a layer-by-layer image of thicker sections.
In diagnostics, electro-roentgenography is also used, which is very effective for emergency information. However, with this method, the patient receives a lot of radiation exposure.
For diseases and injuries of the salivary glands, bronchiogenic fistulas, chronic osteomyelitis of the jaws, contrast radiography is used using iodolipol and water-soluble contrast agents. When sialography of the parotid gland, the norm of the contrast agent is 2.0 - 2.5 ml, for the submandibular salivary gland - 1.0 - 1.5 ml. In pathological processes, these numbers can be corrected in the direction of decrease (calculous sialadenitis, interstitial sialadenitis) or increase (parenchymal sialadenitis). With sialography, intraoral zonography is used - direct and lateral and orthopantomography. Sialography allows you to assess the condition of the ducts of the gland, to determine the presence of a salivary stone. The method can be supplemented with pneumosubmandibulography, digital subtraction sialography, radiometry, scintigraphy.
Contrast radiography is also used for chronic osteomyelitis, fistulas of the face and neck, including congenital ones (fistulography), jaw cysts, and diseases of the maxillary sinus.
For diseases of the temporomandibular joints, arthrography is used.
After intra-articular administration of a contrast agent, tomo or zonograms are obtained at different positions of the condylar process.
Radiography with contrasting arterial and venous vessels of the maxillofacial region is most effective in vascular neoplasms. In some cases, the tumor is punctured, a contrast agent is injected, and radiographs are performed in frontal and lateral projections. In other cases, especially with cavernous hemangioma, the carrying vessel is surgically isolated, and then a contrast agent is injected and a series of radiographs is performed in different projections. Angiography requires special conditions and should be carried out in a hospital, in an X-ray operating room, where anesthesia, surgical isolation of the leading tumor vessel, and an approach to the femoral, subclavian, and external carotid arteries are performed.
Choose water-soluble contrast agents (verografin, urografin, cardiografin, cardiotrast). More often, serial angiography through the external carotid artery is used to diagnose vascular tumors.

Less commonly, lymphography is used - direct for the diagnosis of lymph nodes, blood vessels.
X-ray computed tomography (CT) is a promising tool in the diagnosis of diseases of the maxillofacial region, which makes it possible to obtain two- and three-dimensional layered images of the head. Thanks to the layered image
RKT determines the true size and boundaries of the defect or deformity, the localization of the inflammatory or tumor process. The high resolution of RKT makes it possible to differentiate pathological processes in bone and soft tissues. This method is very important for injuries and the presence of intracranial changes. Establishing the dislocation of cerebral structures, the localization of brain trauma, the presence of hematomas, hemorrhages helps diagnostics, allows planning interventions and their sequence in the maxillofacial region, the cerebral region of the skull and the brain.
In the diagnosis of pathological processes in the maxillofacial region, magnetic resonance imaging (MRI) is also used. It has a particular advantage as it is not associated with ionizing radiation. MRI detects changes in soft tissues: edema, infiltration, accumulation of exudate, pus, blood, tumor growth, including malignant neoplasms, the presence of metastases.
The combined use of X-ray computed and magnetic resonance imaging makes it possible to obtain a three-dimensional image of the soft and bone tissues of the face and, on the basis of spatial layered anatomical and topographic data, create graphic computer models. This determines an accurate diagnosis, allows you to plan the proper amount of intervention. RCT data and
MRI also determines the possibility of intraoperative spatial orientation in the maxillofacial region. Especially important is the ability to create three-dimensional graphic images based on these methods for restorative operations in the maxillofacial region.

After defining β the previously calculated data of the transformers are specified (recalculated):

§ bar diameter d = Ax, where x =

The found diameter is used to select the closest value from the normalized range of bar diameters d n

After selecting the normalized diameter d n clarifies the meaning

β n = β (d n / d) 4

§ active section of the bar Ps = 0.0355x 2 for copper windings or

Ps = 0.0386x 2(m 2 )

§ the average diameter of the channel between the windings d 12 = a d n (m)

§ winding height l = πd 12 / β n (m)

§ bar height l c = l + 2l 0 (m)

§ distance between the axes of the bars С = d 12 + a 12 + b * d + a 22 (m)

§ electromotive force of one turn u in = 4.44 * f * P s * B s (V)

§ weight of steel G st (kg)

§ mass of windings Go (kg)

§ wire mass G pr(kg)

§ current density J (A / m 2)

§ mechanical stresses in the windings s p (MPa)

§ the cost of the active part (in conventional units)

§ cost of the active part = * with st in monetary terms (rub) ( with st - see table 14)

§ losses and no-load current P x (W) , i o (%)

Clinical anatomy of the oral cavity organs of a healthy person. Examination of the oral cavity organs. Examination, determination of the clinical condition of the teeth. Inspection and examination of fissures, cervical area, contact surfaces.

Clinical anatomy of the oral cavity organs of a healthy person.

Oral cavity, cavitasoris is the beginning of the digestive apparatus.

The oral cavity is limited:

Ó in front - with lips,

Ó from above - a hard and soft palate,

Ó from below - by the muscles that form the floor of the mouth, and the tongue,

Ó on the sides - cheeks.

The oral cavity opens with a transverse mouth gap (rimaoris), limited by the lips (labia). The latter are muscle folds, the outer surface of which is covered with skin, and the inner surface is lined with mucous membrane. Through the pharynx (fauces), more precisely, the isthmus of the pharynx (isthmusfaucium), the oral cavity communicates with the pharynx.

The oral cavity is divided into two parts by the alveolar processes of the jaws and teeth:

1) The antero-outer part is called the vestibule of the mouth (vestibulumoris) and is an arcuate gap between the cheeks and gums with teeth.

2) The posterior-internal, located inwardly from the alveolar processes, is called the oral cavity itself (cavumorisproprium). In front and on the sides, it is bounded by the teeth, from below by the tongue and the bottom of the mouth, and from above by the palate.

The oral cavity is lined with the mucous membrane of the mouth (tunicamucosaoris), covered with stratified squamous non-keratinized epithelium. It contains a large number of glands. The area of the mucous membrane attached around the neck of the teeth on the periosteum of the alveolar processes of the jaws is called the gum (gingiva).

Cheeks (buccae) are covered with skin on the outside, and on the inside by the mucous membrane of the mouth, which contains the ducts of the buccal glands, and are formed by the buccal muscle (m. buccinator). The subcutaneous tissue is especially developed in the central part of the cheek. Between the chewing and buccal muscles is the fatty body of the cheek (corpusadiposumbuccae).

The upper wall of the oral cavity (palate) is divided into two parts. The front part - the hard palate (palatiumdurum) - is formed by the palatine processes of the maxillary bones and horizontal plates of the palatine bones, covered with a mucous membrane, along the median line of which there is a narrow white stripe, called the "suture of the palate" (raphepalati). Several transverse palatine folds (plicaepalatinaetransversae) depart from the suture.

Posteriorly, the hard palate passes into the soft palate (palatiummolle), formed mainly by the muscles and aponeurosis of the tendon bundles. In the posterior part of the soft palate there is a small conical protrusion called the uvula, which is part of the so-called velumpalatinum. At the edges, the soft palate passes into the anterior arch, called the palatine-lingual arch (arcus palatoglossus) and heading to the root of the tongue, and the posterior palatopharyngeal (arcus palatopharyngeus), which goes to the mucous membrane of the lateral pharyngeal wall. In the grooves formed between the arches on each side, the tonsils (tonsillaepalatinae) lie. The lower palate and arches are formed mainly by the muscles that take part in the act of swallowing.

Language (lingua)- a mobile muscular organ located in the oral cavity and facilitating the processes of chewing food, swallowing, sucking and speech production. In the language, the body of the tongue (corpuslinguae), the apex of the tongue (apexlinguae), the root of the tongue (radixlinguae) and the back of the tongue (dorsumlinguae) are distinguished. The body is separated from the root by a border groove (sulcusterminalis), consisting of two parts, converging at an obtuse angle, at the apex of which there is a blind hole of the tongue (foramencaecumlinguae).

Above, from the sides and partly from below, the tongue is covered with a mucous membrane, which grows together with its muscle fibers, contains glands, lymphoid formations and nerve endings, which are sensitive receptors. On the back and body of the tongue, the mucous membrane is rough due to the large number of papillae of the tongue (papillaelinguales).

From the lower surface of the tongue to the gums, in the sagittal direction, there is a fold of the mucous membrane, which is called the frenulum of the tongue (frenulumlinguae). On both sides of it, at the bottom of the mouth, on the hyoid fold, the ducts of the submandibular gland (glandulasubmandibularis) and the sublingual gland (glandulasublingualis) open, which secrete saliva and are therefore called salivary glands (glandulaesalivales).

Examination of the oral cavity organs carried out in the following order:

1. Examination of the oral mucosa:

Ó the mucous membrane of the lips, cheeks, palate;

Ó the state of the excretory ducts of the salivary glands, the quality of the discharge;

Ó the mucous membrane of the back of the tongue.

2. Study of the architectonics of the vestibule of the oral cavity:

Ó the depth of the vestibule of the oral cavity;

Ó frenulum of the lips;

Ó lateral cheek cords;

Ó frenum of the tongue.

3. Assessment of the periodontal condition.

4. Assessment of the bite condition.

5. Assessment of the condition of the teeth.

Sign	Norm	Pathology
The condition of the mucous membrane of the lips and cheeks.	The mucous membrane of the lips is pink, clean, moist, veins are visible on the inner surface of the lips, there are nodular protrusions (mucous glands). On the mucous membrane of the cheeks along the line of closing of the teeth - sebaceous glands (yellowish-gray tubercles). At the level of the second upper molar is the papilla, into the apex of which the parotid duct opens. Saliva flows freely during stimulation, in children 6-12 months. - physiological salivation.	The mucous membrane is dry, bright pink, with a bloom, there are rashes of elements. In place of the mucous gland there is a vesicle (blockage of the gland). Along the line of closing of the teeth - their imprints or minor hemorrhages - traces of biting. On the mucous membrane of the upper molars there are whitish spots. The papilla is swollen, hyperemic. When stimulated, saliva flows out with difficulty, is cloudy, or pus is released. Children over 3 years old have hypersalivation.
The nature of the frenulum of the lips and mucous cords.	The frenum of the upper lip is woven into the gum at the border of the free and attached parts; in children during milk bite - at any level up to the apex of the interdental papilla. The frenum of the lower lip is free - when the lower lip is abducted to the horizontal position, there are no changes in the papilla. Lateral cords or ligaments of the mucous membrane do not change the state of the gingival papillae when pulled.	Low attachment, the bridle is short, wide, or short and wide. The frenulum of the lower lip is short; when the lip is retracted to a horizontal position, paleness (anemia) occurs, exfoliation of the gingival papilla from the necks of the teeth. The ligaments are strong, attach to the interdental papillae and cause them to move when pulled.
The condition of the gums.	In schoolchildren, the gums are dense, have a pale pink color, the appearance of a lemon peel. In preschoolers, the gum is brighter, its surface is smooth. The papillae in the area of single-rooted teeth are triangular, in the area of the molars they are triangular or trapezoidal, the gums fit tightly to the neck of the teeth. No dental plaque. The dentogingival groove (groove) is 1 mm.	The gingival margin is atrophied, the necks of the teeth are exposed. The papillae are enlarged, edematous, cyanotic, the tops are cut off, covered with bloom. The gums flake off from the necks of the teeth. There are supra- and subgingival dental deposits. Physiological periodontal pocket more than 1 mm.
Tongue frenum length	The frenum of the tongue is of the correct shape and length.	The frenum of the tongue is attached to the apex of the interdental papilla and, when pulled, causes it to move. The frenum of the tongue is short, the tongue does not rise to the upper teeth, the tip of the tongue bends and bifurcates.
S.O. tongue, floor of the mouth, hard and soft palate.	The tongue is clean, moist, the papillae are pronounced. The bottom of the oral cavity is pink, large vessels are visible, the excretory ducts of the salivary glands are located on the frenum, salivation is free. The mucous membrane of the palate is pale pink, clear, in the area of the soft palate pink, small-knobby.	Tongue coated with bloom, varnished, dry, foci of desquamation of filiform papillae. The mucous membrane of the floor of the oral cavity is edematous, hyperemic, salivation is difficult. The rollers swell sharply. On the mucous membrane of the palate, areas of hyperemia. Elements of defeat.
The nature of the bite.	Orthognathic, straight.	Distal, mesial, open, deep, cross.
The condition of the dentition.	The dentition is of the correct shape and length. Teeth of the correct anatomical shape, color and size, correctly positioned in the dentition, individual teeth with fillings, after 3 years - physiological tremors.	The dentition is narrowed or widened, shortened, individual teeth are located outside the dental arch, are absent, there are supernumerary or merged teeth. The structure of hard tissues has been changed (caries, hypoplasia, fluorosis).
Dental formula.	Age appropriate, healthy teeth.	Violation of the sequence and parity of teething, cavities, fillings.
The state of oral hygiene.	Good and satisfactory.	Bad and very bad.