1. Nose, Mouth, and Throat Chapter 16

2. Slide 16-2

3. Slide 16-3 Nasal Cavity

4. Slide 16-4 Sinuses

5. Functions of the Nose Functions of the Nose First Segment of the Respiratory System Warms, moistens, and filters inhaled air Sensory organ for smell –Olfactory receptors, hair cells, lie at roof of nasal cavity and upper third of septum These receptors for smell merge into olfactory nerve, cranial nerve I, which transmits to temporal lobe of brain Although not necessary for human survival, the sense of smell adds to nutrition by enhancing pleasure and taste of food Slide 16-5

6. History/Subjective Data Discharge Frequent colds, upper respiratory infections Sinus pain Trauma Epistaxis, nosebleeds Allergies Altered smell Slide 16-6

7. Assessment/Objective Data Preparation Position sitting up straight with head at eye level Equipment needed –Otoscope with short, wide-tipped nasal speculum, or nasal speculum –Penlight –Gloves Slide 16-7

8. Objective Data Inspect External nose –Note symmetry, alignment, and proportion to other facial features –Inspect for any deformity, asymmetry, inflammation, or skin lesions Palpate External Nose –Test patency of nostrils –Palpate for consistency/pain, lumps/ bony deformity Slide 16-8

9. Inspect the Nasal Cavity –Mucosa, normally red- note any swelling, discharge, bleeding, or foreign body –Septum- deviation, perforation –Turbinates- inferior, middle superior Slide 16-9

10. Palpate Sinuses Using thumbs, press frontal sinuses by pressing up and under the eyebrows and over maxillary sinuses below cheekbones Slide 16-10

11. Transillumination Slide 16-11

12. Mouth Structure and Function –First segment of digestive system and an airway for the respiratory system –Oral cavity: short passage bordered by lips, palate, cheeks, and tongue Contains teeth and gums, tongue, and salivary glands Slide 16-12

13. Throat Structure/Function Throat, or pharynx –Area behind mouth and nose Oropharynx: separated from mouth by a fold of tissue on each side, the anterior tonsillar pillar Tonsils: behind folds, each is a mass of lymphoid tissue look more granular, and surface shows deep crypts Tonsillar tissue enlarges during childhood until puberty Posterior pharyngeal wall is seen behind these structures Nasopharynx: continuous with oropharynx above oropharynx and behind nasal cavity Pharyngeal tonsils (adenoids) and eustachian tube openings are located here Slide 16-13

14. History/Subjective Data ● Mouth and Throat –Sores or lesions –Sore throat –Bleeding gums –Toothache –Hoarseness –Dysphagia –Altered taste –Smoking, alcohol consumption –Self-care behaviors –Dental care pattern –Dentures or appliances Slide 16-14

15. Subjective Data Additional history for infants and children –mouth infections or sores (thrush, canker sores) Does child have frequent sore throat or tonsillitis? How often? How are these treated? Have they ever been documented as streptococcal infections? –Tooth eruption/development Concerns about teeth Use of bottle at bedtime Thumb-sucking Teeth-grinding Slide 16-15

16. Subjective Data Additional history for aging adult –Dryness - OTC or prescription medications –Tooth loss –Trouble with mastication –Changes in sense of taste Slide 16-16

17. Objective Assessment of the Mouth and Throat Preparation Position sitting up straight with head at eye level If person wears dentures, examine with and without them Equipment needed –Otoscope or Penlight –Tongue blade –2X2gauze –Gloves

18. Inspection & Palpate –Begin with anterior structures and move posteriorly; use tongue blade to retract structures and bright light for optimal visualization –Lips –Buccal Mucosa- salivary gland/ducts –Tongue- (and floor of mouth) –Teeth/gums –Hard/soft palate –Posterior oral pharynx- tonsils, pillars Slide 16-18

19. Slide 16-19 Mouth

20. Tongue

21. Salivary Glands Slide 16-21

22. Teeth

23. Throat

24. Slide 16-24

25. Developmental Competence Infants and children Salivation starts at 3 months; baby will drool periodically for a few months before learning to swallow saliva Teeth, both sets, begin development in utero Children have 20 deciduous, or temporary teeth that erupt between 6 months and 24 months of age; all 20 should appear by 2½ Deciduous teeth lost beginning at age 6 through 12; replaced by permanent, starting with central incisors Nose develops during adolescence, along with other secondary sex characteristics –This growth starts at age 12 or 13, reaching full growth at age 16 in females and age 18 in males Slide 16-25

26. Pregnant woman –Nasal stuffiness and epistaxis may occur during pregnancy as a result of increased vascularity in the upper respiratory tract –Gums may be hyperemic, hypertrophic and softened and may bleed with normal toothbrushing Slide 16-26

27. Aging adult –Gradual loss of subcutaneous fat starts during later middle adult years, making the nose appear more prominent in some people Nasal hairs grow coarser and stiffer Sense of smell may diminish because of a decrease in number of olfactory nerve fibers In the oral cavity, soft tissues atrophy and epithelium thins, especially in cheek and tongue resulting in loss of taste buds, with about an 80% reduction in taste Further impairments include decrease in salivary secretion needed to dissolve flavoring agents Slide 16-27

28. Aging adult –Atrophic tissues ulcerate easily increasing risk for older persons for infections such as oral moniliasis and malignant lesions –Many dental changes occur with aging Tooth surface is abraded Gums begin to recede and teeth begin to erode at gum line; a smooth V-shaped cavity forms around neck of the tooth, exposing nerve and making tooth hypersensitive Some tooth loss may occur from bone resorption (osteoporosis), which decreases inner tooth structure and its outer support Slide 16-28

29. Aging adult –Natural tooth loss exacerbated by inadequate dental care, poor oral hygiene, and tobacco use If tooth loss occurs, remaining teeth drift, causing malocclusion Chewing with maloccluding teeth causes problems –Excessive bone resorption with further tooth loss occurs –Muscle imbalance results from mandible and maxilla now out of alignment, which produces muscle spasms, tenderness of muscles of mastication, and chronic headaches –Temporomandibular joint stressed, leading to osteoarthritis, pain, and inability to fully open mouth Slide 16-29

30. Aging adult Diminished sense of taste and smell decreases aging person’s interest in food and may contribute to malnutrition Saliva production decreases; saliva acts as a solvent for food flavors and helps move food around the mouth Decreased saliva reduces mouth’s self-cleaning property Major cause of decreased saliva flow is not aging process itself but use of medications that have anticholinergic effects More than 250 medications have side effect of dry mouth Slide 16-30

31. Aging adult –Absence of some teeth and trouble with mastication –may result in older persons eating soft foods, usually high in carbohydrates –decreasing meat and fresh vegetable intake resulting in risk of nutritional deficit for protein, vitamins, and minerals Slide 16-31

32. Cultural Competence Bifid uvula-a condition in which uvula is split either completely or partially occurs in 18% of some Native American groups and in 10% of Asians; occurrence in whites and African Americans rare Slide 16-32

33. Cultural Competence Cleft lip and cleft palate most common in Asians American and American Indian newborns and less in Caucasians and least common in African Americans

34. Cultural Competence –Leukoedema, a benign lesion occurring on buccal mucosa, is seen more often in African Americans –Incidence of natal teeth is rare but more common among American Indian infants Slide 16-34

35. Cultural Competence –Caucasions have more tooth decay than African Americans African Americans have harder and denser tooth enamel, thus teeth less susceptible to organisms causing caries –Edentulism has dropped to 10.5% of US population –African Americans, Hispanics, Native Americans, and Alaska Natives have poorest oral health of all racial and ethnic groups in U.S. Slide 16-35

36. Cultural Competence –African American males have highest rate of oral cavity and pharyngeal cancers in US –5-year survival rate for oral cancer is also much lower in African Americans (34%) than in whites (56%). May be related to fact that cancers are usually diagnosed at a much later stage of disease in African Americans –Poverty is an extenuating factor in this problem because 65.8% of population living in poverty visited a dentist Slide 16-36

37. Abnormal Findings: Abnormalities of the Nose Choanal atresia Epistaxis Foreign body Perforated septum Furuncle Acute rhinitis Allergic rhinitis Sinusitis Nasal polyps Carcinoma Slide 16-37

39. Abnormalities of the Lips Cleft lip Herpes simplex I Angular cheilitis (stomatitis, perleche) Carcinoma Retention “cyst” (mucocele) Slide 16-39

40. Abnormalities of Teeth and Gums Baby bottle tooth decay Malocclusion Dental caries Epulis Gingival hyperplasia Gingivitis Meth mouth Slide 16-40 Meth mouth Baby bottle mouth

41. Abnormalities of Buccal Mucosa Aphthous ulcers Koplik’s spots Leukoplakia Candidiasis or monilial infection Slide 16-41

42. Abnormalities of the Tongue Ankyloglossia Fissured or scrotal tongue Geographic tongue (migratory glossitis) Smooth, glossy tongue (atrophic glossitis) Black hairy tongue Enlarged tongue (macroglossia) Carcinoma Slide 16-42

43. Abnormalities of the Oropharynx Cleft palate Bifid uvula Oral Kaposi’s sarcoma Acute tonsillitis and pharyngitis Slide 16-43