| Examination of the oral cavity is part of every general physical examination. Oral findings in many systemic diseases are unique, are sometimes pathognomonic, and may be the first sign of the disease. Early detection of oral cancer may be possible. | 口腔檢查是全身檢查的一部分.在許多系統(tǒng)性疾病中,口腔表現(xiàn)是獨(dú)特的,有時(shí)是病征性的,可以是疾病的首先征兆.口腔癌的早期發(fā)現(xiàn)是可能的. |
| A dental history is obtained first. It may indicate a particular dental problem or neglect of dental care. A complaint of difficulty in chewing food suggests insufficient teeth for proper mastication, loose or painful teeth, poorly fitting dental appliances, or disorders of the temporomandibular joint or the masticatory muscles. Slight bleeding after brushing suggests mild gingivitis; frequent, spontaneous, or profuse bleeding may indicate a blood dyscrasia. Recurring oral infections may indicate diabetes mellitus （the most common cause）, agranulocytosis, neutropenia, leukemia, immunoglobulin defects, or disorders of leukocyte function. Immunosuppressed persons may experience painful reactivation of oral herpes simplex or other infections, with pain, oral ulcerations, and consequent interference with food intake. | 首先采集口腔科病史,可提示一個(gè)特別的口腔問題或被忽略的口腔保健.主訴咀嚼食物困難提示能行使咀嚼功能的牙齒缺失或疼痛,或顳頜關(guān)節(jié)及咀嚼肌群功能紊亂.刷牙后輕度出血,提示輕度牙齦炎；經(jīng)常的,自發(fā)的,大量出血,表示血液病.反復(fù)出現(xiàn)的口腔感染,可能存在糖尿病（此為最常見原因）,粒細(xì)胞缺乏癥,中性粒細(xì)胞減少癥,白血病,免疫球蛋白缺乏病或白細(xì)胞功能紊亂.免疫抑制者可經(jīng)歷口腔單純皰疹的疼痛反應(yīng),并伴有口腔潰瘍而導(dǎo)致妨礙攝食.
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| A thorough evaluation requires good illumination, a tongue blade, gloves, and a gauze pad. A dental or laryngeal mirror, if available, is helpful. | 全面的評(píng)估需要良好的照明,壓舌板,手套和紗布?jí)|.口鏡或咽喉鏡有助于口腔檢查. |
| The examiner initially looks at the face for appreciable asymmetry, skin lesions, and other abnormalities, such as restricted movement during speech, as occurs in scleroderma or acromegaly. Numerous congenital syndromes produce characteristic facies. For example, a very thin upper lip suggests the fetal alcohol syndrome or Prader-Willi syndrome. Trauma in youth, particularly blunt trauma to the point of the chin, can damage growth centers in the condyles and lead to unilateral or bilateral impairment of mandibular growth. Idiopathic hypertrophy of one or both sides of the mandible or other parts of the face may distort the face, as may acromegaly or a salivary gland or jaw tumor. If the posterior teeth or dental prostheses are missing, the cheeks may be sunken, producing a prematurely aged or cachectic appearance. One or both cheeks may appear swollen due to cherubism, parotitis, Sjögren's syndrome, tumor, an excessively thick denture flange, or cellulitis from an abscessed tooth. Multiple basal cell carcinomas on the face may indicate the nevoid basal cell carcinoma syndrome, which alerts the examiner to look for multiple odontogenic keratocysts on x-rays. | 檢查者首先觀察面部有無明顯的不對(duì)稱,皮膚病損和其他的不正常,如當(dāng)說話時(shí)運(yùn)動(dòng)受限常出現(xiàn)于硬皮病或肢端肥大癥.許多先天性綜合征均產(chǎn)生特殊的面貌.例如,很薄的上唇提示胎兒酒精綜合征或Prader-Willi綜合征,青少年時(shí)期的創(chuàng)傷,特別是頰部的鈍傷,能傷及髁狀突的生長(zhǎng)中心和導(dǎo)致下頜骨單側(cè)或雙側(cè)生長(zhǎng)發(fā)育受損.下頜一側(cè)或雙側(cè)自發(fā)性肥大,或面部其他部分自發(fā)性肥大,如肢端肥大癥或涎腺腫瘤或頜骨腫瘤均可破壞面部外貌.如果后牙或義齒缺失,頰部會(huì)凹陷而形成早老的或惡病質(zhì)樣的面貌.由于頜骨增大癥,腮腺炎,SjÖgren綜合征,腫瘤,過厚的義齒突緣,或牙槽膿腫引致的蜂窩織炎,均可使一側(cè)或雙側(cè)頰部腫起.面部多發(fā)性基底細(xì)胞肉瘤可表現(xiàn)痣樣基底細(xì)胞肉瘤綜合征,這可使檢查者留心地在X線片上尋找多發(fā)性牙源性角化囊腫. |
| The lips are palpated. With the patient's mouth open, the buccal mucosa and vestibules are examined using a tongue blade; then the hard and soft palates, uvula, and oropharynx are viewed. The patient is asked to extend the tongue as far as possible, exposing the dorsum, and to move the extended tongue as far as possible to each side, so that its posterolateral surfaces can be seen. If a patient does not extend the tongue far enough for the circumvallate papillae to be seen, the examiner uses a gauze pad to grasp the tip of the tongue and extend it to the desired position. The tongue is then raised to view the ventral surface and the floor of the mouth. The teeth and gingivae should be viewed. | 對(duì)唇部作捫診,同時(shí)令患者張口,用舌板檢查頰粘膜和口腔前庭；然后巡檢硬軟腭,懸雍垂和口咽部.請(qǐng)患者盡快地伸出舌,暴露舌背,并且盡快地向每側(cè)移動(dòng)舌,這樣就可看到舌的后側(cè)表面.如果患者不能將舌伸出足夠以使輪狀乳頭能被看見時(shí),檢查者可用紗布?jí)|拉住舌尖,使其伸出到所需的體位.然后巡檢舌腹部表面和口底,再檢視牙齒和牙齦. |
| With gloved hand, the examiner palpates the vestibules and the area over the roots of the teeth with one finger and the cheek with two fingers. The index finger of the dominant hand is inserted inside the mouth, and the contents of the floor of the mouth are compressed gently between it and the fingers of the other hand. To make palpitation more comfortable, the examiner asks the patient to relax the mouth, keeping it open just wide enough to allow access. The cervical lymph nodes should also be palpated. | 檢查者用戴手套的手指對(duì)口腔前庭進(jìn)行捫診并用一個(gè)指頭捫所有牙齒的根部,用兩個(gè)指頭核對(duì).主檢手的示指放入口內(nèi),另個(gè)手的幾個(gè)手指置于口外相當(dāng)部位,輕柔地觸捫口底.為了使捫診更舒適些,可請(qǐng)患者將口腔放松,維持一定的開口度以使手指能進(jìn)入口腔.對(duì)頸部淋巴結(jié)也應(yīng)作捫診. |
| The temporomandibular joint （TMJ） is assessed by looking for jaw deviation during opening and by palpating the head of the condyle, anterior to the ear. The examiner then places his little fingers intrameatally while the patient opens widely and closes three times. The patient should be able to comfortably open wide enough to fit three fingers between the incisors. Trismus, the inability to open the mouth, may indicate scleroderma, arthritis, ankylosis of the TMJ, dislocation of the temporomandibular disk, tetanus, or tonsillar abscess. Unusually wide opening suggests subluxation or type III Ehlers-Danlos syndrome. | 顳下頜關(guān)節(jié)（TMJ）的檢查為當(dāng)開口時(shí)在耳前方捫診髁狀突的頭,檢視頜骨的偏向.然后檢查者將小指深入置于外耳道內(nèi),請(qǐng)患者張大口和閉口3次.患者能舒適地張大口,足以使上下切牙之間能放進(jìn)三個(gè)手指.不能張口的牙關(guān)緊閉提示可能為硬皮病,關(guān)節(jié)炎,顳下頜關(guān)節(jié)強(qiáng)直,顳下頜關(guān)節(jié)盤脫位,破傷風(fēng)或扁桃體膿腫.異常的大開口提示關(guān)節(jié)盤半脫位或Ehlers-Danlos綜合征的Ⅲ型（先天性遺傳性綜合征,特征為關(guān)節(jié)過度伸長(zhǎng),皮膚彈性脆弱等---譯者注）. |
| Malodor of exhaled breath may have many causes. Fetor oris originates in the mouth. Most commonly, it is caused by volatile sulfur compounds resulting from bacterial metabolism, particularly when oral hygiene is poor or xerostomia is present. Halitosis may follow eructation from the GI tract or may be caused by systemic metabolic conditions--eg, an acetone odor with diabetes mellitus, a mousy odor with liver failure, and a urinous odor with kidney failure. Halitosis may also originate from the nose, sinuses, nasopharynx, and lungs, particularly when infections or necrotic neoplasms are present. A patient whose breath frequently smells of mouthwash may be masking halitosis or may have parosmia （a perversion of the sense of smell, usually involving smelling unpleasant odors that do not exist）. | 呼吸氣味的惡臭可由許多原因引起.口臭起源于口腔.最多的原因是來自于細(xì)菌代謝產(chǎn)生的易揮發(fā)的硫化物,尤其是口腔衛(wèi)生不良或口干癥時(shí).口臭也可隨胃腸道的噯氣而來或由系統(tǒng)性代謝性疾病引起,也即丙酮味與糖尿病有關(guān),鼠臭味與肝功能衰竭有關(guān),尿味與腎功能衰竭有關(guān).口臭也可起源于鼻部,上頜竇,鼻咽部和肺,尤其當(dāng)這些部位有感染或壞死性腫瘤時(shí).經(jīng)常散發(fā)著漱口液氣息的患者常感覺有潛在的口臭或可能是個(gè)嗅覺倒錯(cuò)者（嗅覺反常,常自己感到不適的臭味,而事實(shí)上此味是不存在的）. |
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