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The palate forms the roof of the mouth. The front two thirds of the palate comprises the hard palate, and the back third, the soft palate. The soft palate is hinged to the hard palate and is flanked on both sides by the tonsils. In the middle of the soft palate is the uvula, a projection pointing down to the tongue. At the root of the tongue, below the uvula, lies the epiglottis.
Cancer can afflict the sides of the mouth, the lips, the tongue, and occasionally the salivary glands. Continued irritation, such as pipe smoking, is thought to be a cause of many mouth cancers. Any persistent sore or swelling should be promptly examined by a health care worker.
Birth defects affecting the mouth include cleft lip and cleft palate. Both have the same cause: failure of adjacent parts of the body to unite properly in fetal life. A cleft lip (popularly called “harelip”) involves a split in the upper lip. Sometimes the cleft extends into the upper jaw, the floor of the nose, and the palate. The resulting deformity of nose and mouth interferes with sucking and speech unless corrected by surgery. A cleft palate, which may cause difficulties in speaking and eating, signifies a cleavage in the uvula and the soft palate. Both conditions can be successfully corrected by surgery.
In the normal mouth a healthy oral mucosa is maintained in part by movements of the tongue, lips, and cheeks during speech, chewing, and swallowing. Salivation and the mechanical action of chewing foods also help keep the mucosa soft and moist. Brushing and flossing or other less forceful measures facilitate removal of debris, bacteria, and plaque and preserve the integrity of the teeth and gums.
Patients most in need of special mouth care include those who (1) breathe through their mouths because of nasal obstruction or other conditions, (2) are receiving nasal oxygen, (3) have a restricted oral intake or are being fed by tube, (4) are comatose or otherwise unable to care for their teeth and mouth, (5) are receiving radiation therapy to the head and neck, or (6) are receiving chemotherapy for a malignancy. Both radiation and chemotherapy can cause severe stomatitis and xerostomia.
Initial and ongoing assessment of the oral cavity can establish the type and frequency of mouth care needed. In general, the more easily damaged the integrity of the oral mucosa, the more gentle the chemical and mechanical cleansing. If brushing with a soft nylon toothbrush and nonabrasive toothpaste and flossing cannot be tolerated, the teeth can be cleaned with unflavored oral care sponges dipped into plain water or a physiologic saline solution. Flossing is contraindicated if the patient has a low platelet count or low white cell count. Mouthwashes are not a substitute for toothbrushing.
Xerostomia (excessive dryness of the mouth) can be relieved by artificial saliva or by application of a water soluble lubricant such as KY jelly. If the patient is able to eat and drink, fluids and moist foods are encouraged. Dry, cracked lips respond best to petroleum jelly or a camphor-based lip balm. Lemon juice and glycerin are not recommended in patients with mucositis because when used over a period of time glycerin tends to dry oral tissues.
Thick and tenacious mucus in the oral cavity can be removed by diluted hydrogen peroxide or socium bicarbonate solution. The hydrogen peroxide solution is prepared by mixing equal parts hydrogen peroxide (USP 3 per cent) and water just before application. A peroxide solution is contraindicated if the patient has leukemia or there are freshly granulating surfaces or exposed bone in the oral cavity. Sodium bicarbonate solution is made by adding one teaspoon of sodium bicarbonate to one pint (half a liter) of water. The same proportions of salt and water are used to prepare a 0.9 per cent solution of normal saline.
If pain in the mouth prevents a patient from eating comfortably, it may be possible to provide temporary relief by rinsing the mouth with a solution of one part lidocaine viscous 2 per cent added to two parts water. However, since this solution diminishes sensitivity to heat, the patient must not be fed hot food or drinks that could cause burns.
Diligent, systematic mouth care is an integral part of hospital care. Research has shown that such care prevents many problems of nutrition, infection, and pain associated with stomatitis, especially those occurring as a complication of chemotherapy and radiation therapy. Moreover, routine care of the mouth, teeth, and gums, no matter what the health status of the patient, can prevent many problems, maintain a healthy oral cavity, and do much to make the patient more comfortable.
nec·ro·tiz·ing ul·cer·a·tive gin·gi·vi·tis (NUG),
Aetiology Opportunistic overgrowth of oral flora, resulting in painful ulcers, most common in young adults
Risk factors Poor oral hygiene, poor nutrition, infections, smoking, emotional stress
trench mouthAcute necrotizing ulcerative gingivitis, stomatitis, Vincent's stomatitis ENT A form of gingivitis Etiology Opportunistic overgrowth of oral flora, resulting in painful ulcers, most common in young adults Risk factors Poor oral hygiene, poor nutrition, oral infections, smoking, emotional stress.
nec·ro·tiz·ing ul·cer·a·tive gin·gi·vi·tis(NUG) (nek'rō-tīz-ing ŭl'sĕr-ă-tiv jin'ji-vī'tis)
Synonym(s): fusospirochetal gingivitis, trench mouth, ulceromembranous gingivitis, Vincent disease, Vincent infection.
Tongue: dry, coated, smooth, strawberry, large, pigmented, geographic, deviated, tremulous, sore. Gums and teeth: gingivitis, sordes, lead line, pyorrhea, atrophy, hypertrophy, dental caries, alveolar abscesses. Mucous membranes and other parts of mouth: eruptions accompanying exanthematous diseases, stomatitis, canker sores, herpes simplex, thrush, trench mouth, cysts, tumors, carcinoma, lesions of syphilis such as chancre, mucous patches, gumma, lesions of tuberculosis, abscesses.
Disorders of the mouth cavity may be indications of purely local diseases or they may be symptoms of systemic disturbances such as dehydration, pernicious anemia, and nutritional deficiencies, esp. avitaminosis.
Rashes of the mouth may indicate stomatitis, measles, or scarlet fever. Rashes on lips may indicate typhoid fever, meningitis, or pneumonia. In secondary syphilis, chancre, cancer, and epithelioma, mucous patches appear.
In addition to visual examination, careful digital examination should be made because it reveals areas of tenderness and alterations of texture characteristic of leukoplakia, cancer, cystic swellings, and lymphadenopathy.
Excessive moisture of the mouth is seen in stomatitis, irritation of the vagus nerve, ingestion of irritating drugs or foods, nervous disorders, teething, seeing appetizing foods, and smelling pleasant odors. See: burning mouth syndrome