Master Throat and Mouth Assessment with Picmonic for Nurse Practitioner

Begin the mouth exam at the anterior portion and move to the posterior throat. Anterior structures of the mouth include surrounding facial muscles, lips and gums. Lip color is deeper and more pink than facial skin in most racial groups. Lip and mouth symmetry is expected, and asymmetry can indicate an underlying pathologic condition like Bell’s palsy or a Cerebrovascular Accident. Swelling of the lips, also known as angioedema, can severely affect the airway and can often be an emergency.

With use of a tongue depressor and gloves, inspect the lips for color, moisture or lesions. Using a tongue depressor or finger to retract the bottom and observe the inner surface can reveal valuable information about both oral and systemic health. Gingivitis and inflammation of this mucosa is erythemic, swollen and possibly purulent or bleeding. Next, inspect and palpate the teeth and gums with a gloved finger. Note tooth loss, cracked teeth, or loose teeth with other findings. Also, compare spacing and symmetry of teeth with an open mouth and smile. Finally, assess the moisture, color and condition of the oral cavity including the hard and soft palate.

Inspect the tongue’s color, condition, movement and moisture. Color is expectedly pink and even, with roughened papillae to the dorsal surface. The ventral surface is smooth and glistening with present veins. A red, beefy and swollen tongue may indicate an underlying Vitamin B12 deficiency. Movement of the tongue is expectedly unobstructed and symmetrical. The tongue can be assessed for moisture and saliva.

Applying gentle pressure with the tongue depressor to the dorsal surface of the tongue and using the light from a penlight, observe the posterior oral cavity. This includes the pharynx, tonsils (if present) and tonsillar pillars bilaterally. These structures are expectedly uniform in color with the rest of the oral cavity, and presence of erythema, enlarged or touch tonsils, exudate, voice changes or “strawberry petechiae” can indicate an inflammation and infection.