Physical Exam

Mouth and Tongue Inspection

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Video coming September 2026

How to Perform

With a good light and a tongue depressor, inspect the lips, then the buccal mucosa, gums, and teeth. Have the patient lift the tongue to inspect its undersurface and the floor of the mouth, and protrude the tongue to inspect its dorsum. Observe the hard and soft palate, and note the color, moisture, and any lesions, swelling, or bleeding of the oral mucosa and tongue.

How to Interpret

Anemia

Moderate tongue pallor (hemoglobin below 12 g/dL)

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

Hepatopulmonary Syndrome

Cyanosis

Rule in

Somewhat helpfulDerived CI

Rule out

HelpfulDerived CI

Evidence:Limited

Hypovolemia

Dry oral mucous membranes, with longitudinal furrows on the tongue

Rule in

InconclusiveWide CI

Rule out

Somewhat helpful

Evidence:Limited

Measles

Koplik spots on the buccal mucosa, appearing before the measles rash

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

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Comroe JH Jr, Botelho S. The unreliability of cyanosis in the recognition of arterial anoxemia. Am J Med Sci. 1947;214(1):1-6. doi:10.1097/00000441-194707000-00001. PMID 20250015.
Nanteza M, Tusiime JB, Kalyango J, Kasangaki A. Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital. BMC Oral Health. 2014;14:143. doi:10.1186/1472-6831-14-143. PMC4280738.
Walsh T, Warnakulasuriya S, Lingen MW, et al. Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev. 2021;12(12):CD010173. doi:10.1002/14651858.CD010173.pub3. PMID 34891214.
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McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals. Circulation. 2017;135(17):e927-e999. doi:10.1161/CIR.0000000000000484. PMID 28356445.
Kimura H, Shirabe K, Takeda M, Kobayashi M, Tsukagoshi H, Okayama K, Ryo A, Nagasawa K, Okabe N, Minagawa H, Kozawa K. The association between documentation of Koplik spots and laboratory diagnosis of measles and other rash diseases in a national measles surveillance program in Japan. Front Microbiol. 2019;10:269. doi:10.3389/fmicb.2019.00269. PMID 30833942.
Zargar AH, Laway BA, Masoodi SR, Bashir MI, Wani AI, Salahuddin M. A critical evaluation of signs and symptoms in the diagnosis of Addison's disease. J Assoc Physicians India. 2001;49:523-526. PMID 11361265.
Shah AC, Barnes C, Spiekerman CF, Bollag LA. Hypoglossal nerve palsy after airway management for general anesthesia: an analysis of 69 patients. Anesth Analg. 2015;120(1):105-120. doi:10.1213/ANE.0000000000000495. PMID 25625257.
Dreizen S, McCredie KB, Keating MJ, Luna MA. Malignant gingival and skin infiltrates in adult leukemia. Oral Surg Oral Med Oral Pathol. 1983;55(6):572-579. doi:10.1016/0030-4220(83)90373-0. PMID 6576290.
Rerknimitr P, Kantikosum K, Chottawornsak N, et al. Chronic occupational exposure to lead leads to significant mucocutaneous changes in lead factory workers. J Eur Acad Dermatol Venereol. 2019;33(10):1993-2000. doi:10.1111/jdv.15678. PMID 31087433.
International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD); Davatchi F, Assaad-Khalil S, Calamia KT, et al. The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014;28(3):338-347. doi:10.1111/jdv.12107. PMID 23441863.
Kalantri A, Karambelkar M, Joshi R, Kalantri S, Jajoo U. Accuracy and reliability of pallor for detecting anaemia: a hospital-based diagnostic accuracy study. PLoS One. 2010;5(1):e8545. doi:10.1371/journal.pone.0008545. PMID: 20049324.
Alizadeh AHM, Fatemi SR, Mirzaee V, Khoshbaten M, Talebipour B, Sharifian A, Khoram Z, Haj-sheykholeslami A, Ghavami M, Zali MR. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol. 2006;12(12):1954-1956. PMID: 16610006.
Lockhart PB, Brennan MT, Thornhill M, et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc. 2009;140(10):1238-1244. PMID: 19797553.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.