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 and note any deviation. 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

Hypovolemia

Dry oral mucous membranes and a dry tongue with prominent longitudinal furrows — the lining of the mouth looks parched rather than glistening, and the tongue is dry with extra lengthwise grooves

Rule in

—

Rule out

Somewhat helpful

Evidence:Limited

Measles

Koplik spots — tiny blue-white specks on a red base on the buccal mucosa (the inner cheek, opposite the molars), appearing in the day or two before the measles rash

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Limited

References

McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281(11):1022-1029. doi:10.1001/jama.281.11.1022. PMID 10086438.
Comroe JH Jr, Botelho S. The unreliability of cyanosis in the recognition of arterial anoxemia. Am J Med Sci. 1947;214:1-6. doi:10.1097/00000441-194707000-00001.
Oral candidiasis and low CD4+ count among HIV-positive patients, 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.
Sun A, Lin HP, Wang YP, Chiang CP. Significance of serum vitamin B12, folate and iron deficiencies in atrophic glossitis patients. J Oral Pathol Med. 2012;41(6):500-504. doi:10.1111/j.1600-0714.2011.01122.x. PMID 22188475.
Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol. 1995;32(1):45-59. PMID 7878478.
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, Tangkijngamvong N, Kerr SJ, Prueksapanich P, Sithisarankul P, Kumtornrut C, Asawanonda P, Sutheparuk S, Panchaprateep R. 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.
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.
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.