Physical Exam

Mouth and Tongue Inspection

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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:Moderate

Hepatopulmonary Syndrome

Cyanosis

Rule in

Somewhat helpfulDerived CI

Rule out

HelpfulWide CI

Evidence:Moderate

Hypovolemia

Dry oral mucous membranes, with longitudinal furrows on the tongue

Rule in

InconclusiveWide CI

Rule out

Somewhat helpful

Evidence:Moderate

Hypoxemia

Central cyanosis of the tongue, lips, and oral mucosa

Rule in

HelpfulDerived CI

Rule out

Not helpfulDerived CI

Evidence:ModerateResearch in progress

Measles

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

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Moderate

Oral Cancer

A persistent white patch (leukoplakia), red patch (erythroplakia), or non-healing ulcer of the oral mucosa or tongue

Rule in

—

Rule out

—

Evidence:Moderate

Related Bedside Tests

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Orthostatic Blood Pressure

aka Orthostatic vital signs; postural vital signs

Rule in:VHAutonomic Neuropathy, VHHemorrhage, VHHypovolemia +6 more

Rule out:VHAutonomic Failure, VHHemorrhage, SHMultiple System Atrophy +6 more

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Ophthalmoscopy

aka Fundoscopy

Rule in:VHGlaucoma, VHIncreased Intracranial Pressure, SHDiabetic Retinopathy +14 more

Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +14 more

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Spleen Palpation

Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more

Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more

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Blood Pressure

Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more

Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more

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Heart Rate

Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more

Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more

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Jugular Venous Pressure

Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more

Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more

Related Systems / Regions

Head, Eyes, Ears, Nose, Throat

Related Diagnoses

Related Chief Complaints

Abdominal Fullness Abdominal Pain Acne-like Rash Bad Breath Behavioral Changes Bleeding Bleeding Gums Bleeding in the Mouth Blue Line on the Gums Blue Lips Bluish Discoloration Blurred Vision Bone Pain Breathlessness Brittle Nails Carpal Tunnel Symptoms Chills Cold Extremities Confusion Constipation Cough Cracked Lips Cracked Tongue Cracks at the Corners of the Mouth Cyanosis Dark Spots on the Lips Darkening of the Skin Decreased Urination Developmental Delay in a Child Diarrhea Difficulty Speaking Difficulty Swallowing Dizziness on Standing Dry Mouth Early Satiety Easy Bruising Enlarged Tongue Eye Pain Eye Redness Fainting Fast Breathing Fatigue Feeling Generally Unwell Fever Fever in an Immunocompromised Patient Freckles on the Lips Frequent Infections Frothy Urine Gasping Genital Ulcers Grooves in the Tongue Gum Overgrowth Hair Loss Headache High Fever for Several Days Irritability Irritability in a Child Joint Pain Koplik Spots Labored Breathing Learning Problems Leg Swelling Light Sensitivity Lightheadedness Loose Teeth Loss of Appetite Low Blood Pressure Low Oxygen Reading Lump in the Mouth Mouth Pain Mouth Ulcer That Won't Heal Mouth Ulcers Muscle Aches Nausea Neck Lump Night Sweats Non-healing Mouth Sore Numbness Numbness in the Hands Numbness in the Mouth Oral Thrush Painful Nodules on the Legs Pale Tongue Pallor Palpitations Patches on the Tongue Peeling Skin on the Fingers Periorbital Bruising Persistent Fever Persistent Sore Throat Poor Appetite Poor Wound Healing Prolonged Fever in a Child Rash Rash Spreading From the Face Receding Gums Recurrent Infections Recurrent Mouth Ulcers Recurrent Ulcers Red Blotchy Rash Red Cracked Lips Red Eyes Red Palms and Soles Red Patch in the Mouth Restlessness Runny Nose Salt Craving Shortness of Breath Skin Lesions Smooth Red Tongue Sore Tongue Strawberry Tongue Swollen Gums Swollen Hands and Feet Swollen Lymph Nodes Swollen Neck Gland Thirst Tingling Tongue Deviation Tongue Enlargement Tongue Weakness Toothache Unusual Infections Vomiting Weakness Weight Loss White Patch in the Mouth White Patches in the Mouth White Spots in the Mouth Wrist Drop

References

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

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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. PMID: 25432363. PMC4280738.
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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-sheikh-oleslami F, Gholamreza-shirazi 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.
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Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.