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     Where some systemic problem exists, communication with the patient’s physician is essential.

     Patient appraisal
     While taking the history, a general appraisal of the patient should be made, and such features as obesity, general posture, pallor, skin rash, heavy breathing, lip posture should be noted.

     Oral examination
     The examination of the mouth should be carried out in a methodical and thorough manner; this is the dentist’ s special area. Halitosis is noted, as the mouth is opened or even earlier when the patient is giving a history.
     l. The oral mucosa, cheeks, lips, tongue, palate, floor of’ mouth and vestibules, are examined for ulceration, vesicles, swelling, eroded patches, abnormal colour and white lines or patches.
     Tooth indentations in the margin of the tongue and interdental keratosis, i. e. A white line in the cheek at the level of the occlusion, often indicates a clenching or grinding habit.
     Aphthous ulcers frequently occur in the labial or lingual vestibule or inside the lips. Lichen planus may be seen as fine, interlacing white lines on the cheeks or alveolar mucosa. Vesicles or eroded patches should be fully investigated.
     A sinus on the alveolar mucosa with or without the discharge of pus on pressure, indicates the presence of an alveolar abscess.
     In the older individual, a squamous-cell carcinoma may appear as a painless swelling, ulcer or eroded white patch in any part of the oral mucosa, but especially in the vestibules. Oral lesions of primary, secondary or tertiary syphilis may appear on the lips, tongue, palate and even the gingivae; widespread candida lesions in a young male could be indicative of HIV infection.
     Any departure from the norm must be examined carefully, and if infection or malignant disease is suspected, an examination of the submandibular and cervical lymph nodes will help with a diagnosis. Immediate referral to the physician or appropriate specialist is essential.
     2. Removable appliances, if present, should be examined for their fit, design and relationship to any inflammation of the oral mucosa and gingiva.
     3. Oral hygiene. Note presence and position of plaque, supragingival and subgingival calcalus. Subginigival calculus can be detected with a sharp probe or a Cross calculus probe but may also be seen as a dark blue shadow in the gingival margin. The use of a disclosing agent will help to identify plaque and demonstrate its presence to the patient. Sometimes the location of plaque and calculus points to a predisposing factor, e. G. Better oral hygiene on the left side is usually associated with right-handed tooth brushing; interproximal deposits and gingival inflammation may be caused by the overhanging margins of restorations or poor contact relations.
     4. Teeth are charted and cavities, restorations and malalignments recorded. Attrition may indicate a grinding habit; abrasion a vigorous and damaging toothbrushing technique.
     5. Gingivae are examined for colour, shape, size and consistency, keeping in mind the picture of healt