Testing for functional disturbances is necessary to identify those patients likely to experience special needs. The patient should be instructed to perform the following movements:

• Extend the tongue
• Move the tongue from side to side while extended
• Lick the lips
• Swallow
• Open wide
• Protrude the mandible
• Move the mandible from side to side

Hesitation or incorrect action in following any of these directions can signal potential challenges in treatment and treatment outcomes. Often an inability to perform these normal oral functions may confirm a medical condition highlighted in the medical/health history (e.g., stroke).

An inspection of the patient’s existing denture, in combination with patient comments about the appliance’s fit, function, appearance, etc., provides critical information on patient expectations for the new dentures.

The Extraoral Examination

Observe the patient for the following:

• Abnormal facial features: prominent scars, facial asymmetry, etc.
• Temporomandibular joint and/or masticatory muscle dysfunction
• Upper cervical lymph nodes