The Oral Examination

The oral evaluation of the edentulous patient must include assessment of the following features:

• Floor of the mouth (anterior, including size and position of the submandibular and sublingual gland complexes and ducts; posterior of the mylohyoid attachment with special attention to the depth and configuration of the retromylohyoid space)
• Frenum attachments (number, position, and significance)
  
• Lips (herpetic lesions, angular cheilosis, fissuring, scars)
  
• Maxillomandibular relationships (anteroposterior, buccolingual, and inferior/superior)
  
• Oral mucosa (erythema, ulceration, hyperkeratosis, desquamation, edema, epulis, fibroma, tumor)
  
• Palate (hard and soft) and visible oropharynx
  
• Residual ridges (morphology, anatomic shape, consistency)
  
• Tongue (position, size, mobility, consistency, involuntary movement, neoplastic changes)
  
• Saliva quantity and quality
  

The Radiographic Survey

Evaluation of a recent panoramic radiograph is recommended prior to initiating care of an edentulous patient. Conditions to look for include: residual root tips, impacted teeth, cysts, or other pathologic conditions.

Changes in the Residual Ridges After Loss of Teeth

Changes to alveolar bone occur following the extraction of teeth. The edentulous patient will likely display diminished alveolar bone volume and notable changes in ridge morphology. A consistent finding in the edentulous population is that the volume of residual ridge decreases over time. The decrease is most dramatic in the first weeks and months immediately following removal of teeth but continues at a variable but diminishing rate for the rest of the lifetime. The mandible is more severely affected than the maxilla.

Many factors affect ridge resorption including local and systemic biochemical factors and load or physical factors.