The buccal mucosa is examined using direct and indirect vision followed by bi-digital palpation of the entire area. Be sure to pull the tissues away from the retromolar area and stretch the mucosa away from the mucogingival junction (Figures 32 and 33).
Figure 32. Stretch the tissues making sure you look under the areas covered by your fingers.
Figure 33. Stretch the tissues away from the retromolar area.
The buccal mucosa should be bidigitally palpated pressing the tissue between the index finger and thumb of one hand (Figure 34).
Figure 34. Palpating the buccal mucosa.
Normal tissues of the buccal mucosa appear moist and pink/dark pink. They are soft and pliable on palpation with no discernible indurations. Stensen’s duct should be identified with or without the presence of a parotid papilla. Linea alba, Fordyce’s granules and leukoedema are common atypical findings on the buccal mucosa. You may feel small papules within the tissues usually indicative of sclerotic or fibrotic minor salivary glands. Varicosities may often present on the buccal mucosa of older patients. The buccal mucosa is also a prime area for stress related habits such as cheek chewing (morsicatio buccarum). Assisting the patient in stress reduction techniques and providing awareness of the habit is helpful. Pathologic findings associated with the buccal mucosa include:
Traumatic injuries – thermal burns, cheek bites, ulcers, traumatic fibroma (Figure 35)
Leukoplakia associated with spit tobacco (Figure 36)
Neoplastic changes – erythroplakia, speckled leukoplakia and pigmented lesions
Systemic disease – oral lichen planus, pemphigus vulgaris, pemphigoid, lupus, lipomas, aphthous ulcers, erythema multiforme, and Crohn’s disease, as well as, allergy-related tissue responses.
Figure 35. Traumatic fibroma associated with chronic cheek biting.
Figure 36. Leukoplakia associated with spit tobacco.