Assessment Form Page 3
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9
SINUSES
Frontal
L
Tender
x
no
yes
R
Tender
x
no
yes
Maxillary
L
Tender
no
yes
x
R
Tender
no
yes
x
MOUTH
Lips
Symmetrical
yes
no
x
Moist
yes
no
x
Lesions
x
yes
no
Teeth
# 28
no wisdom teeth
Intact
x
yes
no
Dentures
x
no
yes
Tongue
Mobile
yes
no
x
Pink
yes
no
x
Moist
x
yes
no
Papillar
x
yes
no
Dorsum Smooth
x
yes
no
Lesions
x
no
yes
Gums
Pink
yes
no
x
Smooth
yes
no
x
Lesions
x
no
yes
Salivary Glands
Wharton’s—Visible
x
yes
no
Patent
x
yes
no
Inflammation
x
no
yes
Stensen’s—Visible
x
yes
no
Patent
x
yes
no
Inflammation
x
no
yes
Hard Palate
Intact
x
yes
no
THROAT
Uvula
Midline
yes
no
x
Rise with “ah”
yes
no
x
Soft Palate
Intact
x
yes
no
Rise with “ah”
x
yes
no
Tonsils
Present
x
Absent
Inflammation
no
yes
x
Color
Uvula, Pharynx—Pink
x
yes
no
ODOR
Absent
Present
x
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