Infancy

Use both inspection (with a tongue blade and flashlight) and palpation to inspect the mouth and pharynx of newborns. The newborn's mouth is edentulous, and the alveolar mucosa is smooth, with finely serrated borders. Occasionally, pearl-like retention cysts are seen along the alveolar ridges and are easily mistaken for teeth—they disappear within a month or two. Petechiae are commonly found on the soft palate after birth. Palpate the upper hard palate to make sure it is intact.

Infants produce little saliva during the first 3 months, but you will note that older infants produce lots of saliva and drool frequently.

Inspect the tongue. The frenulum of the tongue varies, sometimes extending almost to the tip and other times being thick and short, limiting protrusion of the tongue (ankyloglossia, or tongue tie); these variations rarely interfere with speech or function.

Rarely, supernumerary teeth are noted. These are usually dysmorphic and are shed within days but are removed to prevent aspiration.

Epstein's pearls, tiny white or yellow rounded mucous retention cysts, are located along the posterior midline of the hard palate. They disappear within months.

Although unusual, a prominent, protruding tongue may signal congenital hypothyroidism or Down syndrome.

You will often see a whitish covering on the tongue. If this coating is due to milk, it can be easily removed by scraping or wiping it away.

The pharynx of the infant is best seen while the baby is crying. You will likely have difficulty using a tongue blade because it produces a strong gag reflex. Do not expect to be able to visualize the tonsils.

Oral candidiasis (thrush) is common in infants. The lesions are difficult to wipe away and have an erythematous raw base (see Table 17-15, Abnormalities of the Mouth and Teeth, p. 772).

Listen to the quality of the infant's cry. Normal infants have a lusty, strong cry. The following box lists some unusual types of infant cries.

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