An oral mechanism exam is a key part of many speech therapy assessments. It’s your chance to check out the structure and function of your patient’s chewing and swallowing muscles and will help you to make better recommendations and treatment plans.
So what should you look for?
This post will guide you through the steps of an oral mechanism examination. Feel free to print out these forms or bookmark this page on your browser to use during exams. For print-and-go assessments, check out our shop!
Popular Articles
- Swallowing Exercises and Strategies
- Goal Bank for Adult Speech Therapy
- Complete Guide to Adult Speech Therapy Assessments
Similar Articles
Oral Mechanism Examination Forms
General Instructions
- Observe strength, range of motion, and symmetry.
- Minimal strength and range of motion may signal underlying structural or innervation issues (atrophy, apraxia, dysarthria, etc.)
- Asymmetry may signal innervation or neurological issues (stroke, nerve injury, etc)
- Minimal strength and range of motion may signal underlying structural or innervation issues (atrophy, apraxia, dysarthria, etc.)
- Model as needed.
- Record any significant findings (e.g. obvious strength difference between pushing their tongue to the right versus the left), and note other findings that you’d like to examine further (e.g. possibly reduced hyolaryngeal excursion).
- Remain positive and provide encouragement throughout the examination. Say, “thank you for doing that” or “great effort.”
- Refer to neurology, gastroenterology, or otolaryngology for underlying structural or neurological issues.
1. MANDIBLE (CRANIAL NERVE V)
Observe strength, range of motion, and symmetry
| At rest. |
| Open. |
| Open with resistance. |
| Close. |
| Close with resistance. |
| Lateralize. |
| Protrude. |
| Retract. |
DETAILED INSTRUCTIONS:
- Observe the symmetry of their mouth and jaw at rest.
- Also observe dentition and oral mucosa.
- Say, “Open your mouth.” Observe range of motion and symmetry during opening and while open.
- Observe symmetry as their mouth closes.
- Ask them to close their mouth. Place a few fingers under their chin and say, “Open your mouth again.” Observe strength, range of motion, and symmetry.
- Place a few fingers on their chin (just below their lower lip), and say, “Close your mouth.” Observe strength, range of motion, and symmetry.
- Say, “Move your jaw from side to side,” modeling as needed. Observe range of motion and symmetry. For example, are they able to move their jaw over to one side significantly more than the other?, etc.
- Say, “Jut your jaw out” or “Move your jaw out,” modeling as needed. Observe range of motion. Then, place a clean gloved hand on their chin and gently push. Observe strength. For example, are they able to maintain protrusion against resistance?, etc.
- Observe symmetry as they release the protrusion.
- Say, “Pull your jaw in.” Observe range of motion.
2. LIPS (CN VII)
Observe strength, range of motion, and symmetry
| At rest. |
| Protrude. |
| Retract. |
| Repetitive protrude/retract. |
| Puff cheeks. |
| Puff cheeks against resistance. |
| Sensitivity to touch. |
DETAILED INSTRUCTIONS:
- Observe symmetry of their lips at rest. For example, one side is drooping, one side is drooling, etc.
- Say, “Move your lips side to side,” modeling as needed. Observe range of motion and symmetry.
- Say, “Pucker your lips like you’re about to whistle,” modeling as needed. Test their stimulability by prompting them to protrude their lips more if range of motion seems limited. Observe range of motion and symmetry.
- Press a tongue depressor or a clean gloved finger on their lips. Say, “Push against this.” Observe strength.
- Say, “Smile wide.” Observe range of motion and symmetry. Prompt them to, “Pull your lips back more,” as needed.
- Say, “Pucker, smile, pucker, smile,” modeling as needed. Observe coordination, range of motion, and symmetry.
- Say, “Puff up your cheeks [with air] [like a blowfish].” Then say, “Keep them puffed up,” as you gently press using a clean gloved finger. Observe strength.
- Say, “I’m going to gently touch your cheeks. Please close your eyes and raise your hand when you feel my touch.” Use the stick-end of a cotton swab and touch various parts of their lower face.
3. TONGUE (CN XII)
Observe strength, range of motion, and symmetry
| At rest. |
| Protrude out. |
| Protrude out with resistance. |
| Protrude up. |
| Protrude up with resistance. |
| Protrude down. |
| Protrude down with resistance. |
| Lateralize. |
| Lateralize with resistance. |
| Retract. |
| Lick teeth. |
| Lick lips. |
| Sensitivity to touch. |
DETAILED INSTRUCTIONS:
- Say, “Open your mouth,” and observe tongue at rest. Note symmetry, fasciculations, atrophy, etc.
- Say, “Stick out your tongue.” Observe symmetry and range of motion. Test their stimulability by prompting them to stick their tongue out even further.
- Place a tongue depressor against the tip of their protruded tongue. Say, “Push against this.” Observe strength.
- Say, “Stick your tongue out and up.” Observe range of motion and symmetry. Test strength using the tongue depressor.
- Say, “Stick your tongue out and down.” Observe range of motion and symmetry. Test strength using the tongue depressor.
- Say, “Press your tongue inside your cheek,” modeling as needed. Then, place a clean gloved finger against their cheek and say, “Push against this.” Observe strength. Switch sides and repeat, note any differences in strength.
- Say, “Pull your tongue back.” Observe range of motion and symmetry.
- Say, “Lick all around your teeth.” Observe range of motion and symmetry.
- Say, “Lick all around your lips.” Observe range of motion and symmetry.
- Say, “I’m going to gently touch your tongue and mouth. Please close your eyes and raise your hand when you feel my touch.” Use the stick-end of a cotton swab and touch various parts of their tongue and inner cheeks.
4. VELUM
Observe strength, range of motion, and symmetry
| At rest (CN IX). |
| Prolonged “ah” (CN X). |
| Repetitive “ah” (CN X). |
DETAILED INSTRUCTIONS:
- Say, “Open your mouth,” and use a pen light to observe their velum at rest.
- Say, “Say ‘ahhh.'” Observe range of motion and symmetry.
- Say, “Say ‘ah ah ah ah ah.'” Observe range of motion and symmetry.
5. REFLEXES (CN IX, X).
Observe strength, range of motion, and symmetry
| Gag. |
| Faucial arches. |
DETAILED INSTRUCTIONS:
- Say, “I’m going to place this in your mouth. Open your mouth wide,” then gently touch the back of their throat with a tongue depressor. Of note, if you already observed that their gag reflex is in tact (e.g. they gagged on a drink earlier), you don’t need to subject them to this.
- While their mouth is open, observe faucial arches at rest.
6. OTHER OBSERVATIONS
| Dentition. Note dentures, partials, missing teeth, oral cleanliness |
| Oral mucosa. Note discoloration |
| Raise eyebrows (CN VII). |
| Dysarthria. |
| Breath support. |
| Vocal quality. |
| Resonance. |
| Cough on command. |
| Throat clear on command. |
| Maximum phonation time. |
DETAILED INSTRUCTIONS:
- While their mouth is open during any of the above tasks, observe dentition and oral mucosa.
- Say, “Do you use dentures or partials?” if you’re unsure.
- You may provide or assist in oral care at this time, as needed.
- Say, “Lift your eyebrows.” Observe range of motion and symmetry.
- You may also say, “Smile” while they are lifting their eyebrows to test the branches of CN VII.
- Say, “Cough.” Observe strength of cough and if cough was productive.
- Say, “Clear your throat.” Observe strength of throat clear and vocal quality.
- While gathering their case history and completing the patient interview, observe motor speech, voice, and resonance.
More Resources
