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Oral mechanism examinations are important!

© Schatze Rasmussen

An oral mechanism examination accomplishes two very important things. Speech therapists often look for differences in how features in the mouth are formed physically (I will refer to these as "structure") and also how they act or behave during phonation or sound production (hence known as "function").

It seems strange to most people but speech/language pathologists almost always (or should always) look inside their patient's mouths during an evaluation, whether the patient has had a stroke, "stutters" or can't make the /s/ sound. It actually seems a lot like the doctor's evaluation when he/she tells you to open up and say "ahhhhh". We just make a longer observation and have you say more things. My three year old new students always get scared when they see the purple latex gloves and the "huge" tongue-depressor going into their mouths, but hey it is important to do. And yes I make a game out of it; the "Where is the mouse- I thought I saw one go in your mouth" game?

I have seen undiagnosed cleft palates, paralyzed muscles and even strep throat. Despite a physician's best intentions, they can not always identify the subtle problems a trained speech/language pathologist may see. We have only studied the head and neck; not the whole body. Inside an opened mouth we look at the teeth, throat, hard and soft palates, jaw, tongue, cheeks, tonsil area. We also look at the outside of the face, neck, ears and nose. It is important for a speech/language pathologist to see if all structures are of normal size, proportion, placement, symmetry, etc. Any deviances or differences in the muscle, skin or bone shape may indicate difficulties speaking and/or hearing.

Structures can sometime appear totally normal to the average eye, however, occasionally when the person attempts to speak or vocalize, the structure may not move or only moves a little. Their function is impaired. This can affect how the person sounds and is understood by others. Sometimes the soft palate does not elevate when it is supposed to and the person's speech sounds nasal. Sometimes the tongue is weak on one side and they may slur their speech. The structures then are not functioning the way they should.

When structure and/or function is impaired, a referral to other physician's and resources may be made and speech therapy may continue or be put on hold for an indefinite period of time. At this point, the family, the speech/language pathologist and physician must act as a team and involve all the necessary support they have to, be it a dentist, a social worker, etc. The team then works together to decide what the best treatment for the person is.

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