I know I am not the only clinician who has dreaded greeting new patients with a “Hi, I am here to poke around in your mouth and intentionally make you gag. Now, open wide!” The oral mech exam can be a daunting task for your patient. It requires that the patient trust you as a professional. And I do not think I am far off in presuming that this may be a difficult thing for them to do.
So, my advice to you would be to make the patient as comfortable as possible, and have some patience with them. As a medically fragile individual, the patient is doing the very best that he/she can (and that may not always look like compliance).
Before you begin, be clear and explicitly explain what you are testing, the strength/coordination of the oral/facial muscles as they may affect speech and swallowing. Inform the patient that at any moment during the exam, they are allowed to ask questions or take a break if they become fatigued. Show your humanness and your empathy for the position your patient is in at this moment. I can’t imagine it is easy. I firmly believe that beginning an oral mech exam this way rather than my initial approach stated will improve both yours and your patient’s experience.
In addition, give yourself grace (especially if you are a new clinician). The key to competence in performing oral mech exams is practice and then more practice. Remembering the steps and the oral/facial structures that are to be evaluated can be overwhelming at first. Below is a checklist I used in my graduate study. Carry your checklist on your clipboard. Laminate it. Use it as a reference.
Feel free to pause and check your clipboard during the exam so you don’t miss a step and have to come back in the room and interrupt the patient an additional time. (Yes, this has happened many times for me. And that is ok, too.) We SLPs do not have to be perfect in order to be competent and skilled clinicians. If you have any questions or comments, I would like to support you in using this tool.
All my best,
Brittany Fontenot, M.A., CF-SLP
“The Lord your God is in your midst, a mighty One who will save; He will rejoice over you with gladness; He will quiet you by His love; He will exult over you with loud singing.”