Identify absent teeth and determine if they are permanent or non-permanent teeth. Assess relationship between missing teeth and speech characteristics. Assess for 1. overjet 2. Ask client to tilt head backwards enough to observe the alveolar ridge, premaxillary bone, and the hard palate. Do an in-depth evaluation if evidence of hypernasality or nasal emission.
Blue coloration is one indication of a submucus cleft.
If suspect, shine light into one nostril, closing off the other. Light through the hard palate can be observed with a submucus cleft Check palatine suture line for appropriate fusion or clefts Check alveolar ridge along premaxilla suture lines. Check for unilateral or bilateral clefts Check height of palatal vault relative to ability to make tongue contact. If there is a problem with alveolar sounds, check tongue mobility, lingual frenum, and height of palatal vault. Firmly place tongue depressor on the tongue and push downward.