Radiological examination of the maxillofacial region

Radiographic and functional methods

The only specific radiographic method considered within the framework of this topic is sialography. This is an examination of the salivary glands in which a radiopaque substance is injected into their excretory ducts using special cannulas. Either oil-soluble preparations (Iodolipol) or water-soluble ones (Iohexol, Urografin, Verografin) are used as contrast agents. Based on the obtained sialograms, the physician assesses the condition of the gland parenchyma and ducts, the clarity of contours, and the overall degree of contrast enhancement.

Additionally, to evaluate glandular function, sialometry is used, which is the study of secretory function. The examination can be performed separately for the parotid and submandibular glands, both with stimulation (citric acid, pilocarpine, paraffin) and without it. The indication is the patient's complaint of dry mouth. The level of normal mixed saliva secretion is calculated using a special formula depending on age.

Physical diagnostic methods

For the differential diagnosis of tooth and jaw diseases, methods based on physical phenomena are actively used:

• Electric pulp testing (EPT): Measures the minimum current intensity that causes a response from the pulp or periodontium. While normal (for an intact tooth) values range from 2–6 µA, in pulpitis this indicator increases to 10–100 µA, and in periodontal inflammation it exceeds 100 µA.
• Thermometry: Application of heat and cold. Quickly passing pain indicates caries, prolonged pain indicates pulpitis, and the absence of a reaction suggests pulp necrosis.
• Thermovision: Registration of temperature asymmetry on the body surface. For example, a jaw fracture or acute osteomyelitis is accompanied by a local temperature increase, while a hemorrhage without suppuration is accompanied by its decrease.

Instrumental examination of teeth and periodontium

Instrumental methods are strictly initiated after questioning, visual inspection, and palpation. The obtained results are recorded in the dental chart.

1. Probing. A sharp angled probe is used to examine hard tooth tissues (depth of carious cavities, communication with the pulp cavity). A blunt-tipped probe is used to assess the mucosa, fistulous tracts, measure periodontal pockets, and check for perforation of the maxillary sinus.
2. Percussion. Performed by tapping the tooth with tweezers or the handle of a probe. It can be vertical (along the axis of the tooth) and horizontal (in the cervical region). Pain on percussion is a sure sign of a pathological process in the periodontium; absence of pain is normal. Comparative percussion is always started with healthy teeth to determine individual sensitivity.

Objective examination: tissues, tongue, and teeth

Clinical examination is performed in strict sequence by quadrants and includes bimanual palpation of infiltrates with special attention to the parapharyngeal, pterygomandibular spaces, and the root of the tongue.

When examining the tongue (held with a gauze pad), clinicians assess moisture, papillary relief (normally filiform, fungiform, vallate, and foliate papillae), and size (macroglossia or microglossia). Tooth impressions on the lateral surfaces indicate edema. Pathologies may also be detected here: verrucous leukoplakia or infiltrative-ulcerative carcinoma, requiring oncological vigilance.

Examination of the teeth includes assessing color (depulped teeth turn gray, while trauma to the vascular bundle causes them to turn pink or blue), shape, and position in the dental arch. Pathological angulation of the occlusal surface may indicate tooth dislocation, while the loss of antagonists leads to the development of the Popton-Godon phenomenon.

Laboratory tests

To clarify the diagnosis and determine the prognosis, the following are used:

• Cytological examination: Impression smears or scrapings from ulcers allow the nature of the mucosal disease and the degree of inflammation activity to be established.
• Morphological method (biopsy): Preparation of histological sections stained with hematoxylin and eosin, or picrofuchsin according to van Gieson.
• Microbiological methods: Assessment of total microbial contamination and counting of colony-forming units (CFUs) in oral fluid, pus, or periodontal pockets.
• Biochemical studies: Analysis of blood, saliva, or gingival fluid for protein fractions, calcium, and phosphorus.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Classification of dental arch defects according to Kennedy
• Methods for calculating hygiene indices (Fedorov-Volodkina, Greene-Vermillion)
• The Popov-Godon phenomenon and its clinical significance
• Non-carious lesions of hard dental tissues: fluorosis and pathological tooth wear
• Differential diagnosis in pathological tooth mobility

Other topics in "Chapter 3. Features of patient examination in surgical dentistry (M.M. Pozharitskaya, V.V. Afanasyev)"

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