Basic rules and stages of the interview
The first rule in the practice of an oral and maxillofacial surgeon is adherence to the principles of deontology. The doctor must establish contact with the person, taking mandatory account of their psycho-emotional state and intellectual level.
Subjective examination is conducted in a strict sequence:
- Eliciting complaints (molestia) — what exactly is bothering the person at the moment.
- History of present illness — the development history of the current pathology. The doctor clarifies when the first symptoms appeared, whether any treatment was previously performed, and how effective it was.
- Assessment of occupational hazards — identification of workplace factors capable of affecting oral health.
- Allergological anamnesis — a critically important item for the surgeon, avoiding reactions to anesthetics and other drugs.
- Personal history and comorbidities — past infections, chronic diseases of other organs and systems.
Detailing complaints: how to correctly assess pain
Pain (dolor) is the most common reason for visiting an oral and maxillofacial surgeon. Complaints may be associated both with pathology of the maxillofacial region itself and with radiation from other systems. To ensure an accurate diagnosis, pain is described according to several parameters:
- Time and duration: how long the attack lasts (brief, constant, or coming in waves).
- Intensity: mild, moderate, or unbearably severe.
- Acuity: sharp shooting pains or a dull, aching sensation.
- Distribution: strictly in one place (localized) or radiating to adjacent areas (diffuse).
- Time of onset: whether it depends on the time of day (e.g., occurring only at night).
- Triggers: whether a reaction occurs upon touching the face, tooth, or gingiva, or from thermal stimuli.
Specifics of symptoms in various diseases
Complaints depend directly on the etiology and stage of the pathological process.
Caries complications: In pulpitis, pain is sharp, paroxysmal, often intensifies at night, and occurs without apparent causes. Acute apical periodontitis causes constant pain that sharpens abruptly upon biting. The patient develops a specific sensation of a "grown-out tooth". Chronic forms of periodontitis may be asymptomatic or present only with discomfort and fistulous tracts.
Periodontal pathologies: Patients are concerned about gingival bleeding, dental deposits, halitosis, and periodic pus discharge. In later stages, teeth become mobile, gaps appear (diastemas and tremas), occlusion is disrupted due to premature contacts, leading to premature tooth loss.
Salivary gland disorders: Swelling, lack of saliva (hyposalivation) up to complete dryness (xerostomia), and speech difficulties are noted. This is often associated with systemic processes: liver diseases, endocrine disorders, or autoimmune conditions (lupus erythematosus, scleroderma, Sjögren's syndrome).
Inflammatory processes and intoxication syndrome
Acute purulent-inflammatory conditions (phlegmons, furuncles, osteomyelitis) cause spontaneous throbbing pain, edema, skin hyperemia, and local temperature elevation. If the process affects the floor of the mouth or pharynx, breathing and swallowing may be impaired.
Such conditions are always accompanied by a general deterioration in well-being — intoxication syndrome:
- Weakness and malaise;
- Loss of appetite and sleep disorders;
- Chills and headache.
In chronic inflammation lasting more than two months, the course becomes undulating. During remission, well-being normalizes, though blood tests may reveal lymphopenia and leukopenia. In the exacerbation phase, fistulas form through which dead bone tissue (sequesters) may be expelled.
Hidden threats and oncological alertness
Surgical practice encounters conditions that are asymptomatic or, conversely, cause pain without apparent causes.
Diseases of the oral mucosa (e.g., plaque-type leukoplakia) may cause no complaints for a long time. Malignant tumors pose a particular danger. In early stages, they are frequently painless, leading to delayed diagnosis. Pain appears later, when the tumor invades nerves. It becomes constant and progressive, accompanied by bleeding and severe intoxication.
On the other hand, there are stomalgia and glossalgia — persistent pain and burning of the tongue or mucosa with completely healthy-looking tissue appearance.
Briefly: answers to topical questions
What are the precise temperature thresholds for subfebrile, febrile, and pyretic fever?
Exact temperature thresholds are classified depending on the degree of body temperature elevation during intoxication syndrome. The following types of fever are distinguished:
- Subfebrile — from 37 °C (or from normal) to 38 °C.
- Febrile — from 38 to 39 °C.
- Pyretic — from 39 to 41 °C.
Additionally, hyperpyretic fever is distinguished in the classification, where body temperature rises above 41 °C.
What specific questions does the oral and maxillofacial surgeon ask to properly collect an allergological anamnesis?
To properly collect an allergological anamnesis, the oral and maxillofacial surgeon conducts a mandatory patient interview regarding allergic reactions to various groups of triggers. The doctor checks for allergies to the following factors:
- Food products.
- Medicinal drugs.
- Plant pollen.
- House dust.
- Animal fur/dander.
- Contact with birds.
If indications are revealed during the interview, the doctor refers the patient for specialized laboratory allergological examination.
For pain anamnesis collection, use the mnemonic: Duration, Intensity, Acuity, Distribution, Time of day, Provoking factors.
Class and exam questions
Can a definitive diagnosis be made based solely on history-taking and physical examination?
No, the main examination methods (questioning and inspection) only allow for a provisional diagnosis. Additional instrumental and laboratory examinations are essential to formulate a definitive diagnosis.
What is the difference between the pain in pulpitis and acute periodontitis according to the patient?
In pulpitis, pain is typically paroxysmal, spontaneous, and intensifies at night. In acute periodontitis, it is constant, localized, and sharply increases when biting on the causative tooth (the sensation of a "grown-out tooth").
Which patient complaints require emergency intervention?
Formidable symptoms include complaints of difficulty swallowing and breathing arising against the background of pain and inflammation. These are direct indications for providing emergency care.
What else to study on this topic
- Objective methods: rules of palpation, percussion, and probing of the maxillofacial region.
- Additional hardware examinations: sialography, CT, laser Doppler flowmetry.
- Classification of dental diseases according to ICD-10 (main classes and groups).
- Differential diagnosis of stomatalgia and glossalgia with Fordyce granules.
- Functional diagnostic methods: rheography, myography, masticaciography.
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Other topics in "Chapter 3. Features of patient examination in surgical dentistry (M.M. Pozharitskaya, V.V. Afanasyev)"
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