Diagnostics of oral diseases

Classification of examination methods

Examination of a dental patient requires a strict sequence. All methods are divided into two large groups:

• Basic methods. Include subjective (collection of complaints, life history, and medical history) and objective examinations. Objective methods include external examination of the face and neck, palpation of perimaxillary tissues, assessment of movements in the temporomandibular joint (TMJ), as well as examination, percussion, palpation, and probing of the oral cavity. Single-ended and double-ended explorers are used for probing.
• Supplementary methods. Used to refine the diagnosis. These include temperature testing, radiography, and electric pulp testing (EPT), which makes it possible to assess the excitability of healthy pulp.

Special indices are used for an objective assessment of hygiene. To detect plaque, calculus, or focal demineralization (spot-stage caries), indicating agents—dyes and caries markers—are used. A graduated periodontal probe with a ball tip is used to measure periodontal pocket depth.

History taking and pain characteristics

The interview is the first stage allowing for a provisional diagnosis. The physician must separate complaints into primary and secondary, as well as detail the pain syndrome by duration, character, localization, and triggers.

Specific complaints help in the differential diagnosis of odontogenic pathologies:

• Caries: short-term pain occurring only from stimuli.
• Pulpitis: spontaneous, nocturnal, acute, and diffuse pain prone to radiation.
• Periodontitis: constant localized pain worsening upon biting, characteristic sensation of an "elongated tooth".
• Periodontal diseases: gingival bleeding, tooth mobility, bad breath, presence of deposits.

Examination of the mucosa and tongue

When visually examining the oral mucosa (OM) and the floor of the mouth, attention is paid to color, moisture, and the presence of pathological elements.

• Examination of the tongue. It is important to differentiate macroglossia from edema. In a folded tongue (often asymptomatic), longitudinal folds are revealed. The main difference between a fold and a fissure: the epithelium in the fold is intact (this is visible when spreading the tongue).
• Floor of the mouth. Normally, the mucosa is pliable; the frenulum and excretory ducts of the salivary glands with droplets of secretion are visible. In smokers, the mucosa may acquire a dull hue.
• Keratinization (hyperkeratosis). Manifests as grayish-white areas. Foci of hyperkeratosis require active intervention, as these are precancerous conditions. When any changes (erosions, ulcers) are detected, it is strictly necessary to rule out the impact of a traumatic factor.

Palpation and differential diagnosis of inflammation

Palpation of the alveolar process is performed from the vestibular, lingual, and palatal sides. If a fistulous tract is found, the discharge is assessed (pus, protruding granulations), and probing is performed to identify bone erosion and communication with the causative tooth.

Differential diagnosis of inflammatory diseases of the jaws:

• Acute periostitis: painful infiltrate (swelling) in the area of the vestibular fornix of the vestibule or a rounded infiltrate on the palate.
• Acute and subacute osteomyelitis: inflammatory infiltration from three sides of the alveolar process, painful percussion of multiple teeth simultaneously, suppuration from pockets and fistulas. Vincent's symptom—impaired sensitivity in the innervation zone of the inferior alveolar and mental nerves—is characteristic.
• Chronic odontogenic osteomyelitis: dense periosteal thickening of the jaw, fistulas on the facial skin and in the oral cavity.
• Chronic granulating periodontitis: presence of a cord along the mucogingival fold, possible bone bulging (requires differentiation from cysts and tumors).

Important: if inflammatory symptoms are accompanied by tooth mobility, oncological alertness is mandatory.

Examination of perimaxillary soft tissues is performed by bimanual palpation. The physician assesses the functions of swallowing, breathing, speech, and mouth opening. Special attention is paid to the risk zones of infection spread: the root of the tongue, sublingual, pterygomandibular, and parapharyngeal spaces.

Class and exam questions

What else to study on this topic

• Procedure and exact normal values of electric pulp testing (EPT).
• Topography of the tongue papillae (filiform, fungiform, foliate, circumvallate).
• Iatrogenic diseases and basic principles of medical deontology.
• Radiological examination: types and methods of application in dentistry.
• Assessment of temporomandibular joint (TMJ) functions.

Other topics of section "Chapter 16. Methodology of dental patient examination"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.