Characteristics of pain syndrome
Pain in the maxillofacial region is one of the main reasons for seeking care. Its nature largely determines the diagnosis:
- Acute periodontitis: pain is localized, increases when biting down, eventually becomes constant and radiates.
- Acute purulent periostitis: pain loses clear localization and becomes diffuse across the jaw.
- Acute osteomyelitis: pain depends on the volume of the affected bone (ranging from sharp and boring to diffuse).
- Phlegmons and furuncles: pain is diffuse, dynamically becoming throbbing and pulsating.
Any inflammatory process may be accompanied by intoxication syndrome (chills, weakness, loss of appetite) and impaired functions of chewing, mouth opening, or swallowing. It is important to clarify the connection between pain and function: if it intensifies during conversation or tongue movement, this may indicate inflammatory, traumatic, or oncological processes.
Anamnesis taking and comorbid conditions
The dentist is obliged to analyze the state of all body systems, as they directly affect treatment tactics and the risks of complications:
- Cardiovascular system: hypertension and IHD create a risk of a crisis or myocardial infarction right in the dental chair. Heart infections can be associated with odontogenic foci.
- Endocrine system: special attention is paid to diabetes mellitus, against the background of which purulent processes of the maxillofacial region frequently develop. In women during menopause, the risk of jaw bone osteoporosis is high.
- Respiratory organs and kidneys: patients with bronchial asthma often take corticosteroids (which is important during surgeries). In renal failure, the blood clotting system is impaired — blood and urine tests are mandatory before interventions.
- Connective tissue diseases: lupus erythematosus or scleroderma can affect the temporomandibular joint (TMJ) and salivary glands, causing disruptions in immune reactivity.
Specific complaints and trauma
Certain symptoms immediately point to specific groups of pathologies:
- Salivary gland pathology: dry mouth, swelling, and a salty taste during meals. The onset of such problems is sometimes associated with past abdominal surgeries.
- Facial asymmetry: requires differential diagnosis between a tumor and inflammation (the nature of the pain and swelling is assessed).
During anamnesis taking after trauma, the physician must ascertain the circumstances of the incident, the presence of cerebral symptoms (nausea, loss of consciousness, ear bleeding), the fact of alcohol intoxication, and data on specific tetanus prophylaxis.
Objective examination: external inspection
Examination begins with assessing the patient's general appearance, facial symmetry, and skin integument. Changes in facial configuration can be caused not only by inflammation but also by endocrine disorders: for example, myxedema (mucous edema) or Basedow's disease (exophthalmos).
The color of visible mucous membranes serves as a marker of anemia, as the skin has varying degrees of translucency. True cyanosis of the lips and face indicates a high level of reduced hemoglobin. Skin rashes identical to elements in the oral cavity always require the exclusion of syphilis and acute infectious diseases (measles, scarlet fever).
Briefly: answers to topical questions
What methods of objective examination are used in the initial examination of a dental patient?
During the initial examination of a dental patient, basic objective methods are used, including visual and instrumental assessment. These include:
- External inspection — assessment of the face and neck.
- Palpation — examination of peri-maxillary soft tissues, organs, and bones of the facial and cerebral skull.
- Functional assessment — evaluation of mouth opening and closing, as well as movements in the temporomandibular joint.
- Oral cavity inspection — visual examination of oral cavity organs.
- Percussion — tapping on teeth to assess the state of the periodontium.
- Probing — instrumental examination of oral cavity organs.
What palpation methods are used in the objective examination of the temporomandibular joint?
In the objective examination of the temporomandibular joint, methods of external and internal palpation are used. The examination is performed with both closed and open mouth, as well as during mandible movements.
- External palpation — performed through the skin anterior to the tragus of the ear.
- Internal palpation — performed through the anterior wall of the external auditory meatus.
These methods make it possible to assess the nature of the excursion of the mandibular heads, their configuration, tenderness, as well as the synchrony and range of movements.
What instruments are included in the basic set for oral cavity inspection in prosthetic dentistry?
The basic set for instrumental oral cavity inspection includes instruments placed in a sterile tray. These include:
- Spatula — used for retracting the lips, cheeks, tongue, and examining mucous membranes.
- Tweezers — used to determine tooth mobility and perform percussion.
- Dental mirror — necessary for examining teeth, the palate, and the sublingual region.
- Angular dental explorer — intended for probing crown defects, the gingival margin, and performing percussion with the handle.
- Probe (blunt/button-ended) — used for probing wounds, fistulas, and palatal defects.
- Baumann probe — used to examine the ducts of the salivary glands.
For the differential diagnosis of edema, remember: "Kidneys keep warm, the heart keeps cool" (in kidney diseases, pale skin is warm, in heart pathologies — cold).
Class and exam questions
In periodontitis, pain is strictly localized to the causative tooth and increases with pressure on it. In periostitis, pain extends beyond a single tooth and becomes diffuse across the jaw.
In periodontitis, pain is strictly localized to the causative tooth and increases with pressure on it. In periostitis, pain extends beyond a single tooth and becomes diffuse across the jaw.
Why is it important for a dentist to know about a patient's kidney diseases?
In renal failure, the function of the blood coagulation system suffers, which increases the risk of bleeding. Before any surgical intervention, such a patient is mandatorily prescribed laboratory tests.
Which symptoms during an appointment require referring a patient for an HIV test?
Chronic diarrhea, unexplained weight loss, and fever combined with enlarged lymph nodes.
What else to study on this topic
- Classification of dental diseases based on ICD-10
- Specific infections in the maxillofacial region (tuberculosis, syphilis, anthrax)
- Assessment of immunological reactivity and allergological status of the patient
- Connection of TMJ diseases with pathologies of the musculoskeletal system and spine
- Facial defects and deformities: congenital and acquired etiological factors
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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.