Diagnostic Goals and Principles
The key goal of any examination during a dentist's appointment is formulating the most accurate diagnosis possible. To achieve this result, the physician must conduct a comprehensive analysis of the presented complaints, study the medical history in detail, and perform a full objective examination.
The physician faces the following basic tasks:
- Assess the general condition of the human body and identify the presence of latent or concomitant somatic diseases.
- Determine both general and local etiological (causative) and pathogenetic factors in the development of the current pathological process.
The main principle of successful clinical work is strict adherence to the sequence of the applied diagnostic methods. The correctness of the final diagnosis depends directly on the systematic and step-by-step nature of these actions.
Interview: the first stage of interaction
Any diagnostic procedure in the clinic always begins with a subjective stage—the interview. The obtained data provide an opportunity to formulate a preliminary clinical diagnosis and outline a competent plan for further investigation.
During the interview, the dentist addresses several tasks at once:
- Clarifies the essence of the problem: gathers complaints, studies the anamnesis of the present illness, specifies past and concomitant pathologies, and necessarily records the allergic status.
- Establishes a strong trusting contact, which is necessary for successful treatment.
- Imperceptibly assesses the patient's neuropsychic status and intelligence level—this is required for an adequate and critical analysis of how the person describes their symptoms.
- Helps the patient with careful leading questions if the patient has difficulty accurately characterizing their condition.
- Strictly observes the rules of medical deontology, necessarily taking into account the individual personality traits of each person.
Classification of clinical research methods
All diagnostic techniques are divided into two broad categories: basic and additional.
1. Basic methods These are routine techniques that the physician performs directly in the dental chair. They are subdivided into:
- Subjective: detailed clarification of complaints, collection of the personal anamnesis and the anamnesis of the present illness (including information on previously performed treatments and their actual efficacy).
- Objective: begin with an external visual inspection of the face and neck. This is followed by a palpation examination of the soft tissues of the perimaxillary region, as well as the bones of the neurocranium and facial skeleton. The function of the temporomandibular joint (TMJ) is mandatory assessed—movements and the nature of mouth opening/closing are evaluated. The stage concludes with a direct examination of the oral cavity organs, including inspection, palpation, percussion, and probing.
2. Additional methods This group includes various instrumental and laboratory tests that are prescribed when basic methods yield insufficient data.
Analysis of complaints and characteristics of pain syndrome
The patient's complaints may be directly related to the pathological focus in the maxillofacial region (MFR) or be a consequence of concomitant general somatic conditions. An experienced physician always purposefully separates them into primary (leading) and secondary.
The most frequent reason for visiting a dentist is pain. MFR pathologies are most often accompanied by signs of inflammation of specifically an odontogenic nature. The specificity, acuity, and periodicity of pain attacks serve as a key to a preliminary diagnosis and the basis for differential diagnosis.
For pain to acquire diagnostic value, it must be strictly detailed according to several criteria:
- By duration: temporary episodes or constant sensations.
- By character: dull or sharp.
- By localization: clearly localized in a single tooth or radiating across the jaw.
- By onset: spontaneous (arising without a cause) or provoked by touching the affected tooth, facial tissues, and other external stimuli.
Practice example: sharp, radiating pain is typical for pulpitis, very often worsening at night and exhibiting a pronounced property of radiating along nerve branches.
Briefly: answers to topical questions
What specific additional research methods are used in conservative dentistry?
A wide range of additional instrumental and laboratory research methods is used in conservative dentistry. These include:
- Thermal diagnostics (thermometry)—assessment of dental tissue response to temperature stimuli.
- Electric pulp testing (EPT)—determination of pulp excitability by electric current.
- Radiological method—the leading method for primary diagnosis and treatment monitoring.
- Transillumination—translucence of dental tissues with light of a specific wavelength.
- Luminescent diagnostics—assessment of tissue color changes under the influence of ultraviolet light.
- Luminescent-histological diagnostics—performed using operating microscopes.
- Laboratory methods—cytological, histological, bacteriological studies, as well as basic blood and urine tests.
What types of dental percussion exist and how are they performed?
In dentistry, there are two main types of dental percussion, which are performed by light and uniform tapping with tweezers or a probe handle. The examination always starts with knowingly healthy teeth to compare the patient's sensations.
- Vertical percussion—the direction of impacts coincides with the longitudinal axis of the tooth (along the incisal edge or occlusal surface). Used to determine the state of the apical periodontium.
- Horizontal percussion—impacts are applied in a lateral (horizontal) direction, in the area of the neck or vestibular surface of the tooth. Allows assessment of the state of the marginal periodontium.
Normally, percussion is painless; the appearance of pain indicates the presence of a focus of inflammation.
What instruments are required to probe a carious cavity?
To probe a carious cavity, a dental mirror and a diagnostic sharp probe are required. The mirror allows inspection of hard-to-reach areas and directs a beam of light into the desired zone. Depending on the nature and location of the carious cavity, the following types of probes are used:
- Angle probe—an instrument with a working part angled at a specific angle, used exclusively for examining hard dental tissues.
- Straight probe—an instrument with a bayonet-shaped straight working part.
During probing, the sharp end of the instrument catches in the carious cavity, which makes it possible to determine its presence, depth, tenderness of the floor and walls, as well as communication with the pulp chamber.
Which groups of lymph nodes are palpated during the examination of a dental patient?
During the examination of a dental patient, lymph nodes are palpated, evaluating their size, consistency, adhesion, and tenderness. The sources mention:
- submandibular and submental lymph nodes;
- cervical lymph nodes, including the upper group;
- parotid (preauricular) lymph nodes;
- supraclavicular lymph nodes.
How is the clinical assessment of temporomandibular joint (TMJ) function performed?
Clinical assessment of temporomandibular joint (TMJ) function includes visual inspection and palpation.
- Assessment of movements: range of motion of the mandible is determined during mouth opening/closing and lateral excursions. Normally, opening is free and painless, with an amplitude of about 5 cm. The presence of deviation (displacement), coincidence of the dental midline, and acoustic symptoms ("crepitus", "clicking") are recorded.
- Palpation: performed at rest and during movement. The joint is palpated through the skin anterior to the tragus of the ear or through the anterior wall of the external auditory meatus. The character of condylar excursion, their configuration, tenderness, and synchronization of movements are evaluated.
To remember the sequence of the objective oral cavity examination, use the rule "IOPS": Inspection, Palpation, Percussion, Sounding (probing).
Class and exam questions
What does the examination of a dental patient always begin with?
Examination invariably begins with an interview. This allows you to establish a trusting rapport with the patient, take a medical history, and make a preliminary diagnosis.
What two main groups are clinical research methods divided into?
Research methods are divided into basic (subjective and objective) and additional (various instrumental and laboratory studies).
According to what criteria must pain syndrome be detailed?
Pain is assessed by duration (constant or temporary), character (sharp or dull), localization (localized or diffused), and mechanism of onset (spontaneous or provoked).
How to differentiate pulpitis by the character of pain?
Pulpitis is characterized by sharp, diffuse pain that most often occurs at night and tends to radiate (spread) to neighboring areas.
What else to study on this topic
- Methodology for sounding and percussion of teeth
- Palpation of lymph nodes in the maxillofacial region
- Instrumental diagnostic methods in dentistry
- Assessment of temporomandibular joint (TMJ) function
- Rules of medical deontology during therapeutic appointments
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Other topics of section "Chapter 16. Methodology of dental patient examination"
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