Symptomatology of hard dental tissue lesions

Basic terms and classification

When describing a pathological process, physicians operate with three key concepts that are often used as synonyms but have subtle semantic differences:

• Symptom (symptoma) or Sign (signum) is any manifestation of a disease, which can be either subjective (patient complaints) or objective (revealed upon examination).
• Phenomenon (phaenomenon) is a striking, attention-grabbing phenomenon that arises as a result of biological or physicochemical reactions in the body.

Depending on their diagnostic value, all symptoms are divided into three groups:

1. Pathognomonic — absolutely specific and occur exclusively in one specific disease.
2. Obligate — leading manifestations without which the given disease practically does not occur.
3. Facultative (nonspecific) — can accompany a number of different nosologies and are far from being detected in every patient.

The concept of a syndrome in clinical practice

The term syndrome (syndroma) denotes a stable set of symptoms that develop according to common pathogenetic mechanisms. A syndrome is characterized by the regularity of manifestations, a certain dynamics, and relative specificity (the same syndrome can be caused by different factors).

In the medical community, the concept is sometimes applied incorrectly:

• A random set of unrelated clinical signs is erroneously called a syndrome.
• Often the word is used as a complete synonym for the term "disease" (morbus), denoting stages of pathology or independent nosologies by it. It is important to remember that a syndrome relates to a disease as a particular phenomenon to a general essence.

For a dentist, knowledge of syndromology is critically important: it helps to correctly navigate borderline conditions of the maxillofacial region (MFR) and choose tactics taking into account the patient's general status.

Dental and maxillofacial symptoms

A number of eponymous symptoms are directly related to the dentognathic system, the oral mucosa (OM), and the bones of the facial skeleton:

• Hutchinson's (II) sign — a classical marker of late congenital syphilis. It manifests as a change in hard tissues: the upper central incisors acquire a chisel-like shape with a semilunar notch on the cutting edge.
• Bogue's sign — an orthodontic criterion. If the distance between permanent molars is less than 28 mm in a child aged 4 to 7 years, this is a direct indication for treatment.
• Hydrovibrational oscillation sign — a sign of a jaw cyst with thinning of the bone wall. Tapping on the teeth in the cyst area causes hydraulic shocks in the liquid contents, which the physician feels by palpation.
• Dupuytren's (I) sign — a specific crunch when pressing on the thinned bone wall of the jaw or alveolar process (found in follicular and radicular cysts, benign neoplasms).
• Vincent's sign — paresthesia or complete anesthesia of half of the chin and lower lip. Indicates compression, inflammation, or rupture of the fibers of the inferior alveolar nerve.

Manifestations of toxic and systemic lesions

Many general diseases manifest in the oral cavity with specific signs:

• Burton's line — a sign of lead intoxication (saturnism), in which a thin gray border forms along the gingival margin of the lower teeth.
• "Hair" sign — characteristic of tetraethyllead poisoning. The patient feels as though there is a thread or hair in the mouth, causing them to constantly make obsessive movements with their lips and tongue.
• Wickham's striae — a reticular pattern on the surface of papules in lichen planus (a consequence of focal granulomatosis).
• "Emerging blister" sign — the appearance of tense blisters with hemorrhagic or serous exudate after light scraping with a spatula. Indicates benign non-acantholytic pemphigus of the oral mucosa.
• Beltz's sign — yellowing of the skin and mucous membranes in aurantiasis (carotenoid jaundice). It differs from true jaundice in that the color of the sclera remains normal.

Neurological and traumatic signs

The dentist is often the first to notice neurological deficits or hidden traumas of the maxillofacial region:

• Bell's sign — a marker of peripheral facial nerve palsy. When attempting to close the eyes tightly, the upper eyelid drops, and the eyeball rolls upward and outward.
• Bechterew's (II) sign — indicates meningeal irritation. Tapping with a percussion hammer on the zygomatic arch provokes headache and contraction of the facial muscles.
• Guérin's sign — a sign of maxillary fracture. Pressure on the pterygoid processes with the mouth open causes pain along the entire fracture line.
• "Two spatulas" sign — diagnostics of a zygomatic arch fracture. The spatula lies asymmetrically and does not fit snugly against the body of the zygomatic bone, unlike the healthy side.
• Battle's sign — skin discoloration up to ecchymoses in the mastoid process area, indicating a fracture of the skull base.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Ophthalmic symptoms in maxillofacial surgery practice (Belostotsky and Berlin signs)
• Semeiotics of inflammatory diseases of ENT organs (Garel, Kaufman, and Davidson signs)
• Signs of glossopharyngeal nerve damage (Berne sign, "curtain" sign)
• Manifestations of endocrine pathologies on the face (Geoffroy and Abadie signs)
• Specific dermatological symptoms (Besnier, Biedermann, "pear" sign)

Other topics in "Chapter 15. Semiotics in Dentistry"

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