Pathologies of the jaw bones and periodontium
In routine dental practice, physical signs indicating bone tissue destruction around tooth roots and the development of hidden neoplasms play an important role.
- Schmreker's sign helps detect a radicular granuloma or cyst in cases where the pathological process has led to the destruction of the anterior wall of the jaw. The clinician performs palpation in the projection of the root apex while gently tapping the tooth crown with an instrument. With a positive reaction, a concussion (fluctuation) is clearly felt under the finger.
- «Parchment crackling» sign is an indicator of significant thinning of the jaw bone caused by the growth of cystic tumors. During palpation pressure, the affected bone wall bends, producing a specific cracking sound resembling the crumpling of dry, thick paper.
- Teleman's sign indicates local functional overload of the anterior teeth. The pathology develops due to the blockage of normal articulation movements of the mandible, caused by the mutual displacement of molars on one side.
- Popov's sign (I) describes a malocclusion manifested by the vertical or horizontal displacement of a tooth toward missing antagonists.
Semeiotics of maxillofacial trauma
When examining patients with suspected fractures of the facial skeleton or skull base, a number of biomechanical and visual markers are checked.
- Load sign serves as a reliable sign of a mandibular fracture. The clinician applies dosed physical force, provoking pain strictly along the fracture line. Slow approximation of the jaw angles causes pain in injuries of the body or mental region, while pressure on the chin from front to back indicates trauma to the ramus.
- Malevich's sign («cracked pot» sound) is detected in closed fractures of the maxilla involving the walls of the maxillary sinus. Upon percussion of the maxillary teeth, instead of a clear sound, a dull, rattling response is heard. A similar dull percussive sound is characteristic of gunshot bone wounds.
- «Step» sign is determined by palpation as a sharp irregularity along the lower orbital margin. This indicates a fracture of the zygomatic process, which is typical for Le Fort II type maxillary trauma Le Fort II.
- «Spectacle» sign is expressed as symmetrical bruising around the eyes and is considered a classic indicator of a skull base fracture.
- Hüter's sign indicates a complicated course of a fracture: vibration transmission through the injury site is blocked due to soft tissue entrapment between bone fragments.
Manifestations of syphilis in the maxillofacial region
Syphilitic infection leaves many specific traces on the face, mucous membranes, and dentognathic system, which depend on the stage of pathogenesis.
- Fournier's teeth — a marker of congenital disease in which the first molars form with shortened crowns and enamel hypoplasia on the masticatory surfaces. A similar sign is Moon's sign — the presence of a short and curved first molar in the late form.
- Krisovsky's sign and Robinson-Fournier sign manifest as coarse radial scars around the mouth. These defects remain after the healing of deep fissures and diffuse papular infiltrates. Similar changes are described by Fournier's sign (III).
- A palpably defined nodularity at the border of the bony and cartilaginous parts of the nose in children is called «nasal crests» sign. As the disease progresses, the formation of a saddle nose deformity is possible (Zaufal's sign).
- Secondary syphilis is characterized by acute tenderness of papules upon pressure with a blunt probe (Jadassohn's sign) and clear demarcation of skin elements (Fournier's sign I).
Infectious diseases and neoplasms
The oral mucosa reacts rapidly to acute infectious and vascular pathologies.
Acute infections:
- Measles and rubella. In the initial stages of measles, small white spots on a red background appear on the mucosa (Filatov's sign). In rubella, red spots on the soft palate are recorded (Forchheimer's sign).
- Mumps. Accompanied by local tenderness at the jaw angle (Hitchcock's sign) and the appearance of a bright border around the opening of the parotid duct (Tresillian's sign). Contact of the tongue with a vinegar solution causes a sharp and painful secretion of saliva (Mirshan's sign).
- Typhoid. Typhoid fever manifests as bright triangular hyperemia of the tip of the tongue (Marfan's sign). In typhus, the inability to protrude the tongue due to nerve nucleus damage is observed (Malch's sign).
Vascular pathologies: Cavernous hemangiomas have unique diagnostic markers. Under mechanical compression, the tumor collapses and loses color (compression or erectility sign). When the head is tilted downward, the vascular bed overfills, and the lesion significantly increases in volume (filling sign).
Briefly: answers to topical questions
How does pain syndrome differ in acute pulpitis and acute apical periodontitis?
According to the cited sources:
- Acute pulpitis: characterized by acute diffuse pain, often occurring at night and tending to radiate; pain from stimuli is possible.
- Acute apical periodontitis: a separate characteristic of the pain syndrome is not provided in the sources. Pain upon percussion indicates the presence of an inflammatory focus in the periodontium.
What tooth shape anomalies are characteristic of congenital syphilis?
Congenital syphilis is characterized by specific deformations of incisors and molars accompanied by enamel hypoplasia.
- Hutchinson's teeth — deformation of both upper central incisors, where the neck is wider than the cutting edge, and a semilunar notch is determined on the cutting surface.
- Fournier's sign — first large molars with shortened crowns and enamel hypoplasia on the masticatory surface.
- Moon's sign — a short curved first molar.
What symptoms are characteristic of a maxillary fracture?
The following signs for a maxillary fracture are indicated in the sources:
- Malevich's sign («cracked pot»): a «cracked pot» sound when striking the crown of the upper teeth with an instrument; observed in closed fractures of the maxillary body with disruption of the integrity of the alveolar process, anterior and outer walls of the maxillary sinus.
- «Step» sign: palpable irregularity in the region of the lower orbital margin; occurs during a fracture of the zygomatic process of the zygomatic bone, including Le Fort II maxillary fractures.
- Impaired mouth opening and closing function, as well as palpable mobility and displacement of bone fragments in jaw and zygomatic bone fractures.
What symptoms indicate a skull base fracture in maxillofacial trauma?
A skull base fracture is indicated by:
- «Spectacle» sign — bilateral periorbital hematoma.
- Battle's sign — bruising or ecchymosis in the retroauricular region over the mastoid process.
- Otorrhea or rhinorrhea (CSF leakage) — leakage of cerebrospinal fluid from the nose or ear.
- Hemotympanum or tympanic membrane rupture — signs often accompanying a skull base fracture.
What are the objective clinical signs of pulp necrosis?
Objective clinical signs of pulp necrosis are visual changes in the crown and lack of response to stimuli.
- Discoloration — a sudden and intensive change in the natural color of the tooth.
- Absence of temperature sensitivity — during thermometry (exposure to heat or cold), the response of dental tissues is completely absent.
To remember how a hemangioma behaves, use the "three C's" rule: Compression, Collapse, Color change. It pales and decreases in size under pressure, and returns to normal when pressure is released.
Class and exam questions
How to properly check Schmreker's sign?
The clinician should gently palpate the mucosa overlying the apex of the causative tooth while simultaneously performing light percussion on its crown. A sensation of jarring felt under the finger indicates the presence of a granuloma or cyst.
What is the essence of the "perchment crackling" sign?
This sign occurs due to significant thinning of the jawbone wall under the pressure of a growing cyst. During palpation, the thinned bone yields and depresses, producing a characteristic sound similar to crushing thick paper.
How to identify a jaw fracture using the load test?
The clinician applies controlled pressure to undamaged areas of the jaw (e.g., bringing the angles of the jaw closer together with the fingers). This elicits a pronounced pain response localized strictly to the occult fracture site.
What else to study on this topic
- Differential diagnosis of facial nerve palsies (Cestan, Mondrad-Crohn, and Strauss signs)
- Albers-Schönberg syndrome (marble bone disease) and its effect on the facial skeleton
- Specific manifestations of pemphigus in the oral cavity and evaluation of Nikolsky's sign
- Pospischill's aphthoid syndrome and herpetic lesions in debilitated patients
- Signs of soft tissue gangrene in the maxillofacial region (Pratt's sign)
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Other topics in "Chapter 15. Semiotics in Dentistry"
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