A physician should always examine the mouth and be able to recognize major oral disorders, particularly possible oral cancers. However, consultation with a dentist is needed to evaluate patients with nonmalignant changes as well as tooth problems. Likewise, patients with xerostomia or unexplained swelling or pain in the mouth, face, or neck require a dental consultation.
Caries is tooth decay, commonly called cavities. The symptoms—tender, painful teeth—appear late. Diagnosis is based on inspection, probing of the enamel surface with a fine metal instrument, and dental x-rays. Treatment involves removing affected tooth structure and restoring it with various materials. Fluoride, diligent dental hygiene, sealants, and proper diet can prevent virtually all caries.
Burning mouth syndrome is intraoral pain, usually involving the tongue, in the absence of intraoral physical signs. There are no specific diagnostic tests, and treatment is symptomatic. Burning mouth syndrome can be either idiopathic or caused by another disorder (secondary).
Periodontitis is a chronic inflammatory oral disease that progressively destroys the tooth-supporting apparatus. It usually manifests as a worsening of gingivitis and then, if untreated, with loosening and loss of teeth. Other symptoms are rare except in patients with HIV infection or in whom abscesses develop, in which case pain and swelling are common. Diagnosis is based on inspection, periodontal probing, and x-rays. Treatment involves dental cleaning that extends under the gingival (gum) tissues and a vigorous home hygiene program. Advanced cases may require antibiotics and surgery.
The term temporomandibular disorders is an umbrella term for a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joint (TMJ), the masticatory muscles, and all associated structures. Temporomandibular disorders often present with pain in the jaw, face, and neck and/or with dysfunction of the jaw joint (often decreased range of motion) and is often accompanied by headache or ear pain. People are considered to have a temporomandibular disorder when the pain or dysfunction is severe enough to make them seek professional care.