Dental Disorders

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.

Bruxism is clenching or grinding of teeth.

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.

Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions:

Burning mouth syndrome (BMS) is intraoral pain, usually involving the tongue, in the absence of intraoral physical signs. There are no specific diagnostic tests, and treatment is symptomatic. BMS can be either idiopathic or caused by a 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 conditions causing dysfunction of the jaw joint or pain in the jaw and face, including headache. The pain is often in or around the temporomandibular joint (TMJ), including masticatory and other muscles of the head and neck, their fascia, or both. A person is considered to have a temporomandibular disorder only if pain or limitation of motion is severe enough to make them seek professional care.