A comprehensive clinical examination is the basis for selecting further diagnostic and therapeutic steps.
Extraoral examination
- Inspection
- Facial asymmetries
- Soft tissue swelling
- Fistulas
- Skin florescences
- Injuries
- Skin circulation
- Abnormal findings on the eye
- Palpation
- Bimanual (symmetry comparison)
- Pressure pain (localization)
- Upper and lower jaw (step formation or abnormal mobility).
- Lymph nodes [lymphadenopathy periodic in primary chronic osteomyelitis]
- Nerves, nerve exit points [innervation disorder after trauma; Vincent’s symptom: sensory disturbance (hypesthesia or paresthesia to complete anesthesia) in the supply area of the inferior alveolar nerve. Symptom: numbness of the right or left lower lip].
Intraoral examination
- Mouth opening – restricted [if necessary in acute osteomyelitis; if necessary, periodically in primary chronic osteomyelitis].
- Mucous membranes
- Swellings
- Fistulas
- Exposed bone/sequester [secondary chronic osteomyelitis].
- Mandibular rim – palpability
- Pressure pain
- Foetor es ore (bad breath) [common in acute osteomyelitis; less common in secondary chronic osteomyelitis].
- Oral hygiene situation
- Dental findings (general dental findings).
- Teeth in need of treatment
- Sensitivity testing on teeth suspected of having periodontal or endodontic problems.
- Periodontal findings
- Periodontal pockets [pus leakage (pus discharge) from periodontal crevice (gap between the tooth root and the alveolus (bony tooth compartment) in the jawbone) in acute osteomyelitis]
- Tooth mobility [“dancing teeth” in acute osteomyelitis]
- Percussion dolences (tapping sensitivity of the teeth).
- Functional findings
- Occlusion (Zusammenbiss) – [possibly disturbed].
Square brackets [ ] indicate possible pathological (pathological) physical findings.
