Patient Survey
Pain Assessment
Dental pain
Single choice
Painful tissue
Multiple choice
note
Information about the location of pain such as a tooth, gum or jaw is important because it helps determine the cause of the pain.
Pain location
Multiple choice
Onset of pain
Date picker
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Information about the time when the pain started helps determine the nature and course of the disease. A long, continued pain indicates chronic nature of the disease, whereas a recent onsent of pain indicates acute nature of the disease.
Pain progression
Single choice
note
Information on how the pain started in combination with the time of onset helps determine the nature and course of the disease.
Acute diseases are characterized by a sudden onset of symptoms, in contrast to chronic diseases, which are characterized by symptoms that appear gradually.
Nature of pain
Single shoice
note
Pain may occur continously or can be intermittent, with periods with no symptoms in between. Continuous pain indicate an acute problem or reactivation of the chronic disease, while intermittent pain indicates disease with more chronic nature.
Type of pain
Single choice
note
Information about the type of pain is diagnostically important because it can help determine the cause of the pain, since different diseases have different patterns of pain.
Pain spread
Multiple choice > Short text
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Information about the spreading of the pain from the original place to other structures, helps to determine the cause and severity of the disease.
Daily pain variation
Multiple choice
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Information on variations in pain in terms of pain intensity during the day helps to determine the origin of pain, and therefore its cause.
Painful body position
Multiple choice
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Information about changing pain when changing body position, such as lying down, bending down abruptly, or walking down the stairs, may indicate the origin of the pain.
Aggravating factors
Multiple choice > Short text
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Factors that aggravate pain may be specific to certain dental diseases and for this reason are diagnostically important. For example, the pain of cracked tooth syndrome occurs when the patient relieves the occlusal pressure over the tooth.
Relieving factors
Multiple choice > Short text
note
Factors which reduce the severity or frequency of pain are considered important in diagnosis. For example, in some cases, pain of chronic pulpitis gets relieved by cold application.
Pain associated symptoms
Multiple choice
note
Pain may occur along with nausea, vomiting, sweating, flushing and increase in pulse rate. The presence of these symptoms indicates the severity of the disease and its acute nature.
Pain severity
Single choice
note
No pain
Feeling perfectly normal and completely pain free.
Mild pain
Pain is very mild, barely noticeable. Most of the time, you don`t think about it. Like a mosquito bite or a poison ivy itch.
Discomforting
Minor pain , annoying and may have occasional stronger twinges. Like lightly pinching the fold of the skin between the thumb and the first finger of the opposite hand, using fingernails.
Tolerable
Very noticeable and distracting pain, however, you can get used to it and adapt- like an accidental cut or a blow to the nose causing a bloody nose or a doctor giving you an injection.
Distressing
Strong , deep pain. You notice the pain all the time and cannot completely adapt. If you are deeply involved in activity it can be ignored for a period of time, but still distracting. Like a minor trauma such as stubbing your toe.
Very distressing
Strong, deep pain. You notice the pain all the time and you are preoccupied by managing it. It can be ignore for more than few minutes , but with an effort. You still can manage work or participate in some activities. Like a sprained ankle or back pain.
Intense
Pain that interferes with normal daily activities and partially dominate your senses . You have difficulties concentrating. Like a really bad non-migraine headache.
Very intense
Pain that dominates your senses completely and significantly limits your ability to perform simple daily activities or maintain social relationships. This pain interferes with sleep. Like a migraine.
Utterly horrible
Pain sto bad that you can no longer think clearly at all, and have often undergone severe personality change if the pain has been present for a long time. Physical activity is severely limited and conversing requires great effort.
Excruciating/Unbearable
Pain so intense that you cannot tolerate it. Unable to converse, crying out and /or mourning uncontrollably.
Unimaginable/unspeakable
Pain so intense that you will briefly go unconscious. Bedridden and possibly delirious. Very few people will ever experience this level of pain.
The perception of pain varies in different individuals. The scale often helps to quantify how much pain the patient is actually having. The severity of pain gives an impression of the acuteness of the symptoms felt by the patient, thus helping in making a proper diagnosis.
Lesion Assessment
Gums lesion
Single choice
Onset of lesion
Single choice
note
Establishing the duration of the lesion provides valuable insight into its nature. For instance, a lesion that has been present for a long period of time might be congenital and it is more likely benign, whereas more rapidly developing lesions are considered more serious.
Lesion size changes
Multiple choice
note
A change in size of a lesion is very important information. By combining information on the growth rate with findings regarding the duration of presence, a more accurate assesment of the nature of the lesion is possible.
Lesion associated symptoms
Multiple choice
note
Information about the presence of symptoms associated with the lesion such as pain, altered function, numbness, abnormal taste, difficulty swallowing or swelling of the lymph nodes in the neck is very important for making a diagnosis.
Lesion changes
Multiple choice
note
For example, an ulceration started as a vesicle or a lump became an ulcer. Changes in the physical characteristics of a lesion can often assist in the diagnosis.
Lesion systemic symptoms
Multiple choice
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Information on the presence of systemic symptoms associated with the lesion such as fever, malaise, and nausea is of great diagnostic value because some of these symptoms indicate a possible association of the lesion with certain systemic diseases or conditions.
Lesion cause
Multiple choice
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Information about an event associated with the onset of a lesion such as trauma, recent dental treatment, exposure to allergens or toxins, or a visit to a foreign country is of great diagnostic value because it may indicate the cause of the lesion.
Oral Health
Gums bleeding
Single choice
note
Bleeding gums when brushing and flossing may indicate underlying gingival disease or the wrong tooth brushing technique. This information, in addition to the intraoral findings, may help in making the diagnosis.
Teeth sensitivity
Single choice
note
The sensitivity of the teeth to pressure, cold, warm and sweet stimuli can indicate the presence of dental caries, pulp disease as well as dentine hypersensitivity. This information, in addition to clinical findings and diagnostic tests, help in making the diagnosis.
Dry mouth
Single choice
note
Dry mouth can be caused by various factors: dehydration, the use of aggressive oral hygiene products or the use of certain medications and treatments. Also, dry mouth occurs in a number of different systemic diseases. Information on the presence of dry mouth in addition to medical history and intaoral findings is of great importance for diagnosis.
Earaches and neck pain
Single choice
note
Ear and neck pain can be caused by various dental diseases, such as pulpal diseases, dental abscess, bruxism and temporomandibular joint disorders.
Information about ear and neck pain, in addition to the clinical findings, can help in making the diagnosis.
Jaw discomfort
Single choice
note
Clicking, popping and discomfort in the jaws can be caused by various factors and diseases such as: infection, bad habits, trauma, malocclusion and temporomandibular joint disorders. Sometimes, the cause of clicking or discomfort in the jaws can be a symptom of an underlying systemic disease such as arthritis.
Information on these phenomena in addition to medical history and intraoral findings can help in making a diagnosis.
Bruxism
Single choice
note
Teeth bruxing and grinding is usually caused by stress and anxiety. If teeth bruxing and grinding occurs in a regular pattern, and lasts for a long period of time, it can lead to various problems and changes such as: clicking of the jaws, pain in the jaws and temporomandibular joint, sensitivity of the teeth to percussion, as well as various forms of tooth wear.
Information on teeth bruxing and grinding in addition to intraoral findings and other symptoms, can help in making a diagnosis.
Ulcers
Single choice
note
Mouth sores and ulcers can be caused by various factors such as trauma, hormonal changes and viral infections. Frequent occurrence of these changes may be part of some systemic diseases and may be a sign of a weakened immune system.
Information on the frequency of their occurrence in addition to intraoral findings is of great diagnostic value.
Dental Care
Head injury
Single choice
note
Serious head and mouth injuries occur as a result of trauma to the head, face and mouth resulting in serious injuries such as fractures of the jaws and facial bones, avulsions and luxation injuries of the teeth, as well as injuries to the temporomandibular joint.
These injuries, caused in the past, can lead to permanent damage to the teeth and jaws, and their consequences are very important in dental diagnosis.
Orthodontic treatment
Single choice
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Information on previous orthodontic therapy is of great importance in the evaluation of the current state of occlusion and the diagnosis of certain conditions that may occur as a result of orthodontic treatment.
Removable dental appliance
Single choice
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Information on wearing removable dental appliances such as complete and partial dentures or nightguards is useful in diagnosing certain conditions that may occur as a result of their use, for example, mechanical irritation, ulceration and denture stomatitis.
Dental treatment problem
Multiple choice > Short text
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Complications related to dental treatment may occur during and after treatment. Complications during the dental treatment include: allergic and toxic reaction to the local anesthetic, injuries to the teeth, soft tissues and jaws, fractures of instruments and needles, as well as bleeding. Complications after dental treatment include: pain and swelling, dry alveoli, bleeding, osteomyelitis and osteonecrosis of the jaw.
Knowing the complications associated with previous dental treatments may be of diagnostic value.
Last dental visit
Single choice
note
The answer to this question gives insight into the regularity of attendance for dental care and the patient’s attitude towards dental professionals and towards treatment. The answer to this question gives insight into recent dental problems.
Last dental procedure
Multiple choice > Short text
note
The answer to this question gives insight into the most recent dental problems that the patient had.
Last xrays
Single choice
note
The answer to this question provides the information necessary to determine the diagnostic value of existing x-rays and whether there is a need for new images.
Teeth appearance
Single choice
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The answer to this question provides information about the patient's satisfaction with the appearance of his teeth.
Female health
Women only
Pregnancy
Single choice
note
The hormonal changes during pregnancy causes changes in the whole body, and the oral cavity is no exception. The oral changes which are seen in pregnancy include gingivitis, gingival hyperplasia, pyogenic granuloma, and salivary changes. Nausea and vomitting , observed in many pregnant women, particularly in first trimester can lead to dental caries and erosive tooth wear.
Birth control
Single choice
note
Birth control pills and hormonal replacement medications have been associated with several oral conditions: gingivitis, canker sores, dry mouth, periodontal diseases and temporomandibular joint disorders.
Nursing
Single choice
note
Nursing information is important for diagnosis and treatment. Nursing or breastfeeding period, due to the influence of hormones has been associated with oral conditions such as gingivitis and an increased risk of dental caries. Caution should be taken during the treatment of breastfeeding women as a large number of drugs pass into breast milk.
General Health
Current health
Single choice
note
This question implies the patient's subjective impression of his general health.
Health past year
Single choice
note
Data on the patient's changed health status in the last year can be of great importance in making a dental diagnosis. Certain systemic diseases can be the cause of certain pathological changes in the oral mucosa and hard dental tissues. If yes, what condition was/is being treated?
Health past 5 years
Single choice
note
Answer to this question provides a better insight into the patient’s health status in the past. Illnesses that require surgery or treatment in a hospital setting can seriously affect a patient's general health, including oral health. In most cases, serious chronic diseases include long-term use of various drugs and the use of treatments that can cause various side effects on oral tissues long after they are discontinued from regular use.
Allergies
Multiple choice > Short text
note
Allergic reactions in the oral cavity can occur as a consequence of direct contact of the allergen with the oral mucosa or as an oral manifestation of systemic allergic reactions. oral manifestations of allergic reactions include the appearance of: redness, swelling of the lips and tongue , burning sensation, itching, blisters or ulceration. A local allergic reaction can be caused by a large number of factors such as: food, medications, dental materials, oral hygiene products, etc. Data on previously determined allergic reactions are diagnostically very important in dentistry.
Contact lenses
Single choice
note
Information on wearing contact lenses is important in the context of certain dental treatments, such as caries removal, root scaling and planning. During these treatments, an aerosol is released, which contains a large amount of bacteria and other microorganisms from the oral cavity. These microorganisms can very easily contaminate the surface of contact lenses and lead to eye infection. Eye dryness occurs in a large number of contact lens wearers. Considering that dry eye can also occur as part of certain syndromes that have an oral manifestation, this information is diagnostically important.
Systemic diseases
Multiple choice > Short text
note
Heart murmur
The presence of a heart murmur may be of significance in dental patients because it may be an indication of underlying heart disease.Depending on the underlying cause of the heart murmur an antibiotic prophylaxis might be advised prior to the dental treatment. There is no evidence of the oral manifestations of the heart murmur but some oral changes in patients with this condition can be observed due to medications used in treatment of the underlying disease.
Artificial heart valves
In patients with artifical valves an antibiotic prophylaxis might be advised prior to the dental treatment.There is no evidence of the oral manifestations caused by artificial valves. Nevertheless, oral changes might be observed due to medications used in treatment such as blood thinners which can cause abnormal bleeding or petechial bleeding spots on the oral mucosa.
Rheumatic fever
In patients with rheumatic fever an antibiotic prophylaxis might be advised prior to the dental treatment.
Angina pectoris
In patients with angina pactoris, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, etc.
Arteriosclerosis
Arterioslerosis can be associated with higher risk of periodontal disease. Also, oral changes might be observed due to medications used in treatment of the disease. Some of the oral changes include: dry mouth, taste sense alterations, blleding, lichenoid reactions, salivary gland swelling, etc.
Congestive heart failure
In people with congestive heart failure, a pink sputum can be observed if the primary disease is associated with acute pulmonary edema. Otherwise, there is no evidence of the other oral manifestations associated with congestive heart failure. Oral changes might be observed due to medications used in treatment of the disease. Some of the oral changes include:dry mouth,lip and face edema, metallic taste in the mouth, burning sensations in mouth, gingival enlargement, etc.
Coronary artery disease
In patients with coronary artery disease, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc.
Damaged heart valves
In some patients with damaged heart valves, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments. In patients with this condition oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc.
Heart attack
In some patients with heart attack, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments.
In patients with heart attack oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth etc. Some of these drugs may have potential interactions with vasoconstrictors in local anesthetic.
Low blood pressure
Informations about hypotension are important for dental treatment and diagnosis. Hypotensive patients are prone to sudden drops in blood pressure when getting up abruptly from a dental chair, which should be taken into consideration when it comes to dental treatment.
There is no evidence of the oral manifestations of the low blood pressure, but some oral changes in patients with this condition can be observed due to medications used in treatment of the underlying disease. Medications used to treat hypotension can cause oral side effects: redness of the oral mucosa, dry mouth, and oral candidiasis.
High blood pressure
The oral manifestations of high blood pressure include gingivitis, periodontitis, salivary gland swellingor pain and lichenoid reactions. Also, medication used in treatment of high blood pressure can cause oral side effects such as: redness and swelling of oral mucosa, burning sensations in mouth, metallic taste and other taste disturbances, dry mouth, etc.
Congenital heart defects
In some patients with non repaired congenital heart defects, an antibiotic prophylactic regimen might be considered prior high - risk dental treatments.
In patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.
Pacemaker
Informations about pacemaker placement are important for dental treatment and diagnosis. Pacemakers are electronic devices sensitive to strong electromagnetic signals. There are possible electromagnetic interferences to pacemakers, due to dental devices such as ultrasonic scalers, electrosurgical unit and battery driven light cure composite unit. Although pacemakers of new generation have more protective features than those of past, still precautionary measures should be taken prior to treatment.
Also, in patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.
Rheumatic heart disease
In patients with rheumatic heart disease, an antibiotic prophylactic regimen should be administered prior high - risk dental treatments. In patients with this condition, oral changes might be observed due to medications used in treatment.
These medications can cause: dry mouth, redness of the oral mucosa, gingival enlargement, taste sense alterations, angioedema of the lips, face or tongue, burning sensations in the mouth, etc.
Anaemia
Oral manifestations of anaemia include pallor of the oral mucosa,burning sensation of tongue and or lips atrophy of the tongue papillae, angular cheillitis.
In patients with anaemia, oral changes such as tooth discoloration, might be observed due to medications used in treatment.
Abnormal bleeding
Informations about abnormal bleeding and blod clotting disorders are very important for dental treatment and diagnosis. Knowing that a patient has an abnormal bleeding disorder is very important before the dental treatment itself in order to avoid unwanted and prolonged bleeding, since many dental interventions involve bleeding.
Abnormal bleeding disorders also have an impact on oral tissues where petechial hemorrhages and hematomas can be seen, as well as spontaneous gingival hemorrhages. Therefore, this information is diagnostically very important.
Hemophilia
Oral manifestations of hemophilia include bleeding from multiple sites, frequently manifested in the mouth as gingival and post-extraction hemorrhages. Also, oral ulcerations and bleding spots involving lips and often. Informations about this disorder have a significant diagnostic value.
Leukopenia
Oral manifestations of leukopenia include recurrent aphthous stomatitis, recurrent gingivitis, and periodontitis.The periodontal manifestations range from marginal gingivitis to rapidly advancing periodontal bone loss caused by bacterial infection of the supporting dental structures.
In patients with this condition, oral changes might be observed due to medications used in treatment. These medications can cause redness of the oral mucosa and oral candidiasis.
Thrombocytopenia
Oral manifestations of thrombocytopenia include small, single or multiple petechial haemorrhages, ecchymosis and haemorrhagic blisters or spontaneous bleeding. The thrombocytopaenic lesions are usually located on the soft tissues most susceptible to trauma, such as the buccal mucosa, the junction between the hard and soft palate and on the gingiva.
Thrombophilia
In patients with thrombophilia, oral changes might be observed due to medications used in treatment. These medications can cause:gingival bleeding , petechie on the oral mucosa, post- extraction bleeding and often nose bleeds.
AIDS or HIV infection
Oral manifestations of AIDS or HIV inflection include include oral candidiasis, hairy leukoplakia, Kaposi sarcoma, linear gingival redness, necrotizing ulcerative periodontitis, aphtae and ulcerations.
Arthritis
Oral manifestations of arthritis include painful opening and closing mouth, limited mouth opening and periodontal disease.
In patients with arhtritis, oral changes might be observed due to medications used in treatment: dry mouth, redness, swelling of lips and tongue, metallic taste in mouth, oral candidiasis.
Rheumatoid arthritis
Oral manifestations of rheumatoid arthritis include painful opening and closing mouth, limited mouth opening, xerostomia and aphtous ulcerations. In patients with rheumatoid arhtritis, oral changes might be observed due to medications used in treatment: oral ulcerations, gingival bleeding, redness and edema, dry mouth, taste disturbances and oral candidiasis.
Systemic lupus erythematosus
Oral manifestation of this condition include oral ulcerations, honeycomb plaque, raised keratotic plaque, nonspecific erythema, purpura, petechiae, cheilitis, hyposalivation, xerostomia, as well as higher risk of dental caries.
In patients with this condition , oral changes such as oral candidiasis might be observed due to medications used in treatment.
Other autoimmune diseases
A broad spectrum of oral manifestations of autoimmune diseases has been observed. These manifestations include: erythematous and edematous mucosal lesions,erosions, ulcerations, diffuse and severe stomatitis, vesicles, bullous lesions and blisters.
In patients with this autoimmune conditions , oral changes such as oral candidiasis might be observed due to medications used in treatment.
Asthma
Oral manifestations of asthma include dry mouth due to decreased salivary flow, excessive dental calculus, dental caries, periodontitis and geographic tongue. In patients with asthma, oral changes such as oral and pharyngeal candidiasis might be observed due to medications used in treatment.
Bronchitis
Oral manifestations of bronchitis include dry mouth dental calculus, dental caries, periodontal disease and gingival enlargement. In patients with bronchitis, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances, ulcerations, oral and pharyngeal candidiasis, perioral dermatitis and tongue hyperthrophy.
Emphysema
Oral manifestations of emphysema include dry mouth excessive, dental calculus, dental caries,geographic tongue, periodontal disease and gingival enlargement. In patients with asthma, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances, ulcerations, oral and pharyngeal candidiasis, perioral dermatitis and tongue hyperthrophy.
Sinusitis
Due to the proximity of maxillary teeth to the maxillary antrum, pain in the maxillary sinus can mimic dental pain. Oral symptoms of sinusitis include sensitivity to percussion of a group of teeh without any obvious dental and periodontal pathology and pain in teeth while patient is descending stairs, jump or runs. In patients with sinusitis, oral changes such as oral and pharyngeal candidiasis might be observed due to medications used in treatment.
Tuberculosis
Oral manifestations of tuberculosis include ulcerations in the posterior part of oral cavity, granulomas , osteomyelitis of the jaws, salivary gland inflammation and enlarged cervical lymph nodes. In patients with tuberculosis, oral changes might be observed due to medications used in treatment:excessive salivation, metallic taste in the mouth, pink saliva, pllor of oral mucoasa and gingival bleeding.
Chest pain upon exertion
Information about chest pain upon exertion is important for dental treatment as well as diagnosis. Chest pain upon exertion is usually associated with cardiovascular and respiratory diseases, so duration of dental treatment as well as the position of the patient in dental chair should be adjusted. Oral lesions found in patients who experience pain upon exertion are usually associated with primary disease and with medications used in the treatment.
Chronic pain
Chronic pain is associated with large number of chronic diseases. There is no specific oral manifestations or chronic pain. Oral lesion found in patient with chronic pain conditions are usually associated with long term use of prescribed analgetics and off the counter painkillers: dry mouth, metallic taste in the mouth, redness or oral mucosa, oral ulcerations, lip and tongue swelling, etc.
Diabetes
Oral manifestations of diabetes include dry mouth, increased rate of dental caries, periodontal disease, especially parodontal and gingival abscesses, burning mouth sindrome, oral lichen, fissured tongue, salivary gland enlargement and delayed found healing.
Eating disorder
Oral manifestations of eating disorders include: dental erosions, increased rate of dental caries, gingivitis and periodontitis, angular cheilitis, inflammatory changes of oral mucosa, mucosal ulcerations and mechanical injuries, burning mouth syndrome and enlarged salivary glands.
Malnutrition
Oral manifestations of malnutrition includea large number of oral pathologies: delayed tooth eruption, structural changes of dental tissue, reduced size of the dental roots, abnormal alveolar bone patterns, gingivitis, angular cheilitis, crcked lips, bad breath, burning mouth syndrome, very rad and painful tongue, pallor of oral mucosa and salivary gland dysfunction.
Gastrointestinal disease
Oral manifestations of gastrointestinal diseases include reccurent aphthae, mucosal tags, labial and facial swelling, taste disturbanceas and multifocal mucosal thickening. In patients with gastrointestinal diseases, oral changes might be observed due to medications used in treatment: licheonid reactions of oral mucosa, dry mouth, loss of taste, erythema multiforme and oral candidiasis.
Gastroesophageal reflux disease/heartburn
Oral manifestations of gastroesophageal reflux disease include bad breath, burning sensations in the mouth, redness of soft palate and uvula, increased salivation, increased rate of dental caries, dental erosions, taste disturbances, and difficulty with swallowing.
Thyroid problems
Oral manifestations of thyroid problems include tooth eruption disturbances, increased rate of dental caries, periodontal disease, oral ulcerations, enlarged tongue, taste disturbances,enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue), maxillary or mandibular osteoporosis and burning mouth syndrome.
Stroke
Oral manifestation of stroke include unilateral paralysis of the face, loss of sensation in the oral mucosa, flaccid tongue with multiple folds, difficulty with swallowing, neglect of oral care on the one side of the mouth, increased rate of dental careis and periodontal disease and bad breath. In patients with stroke, oral changes might be observed due to medications used in treatment:dry mouth, metallic taste in the mouth and gingival bleeding.
Glaucoma
There is no specific oral manifestations or glaucoma. Oral lesions found in patient with this condition are usually associated with medications used in treatment such as dry mouth.
Hepatitis, jaundice, or liver disease
Oral manifestations of hepatic diseases include mucosal membrane jaundice, bleeding disorders, petechiae, increased vulnerability to bruising, gingivitis, gingival bleeding bad breath, cheilitis, smooth tongue, dry mouth, crusted perioral rash and salivary gland enlargement. In patients with hepatic diseases, oral changes might be observed due to medications used in treatment:dry mouth, metallic taste in the mouth and oral candidiasis.
Epilepsy
Oral manifestations of epilepsy include mucosal injuries and ulcerations due to biting to the tongue and cheeks, increased rate of dental caries, fractured teeth and temporomandibular joint displacement. In patients with epilepsy, oral changes might be observed due to medications used in treatment of epilepsy such as dry mouth, taste disturbances, gingival enlargement and gingival bleeding.
Fainting spells or seizures
Information about fainting spells or seizures are important for dental treatment as well as diagnosis. Fainting spells or seizures are usually associated with variety of systemic diseases so duration of dental treatment as well as the position of the patient in dental chair should be adjusted. Oral manifestations of these conditions include mucosal injuries and ulcerations due to biting to the tongue of cheeks and dental traumatic injuries.
Neurological disorders
Oral manifestations of neurological disorders include weaknes of facial and masticatory musles, difficulty with swallowing and chewing food, pain in jaws and temporomandibular joint, increased rate of dental caries and periodontal disease. In patients with neurological disorders, oral changes might be observed due to medications used in treatment : dry mouth, taste disturbances, oral candidiasis.
Sleep disorders
Sleep disturbances can be caused by several systemic diseases such as cardiovascular diseases, obesity , neurological and mental health disorders. There is a few oral manifestations of the sleep disorders such as gingivtis and gingival enlargement. Most oral findings are caused by the primary disease. In patients with sleep disorders, oral changes might be observed due to medications used in treatment :dry mouth, taste disturbances, burning mouth syndrome.
Mental health disorders
Oral manifestations of mental health disorders include increased rate of dental caries, poor oral hygiene, dental erosions, ginigvitis, periodontal disease, bruxsism, temporomandibular joint disorders, mechanical injuries of oral mucosa, salivary gland enlargement. In patients with mental health disorders, oral changes might be observed due to medications used in treatment: dry mouth, metallic taste in the mouth, burning mouth syndrome, gingival enlargement and gingival bleeding.
Recurrent infections
Recurrent infection in oral mouth can be bacterial, viral or fungal origin.These infections are often sign of weakened immune system or underlying systemic disease. Oral manifestations of recurrent infections include multiple vesicles on lips and oral mucosa, mucosal erosion and ulcerations, white pathches on mucosa, gingivitis and abscesses.
Kidney problems
Oral manifestations of kidney diseases include pallor of the oral mucosa, petechiae and hemorrhages in the oral cavity, inflammatory changes of the oral mucosa, altered taste sensations, dry mouth, bad breath, gingivitis and white pathches on the oral mucosa. In patients with kidney problems, oral changes might be observed due to medications used in treatment: dry mouth due to decreased salivary flow, gingival enlargement and oral candidiasis.
Night sweats
Night sweats are associated vith a number of systemic diseases: cardiovascular diseases, tuberculosis, diabetes, thyroid diesases etc.
Information about night sweats in combination with oral lesions may indicate the existence of a systemic disease.
Osteoporosis
Oral manifestations of osteoporosis include periodontal disease, alveolar bone loss, tooth mobility and fractures of the jaws. In patients with osteoporosis, oral changes might be observed due to medications used in treatment: metallis taste in mouth, swelling of tongue and lips, dry mouth, medication induced osteonecrosis of the jaws, etc.
Persistent swollen glands in neck
Persistent swollen glands in neck can be caused by various diseases associated with oral tissues as well as systemic diseases. Swelling of the lymph nodes in neck can be caused by dental conditions such as dental abscess, bacterial and viral infections of the oral cavity and throat. Also, swelling of the neck lymph nodes can be sign of very serious condition so, so knowing about this condition is of great importance for the diagnosis.
Severe headaches/migraines
Severe headaches can be caused by conditions associated with oral cavity such as dental conditions and temporomandibular joint disorders. In patients with severe headaches/ migraines, oral changes might be observed due to medications used in treatment: dry mouth, and taste disturbances.
Severe or rapid weight loss
Information about severe or rapid weight loss is of great importance in diagnosis. Severe weight loss in combination with oral findings and information about night sweats and swollen lymph glands can be a sign of serious illness.
Sexually transmitted disease
Oral manifestations of sexually ransmitted disease include erosions and ulcerations of the oral mucosa,tongue and throat, vesicles on lips and oral mucosa, papillomas or warts.
In patients with sexually transimtted disease,, oral changes might be observed due to medications used in treatment: dry mouth, taste disturbances and fungal infection.
Excessive urination
There is no specific oral manifestation of excessive urination except dry mouth. Excessive urination can be a symptom of underlying systemic disease , so this finding is very important in diagnosis, especially in case of some specific findings in the oral cavity.
Excessive urination can be a symptom of a known systemic disease such as kidney disease or endocrine disorder, or can be a side effect of some medications, for example diuretics.
Cancer
Oral manifestation of cancer include variety of symptoms , depending of the type of the cancer: pallor of the oral mucosa, gingival bleeding, petechiae and hemorrhages in the oral cavity, dry mouth, ulcerations of the oral mucosa, bacterial , viral and fungal infections,increased rate of dental caries and periodontal disease.
In patients with cancer, oral changes might be observed due to medications used in treatment.
Chemotherapy/radiation treatment
Oral manifestations of chemotherapy and radiation treatment include variety of oral lesions: sever inflamation of oral mucosa, redness of the oral mucosa and thorat, dry mouth, metallic taste in the mouth, taste disturbances, mucosal ulcerations, severe dental caries, gingivitis, gingival bleeding, periodontal disease,lichenoid reacions and. osteoradionecrosis.
Other conditions
Single choice > short text
note
The questionnaire contains a list of the most common diseases. If you have a disease that is not listed in the questionnaire, write the name of the disease, the onset of the disease, duration, and whether the disease is still active.
Medical Care
Physician care
Single choice
note
We ask this question because we want to know are you being treated by a primary care or family doctor for some kind chronic illness or for regular check-ups
Last physical exam
Single choice
note
This question involves entering the date of the last medical examination by the family physician or specialist. If the patient does not remember the exact date, he can enter the approximate date of the examination.
Prescription medicine
Single choice > Short text
note
A wide range of prescription and over the counter drugs can cause various oral side effects (e.g. dry mouth, redness of the mucosa, altered taste, swelling of the lips or tongue, etc.). This information can be of great importance in diagnosing various dental conditions.
Diet drugs
Multiple choice
note
These diet medications are used as appetite suppressants. Cardiotoxicity has been demonstrated for these drugs, which has led to permanent damage to the heart valves in a significant number of patients. For this reason, prior to the dental treatment of these patients, antibiotic prophylaxis is required. These medications have oral side effects such as dysgeusia or metallic taste in the mouth, dry mouth, and prolonged paraesthesia, which may be important for the diagnosis of oral diseases.
Bisphosphonates
Multiple choice
note
Alendronate (Fosamax) are Risedronate (Actonel) are bisphosphonates, drugs used in treatment of osteoporosis, Paget's disease and in treatment and prevention of bone metastases of various malignant tumors.
These drugs have a serious side effect: osteoinecrosis of the jaw, which is manifested by exposed bone in the oral cavity, inflammation and pain. Osteonecrosis most often occurs after tooth extraction, but it can also occur spontaneously.
Information on the use of these drugs is very important in distinguishing this disease from other diseases with similar symptoms but a completely different cause: osteoradionecrosis and osteomyelitis.
Intravenous bisphosphonates
Single choice > Date 📆 (MM.YYYY)
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The start of bisphosphonate treatment and the duration of treatment are very important, as it has been proven that these drugs remain in the bones for at least 12 years, which means that they can cause side effects on the jaws long after stopping their use. The intravenous bisphosphonates (Aredia or Zometa) for bone pain, hypercalcemia, or skeletal complications resulting from Paget’s disease, multiple myeloma, osteoporosis or metastatic cancer?
Joint replacement
Single choice > Date > Short text
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Patients with history of complications associated with their joint replacement surgery who are undergoing dental procedures that include gingival manifulation or local incision, prophylactic antibiotic regimen should be considered in consultation with orthopeadic surgeon. During bloody dental interventions, the patient is at risk for bacteria in the mouth entering the bloodstream which can infect artificial joints. After joint replacement patients very often use various medications, for extended period of time such as strong prescribed analgetics or over the counter painkillers. Prolonged usege of these medications can cause oral side effects such as: dry mouth, redness or taste disturbances, which is diagnostically important.
Habits
Drugs use
Single choice > Short text
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Oral health problems are among the most prevalent health problems associated with drug consumption. .These problems may result from direct exposure of oral tissues to drugs during smoking or ingestion, biologic interaction of drugs with normal physiology of oral cavity, and effects of drugs on brain function which result in a spectrum of addictive behaviors such as risk-taking behavior, poor hygiene, aggression, and carelessness. A broad spectrum of oral disaseses are associated with druge use : generalised tooth decay, dry mouth, mucosal infections, severe periodontal disease, candidiasis excessive tooth wear, bruxsism, palate perforation,tooth loss and oral cancer, so data on controlled substances usage is very important in diagnosis.
Tobacco use
Single choice
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Tobacco has chemical and termal effects on oral tissues. The use of tobacco products has been associated with various lesions in oral cavity: teeth staining, dental abrasions, smoker’s melanosis, acute necrotizing ulcerative gingivitis and other periodontal conditions, burns and keratotic patches, black hairy tongue, nicotinic stomatitis, palatal erosions, leukoplakia, epithelial dysplasia and squamous-cell carcinoma.
Alcohol use
Single choice > Short text
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The consumption of the alchoholic beverages has been associated with different lesions in the oral cavity such as dry mouth, dental caries, periodontitis, erosive tooth wear, candidiasis, mucosal lesions and oral cancer.
Sugary drinks
Single choice
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The consumption of the fizzy drinks or sweetened beverages has been asociated with severe dental caries and erosive tooth wear.
Sugary foods
Single choice
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Frequent consumption of sweets and sugary foods has been associated with lerger number of decayed teeth. Information on sweets and sugary food intake is very important in caries risk assesment.