Page 319 - My FlipBook

EXAMINATIONS OF THE MOUTH. 183
presented, should be able to make a proper and sufficient diagno-
sis after some observation and practice in making these examina-
tions. One thing that is more frequently overlooked or passed
without sufficient attention is the lodgment of food between proxi-
mal surfaces. Often patients go to the dentist time after time —
so they relate — on account of pain in chewing food, located
between some two of the teeth, and are assured that there is
nothing wrong. The fact that there is pain from such cause is, in
itself, evidence of something wrong that needs immediate cor-
rection.
When patients come suffering from pain, they usually know
the seat of the trouble or cause of such pain, and can relieve the
operator from any considerable trouble in making the examina-
tion. But it occasionally happens that the patient has no correct
idea of either the location or the cause of the pain. "When the
pain occurs from the penetration of caries at some hidden point
unknown to the patient, the pain from irritation of the pulp
approached by the decay is often referred to some other point by
the patient, and maybe to various points. It should be remem-
bered distinctly that the sense of touch is the localizing sense and
that the pulp of a tooth has not the sense of touch. Conse-
quently it does not in itself localize painful impressions. If there
has not been something, as the knowledge of a cavity, to indicate
to the patient the location, it may be referred to the opposite jaw,
upper or lower, or to any of the teeth on that side of the mouth,
or to points in the neighborhood. In that case a search must be
made for the cause of the pain. If the cause of pain is obscure,
it is important to obtain from the patient as full a history of the
beginning and progress of the pain as possible. This should
first be related by the patient in his or her own way, without
question or direction by the dentist, further than that required
to bring out the complete story of the suffering, the points in
which should be very carefully noted. After this story of the
beginning and progress of the pain has been made as complete
as the patient can do, the dentist may follow out any thought his
knowledge of disease, or that the indications in this particular
case, may suggest, and obtain further information by carefully
directed questions. These should go as far into the history of
the patient as the conditions brought out may seem to require,
but when such pain seems to be from purely local causes, it is not
necessary to seek far into the general history of the person. Gen-
erally pain referred continually to one side of the face, though
apparently occurring at different points, will be found to be due