What Review of Systems (ROS) questions should be asked to assess a patient presenting with dental pain?

Comprehensive Review of Systems Questions for Dental Pain Assessment

A thorough review of systems for dental pain should include questions about timing, location, quality, severity, aggravating/relieving factors, and associated symptoms to properly diagnose the source and guide appropriate treatment. 1

Essential Pain Characteristics Questions

Timing and Onset

• When did the pain start?
• Is the pain continuous or intermittent?
• Does the pain follow any pattern (e.g., worse at certain times of day)?
• Duration of each pain episode?
• Is there a refractory period between attacks? 1

Location and Radiation

• Can you point to exactly where the pain is located?
• Does the pain radiate to other areas (e.g., ear, neck, temple)?
• Is the pain unilateral or bilateral?
• Is the pain localized to a specific tooth or more diffuse? 1

Quality and Severity

• How would you describe the pain (sharp, dull, throbbing, burning, electric shock-like)?
• On a scale of 0-10, how severe is your pain?
• Is the pain constant or does it fluctuate in intensity? 1

Aggravating and Relieving Factors

• Does temperature affect the pain (hot, cold foods/drinks)?
• Does sweet food or drink trigger or worsen the pain?
• Is the pain affected by chewing or biting?
• Does brushing teeth affect the pain?
• Does touching the face or area trigger pain?
• Does weather affect your pain?
• Does physical activity influence the pain?
• Is the pain affected by posture?
• Is the pain worse during times of stress or fatigue? 1

Associated Symptoms

Oral Symptoms

• Have you noticed any changes in taste?
• Do you experience dry mouth or changes in salivary flow?
• Do you clench or grind your teeth?
• Have you noticed clicking or locking of your jaw joint?
• Any swelling in the mouth, face, or neck area?
• Any bleeding from the gums?
• Any loose teeth or changes in how your teeth fit together?
• Any visible lesions, ulcers, or abnormal appearance of oral tissues? 1

Neurological Symptoms

• Any altered sensation (numbness, tingling) in the face or mouth?
• Any muscle weakness in the face?
• Any difficulty speaking or swallowing? 1

ENT Symptoms

• Any nasal symptoms (discharge, congestion, post-nasal drip)?
• Any ear symptoms (pain, fullness, discharge)?
• Any eye symptoms (tearing, redness, visual changes)? 1

Systemic Symptoms

• Any fever or chills?
• Any unexplained weight loss?
• Any night sweats?
• Any fatigue or malaise? 2

Impact Assessment

• How does the pain affect your sleep?
• How does the pain affect your mood?
• How does the pain affect your ability to concentrate?
• How does the pain impact your daily activities and quality of life? 1

Red Flag Questions

For Potential Serious Conditions

• Are you over 50 years old with temporal pain or headache? (Giant cell arteritis)
• Any visual symptoms or vision loss?
• Any jaw pain when chewing? (Jaw claudication)
• Any progressive, unremitting pain?
• Any history of cancer?
• Any unexplained weight loss or night sweats? 2

Medical History Context

• Do you have other pain conditions (headaches, migraines, fibromyalgia)?
• Any significant medical conditions?
• Any recent dental procedures or trauma?
• Complete list of current medications?
• Any history of similar pain episodes in the past?
• Any family history of similar pain conditions? 1

Treatment History

• What treatments have you tried for this pain?
• What healthcare professionals have you seen for this problem?
• Have you used any over-the-counter medications or home remedies?
• What has helped and what hasn't helped? 1

Common Pitfalls and Caveats

• Referred pain: Dental pain can be referred from non-dental sources and vice versa. Always consider both dental and non-dental origins. 3
• Neuropathic components: Chronic dental pain may have neuropathic elements requiring different treatment approaches. 4
• Multiple pain sources: Patients may have overlapping pain conditions (e.g., TMD with concurrent dental pathology). 3
• Post-procedural pain: Pain after dental procedures may be normal healing or indicate complications. 5
• Psychosocial factors: Psychological assessment is important as chronic pain can be influenced by stress, anxiety, and depression. 1

By systematically addressing these ROS questions, clinicians can more accurately diagnose the source of dental pain and develop appropriate treatment plans that address both the cause and symptoms of the patient's condition.