SPECIALIZED EXAMINATION OF OTHER ORGAN SYSTEMS

The compact anatomy of the head and neck and the close relationship between oral function and  the contiguous nasal, otic, laryngopharyngeal, gastrointestinal, and ocular structures often require that evaluation of an oral problem be combined with evaluation of one or more of these related organ systems. For detailed evaluation of these extraoral systems, the dentist should request that the patient consult the appropriate medical specialist, who is informed of the reason for the consultation. The usefulness of this consultation will usually depend on the dentist’s knowledge of the interaction of the oral cavity with adjacent organ systems, as well as the dentist’s ability to recognize symptoms and signs of disease in the extraoral regions of the head and neck. Superficial inspection of these extraoral tissues is therefore a logical part of the dentist’s examination for the causes of certain oral problems.

Disorders of the temporomandibular joint, referred pain, oropharyngeal and skin cancer screening, dysgeusia, salivary gland disease, postsurgical oropharyngeal and oronasal defects, and various congenital syndromes affecting the head and neck are all conditions that are frequently brought to the dentist’s attention and that require the dentist to look beyond the oral cavity when examining the head and neck. The details of special examinations of the ears, nose, eyes, pharynx, larynx, and facial musculature and integument are beyond the scope of this chapter; the reader is advised to consult texts that describe the physical examination of these organs and to obtain training in the use of the headlamp, the otoscope, and the ophthalmoscope, as well as in techniques such as indirect laryngoscopy and the inspection of the nasal cavity. Knowledge of disease processes that affect these organ systems is also a prerequisite.
The dentist’s initial evaluations of extraoral tissues neither infringe on the rights of other medical specialists nor reduce their professional activities. These evaluations can contribute significantly to the collaboration of dentist and physician in the management of many oral problems. More important, information gathered during these examinations will provide invaluable diagnostic information that is necessary to ensure a proper referral to a medical specialist. Provided the patient’s permission is obtained before these nonsurgical procedures are carried out, there seems to be no legal bar to the dentist’s examining these extraoral organ systems. However, the dentist may be prohibited by law from specifically diagnosing and treating extraoral problems .In all cases in which there is any concern about the presence of disease in any of these extraoral organ systems, referral and treatment for the patient must be sought from the appropriate medical service. The dentist needs to clearly indicate the preliminary nature of the examination of extraoral tissues and that the area of legal diagnostic competency is restricted to the oral cavity by recording and describing the results of the extraoral examination as impressions and not as diagnosis. Moreover, attempts at making an appropriate referral to a physician when systemic disease is suspected should also be recorded.