The Review of Systems: A Vital Tool in Dentistry and Oral Medicine
- Dr. Chizobam Idahosa
- Jun 4
- 4 min read
Updated: 7 days ago
The Review of Systems:
A Vital Tool in Dentistry and Oral Medicine
Dentists now routinely care for patients with complex medical conditions, underscoring the importance of understanding the interplay between oral and systemic health. The common phrase, “The mouth is the mirror to the body,” reflects this bidirectional relationship.
Therefore, the Review of Systems (ROS) plays a crucial role in assessing the severity of medical issues that may influence dental treatment. For instance, conducting a focused cardiac ROS is vital when managing patients with known cardiovascular diseases.
In oral medicine and orofacial pain, where most patients present with underlying systemic conditions that directly or indirectly influence the presentation and severity of their chief concern, the importance of a well-executed ROS is not just a formality; it becomes a necessity.
So, What Exactly is a Review of Systems?
The Review of Systems (ROS) is a systematic method used by healthcare providers to gather information about a patient’s overall health by assessing symptoms across various organ systems. It involves a thorough evaluation of current or recent signs and symptoms the patient may be experiencing, organized by body system. Typically, the ROS is conducted through a structured series of questions covering systems such as cardiovascular, respiratory, gastrointestinal, and neurological.
Why is a review of systems important?
As an integral part of the medical history, the review of systems helps to:
1. Identify other medical problems that have not yet been diagnosed and were not mentioned in the chief complaint (e.g., polydipsia, polyphagia, polyuria in a patient who has not been diagnosed with diabetes mellitus).
2. A review of systems is also helpful in assessing the severity of diagnosed medical problems. For example, in patients diagnosed with congestive heart failure, dyspnea at rest is a more ominous symptom than dyspnea on exertion.
3. A review of systems can uncover pertinent details relevant to the chief concern, which aids in reaching a definitive diagnosis (e.g., a systematic review can reveal the presence of dry eyes, chronic fatigue, and generalized musculoskeletal pain in a patient presenting for evaluation of dry mouth, thereby increasing clinical suspicion for Sjogren syndrome).
It helps guide clinical decision-making and referrals to medical colleagues when necessary.
Applications of the Review of Systems in Oral Medicine
In oral medicine, we often see patients referred for “mystery” symptoms—burning mouth, chronic ulcers, neuropathic pain, etc. These aren't always isolated problems. They frequently relate to underlying systemic conditions.
A systematic ROS can help uncover medical conditions such as:
Sjögren’s Syndrome in a patient presenting for evaluation of burning mouth
Positive ROS responses may include: dry mouth, dry eyes, muscle pain, joint pain/stiffness/swelling, chronic fatigue, dry skin, rash, Raynaud’s phenomenon, chronic cough, neuropathy, brain fog, headaches, reflux
Chron’s disease in a patient presenting for evaluation of oral ulcers and lip swelling
Positive ROS responses may include: fatigue, weight loss, abdominal cramps, diarrhea, blood/mucus in stool, tenesmus, joint pain
HIV in a patient presenting for evaluation of candidiasis
Positive ROS responses may include: fatigue, weight loss, recurrent infections, and chronic diarrhea
Multiple sclerosis in a young patient presenting with trigeminal neuralgia-type pain
Positive ROS responses may include: fatigue, diplopia, muscle spasticity, unsteady gait, numbness or tingling of the face and/or extremities
Amyloidosis in a patient with a noticeably enlarged tongue and oral mucosal changes
Positive ROS responses may include: fatigue, shortness of breath, orthopnea, weight loss, pedal edema, decreased urine output, neuropathy, petechiae
Diabetes mellitus in a patient with chronic periodontitis presenting for evaluation of oral burning
Positive ROS responses may include: dry mouth, dysgeusia, polydipsia, polyuria, polyphagia, weight loss, and dry skin.
The Dentist’s Role in Early Diagnosis
In dentistry and oral medicine, the ROS is especially valuable for uncovering underlying medical conditions that may present first—or only—with oral or facial symptoms.
We are often the only healthcare provider a patient sees on a regular basis. When we recognize systemic disease patterns through the ROS, we become a critical point of entry for medical care. In some cases, dentists have been the first to suggest that a patient seek evaluation for diabetes or even multiple myeloma.
The ROS, then, is not just a box to check. It’s a tool of discovery. It connects the mouth to the body, the symptom to the system, and the dental professional to the broader healthcare team.
Final Thoughts
As oral medicine specialists, we see every day how a few extra questions can change lives. I am not suggesting that a ROS should be completed on every single dental patient. However, whether you’re in general practice, periodontics, or endodontics, taking a few moments to incorporate a focused ROS, when necessary, can improve patient outcomes.
Review of Systems Table
Both pertinent positive and negative responses should be documented when applicable.
All relevant positive responses necessitate more in-depth and focused questions. Patients with concerning positive responses should be referred for further evaluation and management as indicated.
General | Recent weight change, fatigue, malaise, fever, chills, night sweats |
Dermatologic | Rashes, lumps, ulcers, dryness, pruritus, finger clubbing, nail changes |
Head | Headaches, dizziness, head trauma |
Eyes | Changes in vision and visual fields, spots, floaters, diplopia, blurriness, dryness, tearing, itching, |
Ears | Hearing loss, pain, discharge, tinnitus, vertigo |
Nose, Sinuses | Stuffiness, sneezing, rhinorrhea, itching, epistaxis, changes in sense of smell |
Mouth, Throat, Neck | Bleeding or painful gums, dry mouth, lesions, dental pain, halitosis, altered taste, hoarseness, sore throat, dysphagia, neck swelling |
Respiratory | Dyspnea, chest pain, wheezing, cough, sputum, hemoptysis |
Cardiovascular | Chest pain, palpitations, orthopnea, dyspnea at rest and on exertion, paroxysmal nocturnal dyspnea, peripheral edema |
Gastrointestinal | Appetite changes, abdominal pain, nausea, vomiting, diarrhea, constipation, heart burn, belching, bloating, flatulence, dysphagia, hematochezia, jaundice, ascites |
Genitourinary | Frequency, hesitancy, urgency, incontinence, nocturia, dysuria, hematuria, abnormal genital discharge, genital lesions, changes in libido |
Endocrine | Polydipsia, polyuria, polyphagia, heat or cold intolerance, weight gain or loss, excessive sweating, thyroid enlargement or pain |
Hematologic | Easy bruising or bleeding, lymphadenopathy |
Musculoskeletal | Arthritis, arthralgia, pain, swelling, redness, limitations in range of motion, muscle weakness, trauma |
Neurologic | Seizures, memory loss, loss of consciousness, paresthesia, anesthesia, muscle weakness, paralysis, |
Gynecologic | Menopause, menstrual changes, dysmenorrhea |
Psychiatric/Emotional | Mood, anxiety, depression, changes in sleep pattern, decreased ability to concentrate |
Until next time…
Chizobam Idahosa, BDS, DDS, MS.
Board-Certified Oral Medicine and Orofacial Pain Specialist
© The Review of Systems: A Vital Tool in Dentistry and Oral Medicine.
Dr. Chizobam Idahosa.
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