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Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
Assessment & investigation of dental patient
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Assessment & investigation of dental patient

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  • 1. Dr. Ali Tahir
  • 2.  History ◦ Complaint ◦ Medical history ◦ Drug history ◦ Social history
  • 3.  Clinical examination ◦ Extra-oral ◦ Intra-oral Investigations ◦ Blood ◦ Biochemical ◦ Radiographic ◦ Histological
  • 4.  Basis of investigation Complaint in patient’s own words Clinician should not try to influence patient’s response Should not hurry ConfidentialityMedical History
  • 5.  History of any previous dental treatment, oral/panoral abnormality, systemic disease, skin disorder, trauma/accident, major surgery Drug therapy Use of alcohol & tobacco Consult patient’s general practitioner or go through patient’s file
  • 6. Extra-oral: General appearance ◦ Wasted, mal-nutritioned, anxiety, agitation? Breathlessness ◦ Cardiorespiratory problem? Face ◦ Shape & symmetry ◦ Cranio-facial syndromes ◦ Cushingoid appearance? ◦ Neurological deficits? ◦ Cyanosis? Scalp & face ◦ Scant hair
  • 7.  Eyes ◦ Conjuctival sacrring (pemphigoid) ◦ Pale, yellow or blue sclera ◦ Exophthalmia Neck ◦ Lymph nodes ◦ Goitre
  • 8.  Hands ◦ Raynaud’s phenomenon ◦ Koilonychia ◦ Joints ◦ Palmar keratosis Wrists ◦ Purple papules Skin ◦ Petechiae or ecchymoses, cyanosis. Jaudice, pigmentation
  • 9. Intra-oral (with adequate light source) Remove all removable appliances Gently retract lips & cheeks Examine the whole oral mucosa Tongue Teeth Hard & soft palate Floor of mouthIn the end, a well taken clinical photograph
  • 10. Blood examinationCan be helpful in diagnosis of Leukopenias Thrombocytopenias Myelomas Anaemias Infectious mononucleosis Polycythemias Leukaemis
  • 11. Normal values Hb 12.5-17.5 (male) 11.5-16 (female) Mean Cell Volume 80-90 ESR 0-15mm/h Red cell count 4-6 × 1012 /l 4-5 × 1012/lWBC count 4-10 × 109/lPlatelet 150-400 × 109/lSerum B12 170-590 µg/l
  • 12.  Glucose Urea Creatinine Electrolytes ◦ Sodium ◦ Potassium ◦ Calcium ◦ Phosphate Alkaline phosphatase Total protein Liver enzymes
  • 13.  Autoantibodies ◦ RA ◦ Antinuclear factor ◦ SS-A, SS-B ◦ Epithelial basement membrane C1 estrase inhibitor ◦ Reduced in hereditory angioedema Viral antibodies ◦ HIV ◦ EBV C-reactive protein
  • 14. A biopsy involves the removal of part or all of a lesion so that it can be examined by histopathological techniquesDone is suspected Neoplasia White patches Swellings (soft or bony) Desquamative lesions
  • 15. Types1. Incisional2. Excisional3. FNA
  • 16. General principles: All sterilization protocols to be followed Patient consent & councelling LA to be given in the adjacent area & not within the lesion Better taken with a knife than with a cutting diathermy Specimen should be big enough to allow the pathologist to make a diagnosis
  • 17.  After excision, put into a fixative (10 formol saline being the standard solution) Apply stitches to the specimen for orientation If the specimen is thin, lay it on a piece of card Label the container with patient’s name & age & site of biopsy Fill the biopsy form, draw the specimen diagram if necessary
  • 18. Excisional Biopsy: Done when the lesion is small (usually 2cm or less)Incisional biopsy: When the lesions is larger than 2cm Should include typical area of lesion & edge of the lesion with a small margin of normal tissue
  • 19. Biopsy for immunoflourescence Particularly done for immunobullous (pemphigus & pemphigoid) or erosive lesions Clinically normal tissue adjacent to lesion is taken Fresh unfixed tissue passed on for immediate processing
  • 20. Fine Needle Aspiration Done in a soft, fluctuant swelling Particularly to collect fluid or pus 20/21 gauge needle is used Ultra-sound can be used to guide the needle Definitive diagnosis is difficult from FNA & needs vast experience
  • 21.  Direct smear Culture Molecular techniques to avoid culture use ◦ Microbial products  Toxins  DNA  PCR  FISH ◦ Antigen/Antibody detection
  • 22. Plain film radiography Extra-oral ◦ Panoramic ◦ Lateral view ◦ Occipitomental ◦ PA ◦ Submentovertex Intra-oral ◦ Peri-apical ◦ Bitewing ◦ Occlusal Digital radiographs
  • 23. Contrast studiesBy enhancing the radiodensity of patients tissueUsually used in Salivary glands & TMJ
  • 24.  Certain tissues concentrate specific compounds e.g. Thyroid concentrates Iodine Major salivary glands entrap & release technetium (99mTc) Bone takes up methylene diphosphonate as carrier of radioisotope
  • 25.  Machine using ring of X-ray detectors Uses high doses of radiation The generated image represents a slice through the area Used in ◦ Soft & hard tissue tumours of head & neck ◦ Facial fractures ◦ Osteomyelitis Metallic objects cause artefacts
  • 26.  Uses high frequency pulsed ultrasound beam Can be used to detect ◦ Vascular disorders ◦ Soft-tissue swellings ◦ Salivary glands to locate salivary calculi ◦ Lymph n nodes ◦ Used in conjunction with FNA
  • 27.  Utilized protons in a magnetic field Produces excellent differentiation between soft & hard tissues but gives poor hard tissue detailsContraindications Patients having certain surgical clips Heart pacemaker Metallic foreign body (metal silver) in their eye Severe claustrophobia
  • 28.  Ionizing radiations  Non-ionizing ◦ Plain radiographs radiation ◦ Contrast studies ◦ Ultrasound ◦ Radioisotope studies ◦ MRI ◦ Computerized tomography (CT)
  • 29. A careful correlation of the history, clinical examination, radiographic and other investigations can help in reaching the definitive diagnosis.It should be remembered that careful history taking plays the most important role in reaching the diagnosis

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