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the lecture present definition of oral diagnosis, its steps and components and significance of each

the lecture present definition of oral diagnosis, its steps and components and significance of each

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  • 1. D r: M ah a M . M ah m o u d As s o c i ate P ro f. o f O ral M e d icin e
  • 2. :Objectives Define Oral Diagnosis and diagnostic process. Identify steps of diagnostic process. Define the case history, its items and objectives of each. Identify types of clinical evaluation Define signs and symptoms, giving examples for each.
  • 3. Oral diagnosis Oral diagnosis is that branch of dentistry dealing with the identification of oral disease whether of local or systemic origin.
  • 4. Oral Diagnosis It is that area of dental science which deals with the Gathering Recording Evaluating informationthat ultimately contributes to the identification of the patient’s chief complaint and/ or abnormalities of the head and neck region.
  • 5.  The purpose of obtaining information and recording it in an orderly manner is to establish a diagnosis and distinguish one disease from another. The database may be compatible with a variety of disease processes, which constitute the differential diagnosis.
  • 6.  Once all necessary data have been accumulated, sufficient information should be present to determine a definite diagnosis. A rational treatment plan can be formulated.
  • 7. Types of clinical examination
  • 8. Types of clinicalexamination : C omplete E xamination .1  History taking.  Clinical examination.  Supplementary diagnostic aids.
  • 9. 2. Screening T ype of E xamination: Brief clinical examination of the teeth, supporting structures and mouth. Limited radiographic examination. Types of clinical examination
  • 10. 3.Emergency Type of Examination:  For the diagnosis and management of acute and emergency conditions.  Limited to the procedure related to the complaint of the patient. T y p e s o f c lin ic a l e x a m in a t io n
  • 11. 4. Periodic Health Maintenance Care: Started by complete and thorough examination. measure deviations that might have occurred during certain interval. T y p e s o f c l in ic a l e x a min a
  • 12. DIAGNOSIS Case history Extra oral Clinicalexamination Intra oral Radiographical examinationDiagnostic aids biopsy Biochemical investigations
  • 13. Case history
  • 14. PAST MEDICAL-4 PERSONAL DATA-1 CHIEF-2 COMPLAINT PAST DENTAL-5 CASE HISTORYPRESENT ILLNESS-3 FAMILY HISTORY-6
  • 15. Personal data
  • 16. Patient name:objectives2. Record keeping3. Administrative purposes4. Better communication
  • 17. Age diseases affect certain age group e.g. certain diseases affect children as acute herpetic gingivostomatitis, measles, rickets. In older age group, patients are subjected to atrophic and degenerative age changes, in addition to some malignancy as carcinoma or leukoplakia.
  • 18. Sex Some patients carry mixed names. Certain diseases or conditions related to either sex e.g. Hemophilia usually occur in male, while females are usually carriers of the disease( sex linked disease).
  • 19. Marital status •Psychological stress of some married people, may predispose or exacerbate certain oral diseases. •Gingivitis and gingival enlargement related to Pregnancy. •could be a source of infection in some contagious diseases.
  • 20. Adress •Throws light about the patient’s social and home back ground. •For patient recall. •Patients living near factories are liable for pulmonary diseases.
  • 21. OCCUPATION Occupation causing abnormal wear of hard dental tissues as glass blowers, stone cutter and sand blasters, Carpenters hold nails in mouth. Occupation causing oral lesions due to systemic absorption of metallic or non metallic compounds as workers in bismuth, lead and mercury factories.
  • 22. PAST MEDICAL PERSONAL DATA CHIEF COMPLAINT PAST DENTAL CASE HISTORYPRESENT ILLNESS FAMILY HISTORY
  • 23. :(Chief Complaint (C.C The 1st segment of database procurement. C.C is written in patient’s own words. There may be more than one single complaint. As data documented, clinician may be thinking of possible diagnosis that conform to subjective findings.Symptoms: Pain, burning, dry mouth, swelling, parasthesia & loose teeth.
  • 24. Signs: Are objective findings discovered by the examiner. ie; an change or changes observed by examiner as in color, shape, form, or size of tissues. eg; pulse, blood pressure, mass, ulcer, erosions, pigmentation. Signs of disease detected by visualization, listening (auscultation), smelling, palpation of tissues.
  • 25. Symptoms: Are subjective information reported by the patient. A report of patient’s own sensory experience. These are usually the 1st aspects of history to be recorded. Symptoms may be described by parent or guardian, as in children and mentally compromised patients.
  • 26. Symptomse.g: Pain , burning sensation. altered taste foul odor dryness of the mouth. Bleeding Swelling.
  • 27. Chief complaint 1- pain. 2- burning sensation. 3-parathesia or numbness. 4-bleeding. 5- swelling. 6-oral ulceration. 7- sensitivity.
  • 28. .…Cont 8- TMJ disorders. 9- functional disorders. 10- bad breath (Halitosis). 11-Esthetic problem. 12-Regular check up 13-Referred patient
  • 29. PAST MEDICAL PERSONAL DATA CHIEF COMPLAINT PAST DENTAL CASE HISTORYPRESENT ILLNESS FAMILY HISTORY
  • 30. Present illness  Onset of complaint.  Character of onset.  Severity of the complaint.  Course of complaint.  Duration.  Location of complaint.  Distribution.
  • 31. ..…Present history cont  Relevant facts in the patients medical history  Consider any previous treatment and their effectiveness.
  • 32. .…Present history cont  Prior occurrence.  Exacerbating factors .  Relieving factors .  Associated phenomenon. Fever, sp bleeding bad odour
  • 33. Taking Pain HistoryCharacteristics Informative FeaturesType Ache, tenderness, dull, stabbing, electric shock.Severity Mild, moderate, severe.Duration Time since onset, duration of pain or attacks.Nature Continuous, in attacks o paroxysmal.Initiating Factors Any potential initiating factors. Association + dental treatment or lack to eliminate dental causes.Exacerbating & Record all, note hot & cold sensitivity or painRelieving Factors on eating; suggests dental cause.Localization Patient should map out distribution of pain if possible; Is it well or poorly defined?Referral Try to determine whether pain is referred.
  • 34. PAST MEDICAL PERSONAL DATA CHIEF COMPLAINT PAST DENTAL CASE HISTORYPRESENT ILLNESS FAMILY HISTORY
  • 35. ESSENTIAL PRINCIPLES
  • 36. Different formats Include:o Self-administered pre-printed forms filled by the patiento Direct interview of the patient by the cliniciano A combination of both
  • 37. Past medical history  Serious illness(heart attack, bleeding disorders).  Fits or faints.  Hospitalization.  Allergies(allergic testing should be considered for susceptible patients).  Medications taken in the last six month .  Childhood diseases(as rheumatic fever).
  • 38. Significance  It may be related to the diagnosis  Precautionary measures are sometimes indicated.  Pre-medication, or controlling before dental treatment.  For medical consultation if needed.  Dental treatment might affect the patient systemic health.
  • 39. ?Why take a medical history Many medical problems and/or drugs can affect or influence the provision of dental care Examples:  Heart disease (infection, bleeding, drug interactions, cause an MI or angina, oral lesions)  Allergies (reactions to local anesthetics, antibiotics, analgesics, latex)  Diabetes (infection, hypoglycemia, periodontal disease)  Bleeding disorders; drug induced or genetic (abnormal hemostasis)
  • 40. Basic Medical Questionnaire Anemia or Allergies? Bleeding tendencies? Cardiorespiratory complaints? Drug treatment? Endocrine disorders? Fits or faints? Gastrointestinal complaints? Hospital admission or attendance? Infections including HIV/AIDS Jaundice or liver disease? Kidney disease? Likelihood of, or existing pregnancy? Medical warning card carried? (hemophilic, long-term corticosteroid therapy, allergic to penicillin)
  • 41. medications1-drugs produce oral manifestations2-drugs indicate systemic diseases3-drugs adjustment.4-Drug interaction5 adverse reactions
  • 42. PERSONAL DATA PAST MEDICAL CHIEFPAST DENTAL COMPLAIN CASE HISTORYFAMILY HISTORY PRESENT ILLNESS
  • 43. Past Dental History: Frequency of visiting dentist and purpose of visit. Assessment of past caries experience, restorative dental procedures. Administration of local anesthesia. Past oral surgical procedures, bleeding & healing process. Previous orthodontic treatment. Periodontal disease & previous periodontal treatment. History of denture wearing, cause of loss of teeth.
  • 44. PAST MEDICAL PERSONAL DATA CHIEF COMPLAINT PAST DENTAL CASE HISTORYPRESENT ILLNESS FAMILY HISTORY
  • 45. Family history Inherited disordersDiabetes mellitus.hypertension.allergies.Hemophilia.
  • 46. :Family & Social history Bleeding disorder as hemophilia. Diabetes Mellitus. Genetic diseases. Even when no familial disease suspected questions about family members lead to questions about home circumstances, relatives & social history so reveals psychogenic factors if suspected.
  • 47. Personal Habits: Oral Hygiene habits: Frequency & technique of tooth brushing & flossing. Habits as nail biting, lip biting, thumb sucking. Parafunctional habits as bruxism, clenching & tapping. Smoking habits.
  • 48. References Steven L. Bricker, Robert P. Langlais, Craig S. Miller. Oral Diagnosis, Oral Medicine, and Treatment Planning, second edition, BC Decker Inc.2002 Greenberg MS, Glick M. Burketts Oral Medicine& Diagnoses, 11th ed., Philadelphia P.C Decker. Inc.2008 page 5
  • 49. Thank you