This document discusses the process of oral diagnosis. It defines oral diagnosis as dealing with the identification of oral diseases of local or systemic origin. The diagnostic process involves gathering, recording, and evaluating information from the patient's case history, clinical examination, and diagnostic aids to establish a diagnosis. The case history involves collecting personal data, chief complaint, present illness, past medical history, past dental history, and family history. A thorough clinical examination includes extraoral, intraoral, and radiographic examinations. Signs and symptoms are also discussed.

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.

4. Oral diagnosis
 Oral diagnosis is that branch of dentistry
dealing with the identification of oral disease
whether of local or systemic origin.

5. Oral Diagnosis
 It is that area of dental science which deals
with the
 Gathering
 Recording
 Evaluating information
that ultimately contributes to the identification
of the
patient’s chief complaint and/ or
abnormalities of the head and neck region.

6.  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.

7.  Once all necessary data have been accumulated,
sufficient information should be present to
determine a definite diagnosis.
 A rational treatment plan can be formulated.

8. Types of clinical examination

9. Types of clinical
examination
: C omplete E xamination .1
 History taking.
 Clinical
examination.
 Supplementary
diagnostic aids.

10. 2. Screening T ype of E xamination:
 Brief clinical
examination of the
teeth, supporting
structures and
mouth.
 Limited
radiographic
examination.
Types of clinical examination

11. 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

12. 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

14. DIAGNOSIS
Case history
Extra oral
Clinical
examination Intra oral
Radiographical
examination
Diagnostic aids biopsy
Biochemical
investigations

15. Case history

17. PAST MEDICAL-4
PERSONAL DATA-1
CHIEF-2
COMPLAINT PAST DENTAL-5
CASE HISTORY
PRESENT ILLNESS-3 FAMILY HISTORY-6

18. Personal data

19. Patient name
:objectives
2. Record keeping
3. Administrative purposes
4. Better communication

20. 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.

21. 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).

22. 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.

23. Adress
•Throws light about the patient’s social and
home back ground.
•For patient recall.
•Patients living near factories are liable for
pulmonary diseases.

24. 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.

25. PAST MEDICAL
PERSONAL DATA
CHIEF
COMPLAINT PAST DENTAL
CASE HISTORY
PRESENT ILLNESS FAMILY HISTORY

26. :(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.

28. 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.

29. 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.

30. Symptoms
e.g:
 Pain , burning
sensation.
 altered taste
 foul odor
 dryness of the
mouth.
 Bleeding
 Swelling.

31. Chief complaint
1- pain.
2- burning sensation.
3-parathesia or numbness.
4-bleeding.
5- swelling.
6-oral ulceration.
7- sensitivity.

32. .…Cont
8- TMJ disorders.
9- functional disorders.
10- bad breath (Halitosis).
11-Esthetic problem.
12-Regular check up
13-Referred patient

33. PAST MEDICAL
PERSONAL DATA
CHIEF
COMPLAINT PAST DENTAL
CASE HISTORY
PRESENT ILLNESS FAMILY HISTORY

34. Present illness
 Onset of complaint.
 Character of onset.
 Severity of the complaint.
 Course of complaint.
 Duration.
 Location of complaint.
 Distribution.

35. ..…Present history cont
 Relevant facts in the patients medical
history
 Consider any previous treatment and
their effectiveness.

36. .…Present history cont
 Prior occurrence.
 Exacerbating factors .
 Relieving factors .
 Associated phenomenon. Fever, sp
bleeding bad odour

37. Taking Pain History
Characteristics Informative Features
Type 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 pain
Relieving 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.

38. PAST MEDICAL
PERSONAL DATA
CHIEF
COMPLAINT PAST DENTAL
CASE HISTORY
PRESENT ILLNESS FAMILY HISTORY

39. ESSENTIAL PRINCIPLES

40. Different formats
Include:
o Self-administered pre-printed forms filled by
the patient
o Direct interview of the patient by the clinician
o A combination of both

41. 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).

42. 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.

43. ?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)

44. 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)

45. medications
1-drugs produce oral manifestations
2-drugs indicate systemic diseases
3-drugs adjustment.
4-Drug interaction
5 adverse reactions

46. PERSONAL DATA
PAST MEDICAL
CHIEF
PAST DENTAL COMPLAIN
CASE HISTORY
FAMILY HISTORY PRESENT ILLNESS

47. 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.

48. PAST MEDICAL
PERSONAL DATA
CHIEF
COMPLAINT PAST DENTAL
CASE HISTORY
PRESENT ILLNESS FAMILY HISTORY

49. Family history
 Inherited disorders
Diabetes mellitus.
hypertension.
allergies.
Hemophilia.

50. :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.

51. 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.

52. 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. Burkett's Oral
Medicine& Diagnoses, 11th ed., Philadelphia
P.C Decker. Inc.2008 page 5

53. Thank you