This document summarizes various blood disorders and their oral manifestations. It discusses disorders of red blood cells like iron-deficiency anemia, megaloblastic anemia, pernicious anemia, and sickle cell anemia. It also covers disorders of white blood cells such as leukemia and leukopenia. For each condition, it describes the causes, clinical features, diagnosis, and potential oral signs including gingival bleeding, ulcers, and infections. In general, these blood disorders can cause oral pallor, infections, and changes in taste or tooth development.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
The document provides information about Pindborg tumor, also known as calcifying epithelial odontogenic tumor (CEOT). It defines CEOT as a locally invasive epithelial odontogenic neoplasm characterized by the presence of amyloid material that may become calcified. The document discusses the pathogenesis, histopathological features including epithelial cells, amyloid-like material and calcific deposits, immunohistochemical findings, differential diagnosis and treatment of CEOT. It also mentions the recurrence rate of CEOT is typically 10-15% but can be higher in certain variants.
This document defines and describes odontogenic tumors, which are neoplasms or tumor-like malformations arising from odontogenic tissues. It classifies various odontogenic tumors based on their origin from odontogenic epithelium, mesenchyme, or mixed tissues. Key tumors discussed include ameloblastoma, adenomatoid odontogenic tumor (AOT), calcifying epithelial odontogenic tumor (CEOT), and ameloblastic fibroma. Clinical features, imaging findings, and histopathological characteristics are provided for each tumor type.
This document describes the characteristics of various types of oral ulcers. It defines ulcer terminology like margin, edge, and floor. It outlines the shapes, numbers, positions, edges, floors, discharges, and bases that can help differentiate ulcers. Common acute ulcers include traumatic, necrotizing, herpetic, and syphilitic. Chronic ulcers include tuberculous and major aphthous. Neoplastic ulcers are typically painless and non-healing. The document provides details on examining, diagnosing, and managing different oral ulcer conditions.
Dental sequalae of pulpitis and management of apical lesionsVikram Perakath
The document discusses the dental sequelae of pulpitis, including defensive, bone, soft tissue, and blood reactions. It describes the acute and chronic pathways of pulpitis and various conditions that may arise such as periapical abscesses, osteomyelitis, cellulitis, periapical granulomas, and periapical cysts. Methods for managing apical lesions include nonsurgical approaches like root canal treatment and surgical treatment when nonsurgical methods are unsuccessful. Factors to consider in treatment planning include the diagnosis, proximity to other teeth, patient cooperation, and obstructions within the root canal.
This document discusses various types of tooth wear including attrition, abrasion, erosion, and abfraction. It defines each term and describes the etiology, clinical features, and treatment. Attrition is defined as the normal wearing away of teeth due to tooth contact during functions like chewing. Abrasion is abnormal wearing away due to factors like abrasive toothpaste. Erosion is chemical wear from acids like those in acidic foods and drinks. Abfraction refers to tooth structure loss from repetitive tooth flexing from forces like clenching. Treatment involves restoration of lost structure with materials like composites or protecting teeth from further wear and sensitivity.
This document summarizes various blood disorders and their oral manifestations. It discusses disorders of red blood cells like iron-deficiency anemia, megaloblastic anemia, pernicious anemia, and sickle cell anemia. It also covers disorders of white blood cells such as leukemia and leukopenia. For each condition, it describes the causes, clinical features, diagnosis, and potential oral signs including gingival bleeding, ulcers, and infections. In general, these blood disorders can cause oral pallor, infections, and changes in taste or tooth development.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. The Pathogenesis of infection in oro-facial region due to odontogenic origin is a common clinical issue. bacterial invasion to deeper tissues usually a spread from diseased dental pulp. Recent evidences indicated a multi-microbial nature. The spread of infection is governed by the thickness of the investing bone and the anatomical relation of the tooth root to the attached muscle. Infection could spread from one facial space to another, and the condition may be aggravated to life threatening situations.
The document provides information about Pindborg tumor, also known as calcifying epithelial odontogenic tumor (CEOT). It defines CEOT as a locally invasive epithelial odontogenic neoplasm characterized by the presence of amyloid material that may become calcified. The document discusses the pathogenesis, histopathological features including epithelial cells, amyloid-like material and calcific deposits, immunohistochemical findings, differential diagnosis and treatment of CEOT. It also mentions the recurrence rate of CEOT is typically 10-15% but can be higher in certain variants.
This document defines and describes odontogenic tumors, which are neoplasms or tumor-like malformations arising from odontogenic tissues. It classifies various odontogenic tumors based on their origin from odontogenic epithelium, mesenchyme, or mixed tissues. Key tumors discussed include ameloblastoma, adenomatoid odontogenic tumor (AOT), calcifying epithelial odontogenic tumor (CEOT), and ameloblastic fibroma. Clinical features, imaging findings, and histopathological characteristics are provided for each tumor type.
This document describes the characteristics of various types of oral ulcers. It defines ulcer terminology like margin, edge, and floor. It outlines the shapes, numbers, positions, edges, floors, discharges, and bases that can help differentiate ulcers. Common acute ulcers include traumatic, necrotizing, herpetic, and syphilitic. Chronic ulcers include tuberculous and major aphthous. Neoplastic ulcers are typically painless and non-healing. The document provides details on examining, diagnosing, and managing different oral ulcer conditions.
Dental sequalae of pulpitis and management of apical lesionsVikram Perakath
The document discusses the dental sequelae of pulpitis, including defensive, bone, soft tissue, and blood reactions. It describes the acute and chronic pathways of pulpitis and various conditions that may arise such as periapical abscesses, osteomyelitis, cellulitis, periapical granulomas, and periapical cysts. Methods for managing apical lesions include nonsurgical approaches like root canal treatment and surgical treatment when nonsurgical methods are unsuccessful. Factors to consider in treatment planning include the diagnosis, proximity to other teeth, patient cooperation, and obstructions within the root canal.
This document discusses various types of tooth wear including attrition, abrasion, erosion, and abfraction. It defines each term and describes the etiology, clinical features, and treatment. Attrition is defined as the normal wearing away of teeth due to tooth contact during functions like chewing. Abrasion is abnormal wearing away due to factors like abrasive toothpaste. Erosion is chemical wear from acids like those in acidic foods and drinks. Abfraction refers to tooth structure loss from repetitive tooth flexing from forces like clenching. Treatment involves restoration of lost structure with materials like composites or protecting teeth from further wear and sensitivity.
Amelogenesis Imperfecta is a condition affecting the development of dental enamel. It has several classifications depending on the specific enamel defect present, including hypoplastic (inadequate enamel), hypocalcified (no mineralization), and hypomaturation (failure of enamel to mature). The condition can be inherited in autosomal dominant, recessive, x-linked, or sporadic patterns. Diagnosis is based on family history, clinical examination showing discolored, sensitive teeth prone to disintegration, and radiographic findings of abnormal enamel appearance. It may occur alone or be associated with other systemic abnormalities in syndromes.
Peripheral giant cell granuloma (giant cell epulisKhin Soe
The document discusses two types of giant cell lesions of the jaw: peripheral giant cell granuloma (PGG) and central giant cell granuloma (CGG). PGG is a reactive lesion caused by local irritation or trauma that occurs on the gingiva. CGG is a benign process that occurs within the jaw bones and can be non-aggressive or aggressive depending on symptoms and growth rate. Both lesions contain multinucleated giant cells and are treated with surgical excision, with CGG having a slightly higher recurrence rate. Key distinguishing features and histological characteristics are provided.
The document discusses various joining processes including welding, brazing and soldering. It explains that brazing and soldering involve melting of a filler metal with brazing using higher temperatures and stronger fillers, while soldering uses lower temperatures and weaker tin-lead fillers. Welding involves melting the base metals. The document then goes on to describe various welding techniques like stick welding, MIG welding, TIG welding and spot welding. It also discusses factors like distortion and flaws in welds. The document also provides details about brazing and different types of solders, fluxes used and joint designs for soldering.
This document discusses several systemic diseases and their potential oral manifestations. It describes Wegener's granulomatosis as a necrotizing vasculitis that can cause oral ulcerations and characteristic "strawberry gingivitis." Sarcoidosis is characterized by noncaseating granulomas and can involve the oral mucosa. Psoriasis may rarely cause oral lesions resembling those on the skin. Acanthosis nigricans can involve the lips, tongue, and gingiva with hyperplasia. Amyloidosis commonly causes macroglossia. Sjögren's syndrome and Kawasaki disease are also discussed.
This document describes a case report of a peripheral ossifying fibroma (POF) in a 22-year-old female patient. POFs are non-neoplastic reactive lesions of the gingiva caused by local irritants like plaque or food impaction. Histopathological examination showed fibrous connective tissue with bony trabeculae and dystrophic calcification, consistent with POF. Treatment involves complete surgical excision to remove the lesion and any remaining irritants in order to reduce the risk of recurrence.
This document provides an overview of the use of cone beam computed tomography (CBCT) in endodontics. It discusses the role of imaging in endodontics, compares 2D and 3D imaging, describes the principles and types of CBCT equipment, and reviews the clinical applications, advantages, limitations, and radiation dosage of CBCT. Key applications of CBCT in endodontics include evaluation of root canal anatomy, detection of apical periodontitis, assessment of root canal treatment outcomes, and pre-surgical planning.
The document discusses the history and development of nickel-titanium (NiTi) rotary files for root canal preparation. It describes how ProTaper files were developed in 2001 as a multi-tapered system with various shaping and finishing files to efficiently prepare root canals. The document outlines the characteristics of each ProTaper file and provides the recommended techniques for using them to clean and shape root canals.
This document provides an overview of endodontics. It defines endodontics as the branch of dentistry concerned with the morphology, physiology, and pathology of the dental pulp and periradicular tissues. The scope of endodontics includes treating diseases of the pulp, such as pulpal inflammation and infection, through both nonsurgical and surgical root canal treatment and periradicular surgery. Pathogenesis is discussed, noting that while physical and chemical factors can induce inflammation, microbial infection is essential for progression of pulpal and periradicular disease. Routes of canal infection and the focal infection theory are also summarized.
Embedded teeth are unerupted teeth due to a lack of eruptive forces, while impacted teeth are prevented from erupting by a physical barrier. Common causes include lack of space, tooth rotation, and systemic diseases. Third molars are most frequently affected, and complications can arise like dentigerous cysts, periodontal infections near impacted teeth, and resorption of adjacent tooth roots. Surgical exposure or removal may be required to address problems caused by impacted teeth, with potential short-term complications including sensory loss, trismus, and infection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
cutting instruments in operative dentistry by dr. jagadeesh kodityalaJagadeesh Kodityala
This document discusses dental instruments used for cutting tooth structure. It begins by defining dental instruments and describing the main types as hand instruments and rotary instruments. It then discusses the history and evolution of hand cutting instruments from early bulky chisels to modern steel instruments. Different types of alloys used for instruments and their properties are outlined. Cutting instruments are classified and various types are defined, including excavators, chisels, and specialized chisels. Details are provided on handles, blades, beveling, and proper sharpening techniques. The document covers rotary instruments and alternative cutting methods as well.
This document discusses disease of the pulp, including classification and types. It describes reversible and irreversible pulpitis, with reversible pulpitis causing mild to moderate pain in response to stimuli that subsides after removal of the stimuli. Irreversible pulpitis causes persistent pain even after stimulus removal and can progress to pulp necrosis with total or partial death of the pulp. Other conditions discussed include chronic hyperplastic pulpitis, previously treated teeth, and teeth with previously initiated therapy.
The document discusses different types of cysts that can occur in the jaws.
It classifies cysts as either odontogenic or non-odontogenic, and lists examples of cysts that fall into each category such as dentigerous cysts, radicular cysts, nasopalatine cysts, and others.
It provides details on the pathogenesis, clinical presentation, radiographic appearance, and treatment of some of the more common odontogenic cysts like primordial cysts, dentigerous cysts, and radicular cysts.
This document discusses Necrotizing Ulcerative Gingivitis (NUG), also known as trench mouth. It defines NUG as a microbial disease of the gingiva caused by an impaired host response. Key clinical features include necrosis of gingival tissue and pain. Diagnosis is based on these clinical findings and microscopic examination. Management involves reducing the microbial load, removing necrotic tissue, treating any systemic conditions, and supportive periodontal therapy. Prognosis is generally good with treatment but recurrence is possible without ongoing maintenance of oral hygiene.
This document provides an overview of various classification systems for partially edentulous arches. It discusses the American College of Prosthodontists (ACP) classification system and the Index of Clinical and Keratinized (ICK) classification system in particular. The ACP system offers benefits like improved consistency, communication, education/research, and diagnosis. It classifies partially edentulous cases based on criteria like the location and extent of edentulous areas, condition of abutment teeth, occlusal scheme, and residual ridge.
The document discusses various verrucal-papillary lesions of the oral cavity including reactive lesions such as papillary hyperplasia, condyloma latum, squamous papilloma, condyloma acuminatum, and focal epithelial hyperplasia. It also discusses neoplasms like keratoacanthoma and verrucous carcinoma. Rare lesions of unknown etiology discussed include pyostomatitis vegetans and verruciform xanthoma. Each lesion is described in terms of etiology, clinical features, histopathology, differential diagnosis, and treatment.
This document discusses dental pulp inflammation. It defines dental pulp as the soft tissue within the tooth surrounded by dentin. The pulp has different zones including an odontoblastic zone, cell-free zone, cell-rich zone, and central zone containing various cells, blood vessels, and nerves. The pulp functions to induce dentin formation, provide nutrition, defend against trauma, and allow sensation. Causes of pulpitis include mechanical, thermal, chemical, and bacterial factors. Pulpitis is classified as reversible or irreversible, partial or total, acute or chronic, and open or closed based on severity and communication with the oral environment. Symptoms, clinical features, management, and types of chronic pulpitis are described.
The periodontal pocket is a pathologically deepened sulcus that is a key feature of periodontal disease. It develops as plaque causes gingival inflammation that leads to migration of the junctional epithelium and destruction of supporting tissues. Pockets are classified by morphology as gingival pockets from enlarged gingiva or periodontal pockets from true tissue loss, and by number of tooth surfaces involved. Periodontal pockets contain bacteria and experience cycles of activity and quiescence that further deepen the pocket and destroy bone and connective tissue.
This document discusses pigmented lesions that can occur in the oral cavity. It begins by explaining that pigmentation can be exogenous or endogenous in origin, with the main endogenous pigments being melanin, hemoglobin, hemosiderin and carotene. It then discusses several specific conditions that can cause oral pigmentation, including physiologic pigmentation, Peutz-Jeghers syndrome, Addison's disease, heavy metal exposure, Kaposi's sarcoma, drug-induced pigmentation, postinflammatory pigmentation, smoker's melanosis, vascular lesions, melanotic macules, pigmented nevi, blue nevi, melanoacanthoma, and oral melanoma. Differential diagnosis of pigmented lesions involves considering
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is initiated by specialized nerve endings called nociceptors and transmitted by neurons. There are four processes involved in pain: transduction, transmission, modulation, and perception. Pain can be classified as nociceptive (resulting from tissue damage) or neuropathic (resulting from damage or disease affecting the nervous system). A thorough history and clinical/radiographic examination is needed to diagnose the source and type of pain. Common sources of dental pain include pulpal and periapical diseases, periodontal diseases, fractures, cysts, and tumors. Non-dental sources can also mimic dental pain and should be considered.
An overview of the diagnostic process in endodontics, including information about the pain system, referred pain, non-odontogenic pain, the diagnostic process, tests and treatment planning in endodontics.
Amelogenesis Imperfecta is a condition affecting the development of dental enamel. It has several classifications depending on the specific enamel defect present, including hypoplastic (inadequate enamel), hypocalcified (no mineralization), and hypomaturation (failure of enamel to mature). The condition can be inherited in autosomal dominant, recessive, x-linked, or sporadic patterns. Diagnosis is based on family history, clinical examination showing discolored, sensitive teeth prone to disintegration, and radiographic findings of abnormal enamel appearance. It may occur alone or be associated with other systemic abnormalities in syndromes.
Peripheral giant cell granuloma (giant cell epulisKhin Soe
The document discusses two types of giant cell lesions of the jaw: peripheral giant cell granuloma (PGG) and central giant cell granuloma (CGG). PGG is a reactive lesion caused by local irritation or trauma that occurs on the gingiva. CGG is a benign process that occurs within the jaw bones and can be non-aggressive or aggressive depending on symptoms and growth rate. Both lesions contain multinucleated giant cells and are treated with surgical excision, with CGG having a slightly higher recurrence rate. Key distinguishing features and histological characteristics are provided.
The document discusses various joining processes including welding, brazing and soldering. It explains that brazing and soldering involve melting of a filler metal with brazing using higher temperatures and stronger fillers, while soldering uses lower temperatures and weaker tin-lead fillers. Welding involves melting the base metals. The document then goes on to describe various welding techniques like stick welding, MIG welding, TIG welding and spot welding. It also discusses factors like distortion and flaws in welds. The document also provides details about brazing and different types of solders, fluxes used and joint designs for soldering.
This document discusses several systemic diseases and their potential oral manifestations. It describes Wegener's granulomatosis as a necrotizing vasculitis that can cause oral ulcerations and characteristic "strawberry gingivitis." Sarcoidosis is characterized by noncaseating granulomas and can involve the oral mucosa. Psoriasis may rarely cause oral lesions resembling those on the skin. Acanthosis nigricans can involve the lips, tongue, and gingiva with hyperplasia. Amyloidosis commonly causes macroglossia. Sjögren's syndrome and Kawasaki disease are also discussed.
This document describes a case report of a peripheral ossifying fibroma (POF) in a 22-year-old female patient. POFs are non-neoplastic reactive lesions of the gingiva caused by local irritants like plaque or food impaction. Histopathological examination showed fibrous connective tissue with bony trabeculae and dystrophic calcification, consistent with POF. Treatment involves complete surgical excision to remove the lesion and any remaining irritants in order to reduce the risk of recurrence.
This document provides an overview of the use of cone beam computed tomography (CBCT) in endodontics. It discusses the role of imaging in endodontics, compares 2D and 3D imaging, describes the principles and types of CBCT equipment, and reviews the clinical applications, advantages, limitations, and radiation dosage of CBCT. Key applications of CBCT in endodontics include evaluation of root canal anatomy, detection of apical periodontitis, assessment of root canal treatment outcomes, and pre-surgical planning.
The document discusses the history and development of nickel-titanium (NiTi) rotary files for root canal preparation. It describes how ProTaper files were developed in 2001 as a multi-tapered system with various shaping and finishing files to efficiently prepare root canals. The document outlines the characteristics of each ProTaper file and provides the recommended techniques for using them to clean and shape root canals.
This document provides an overview of endodontics. It defines endodontics as the branch of dentistry concerned with the morphology, physiology, and pathology of the dental pulp and periradicular tissues. The scope of endodontics includes treating diseases of the pulp, such as pulpal inflammation and infection, through both nonsurgical and surgical root canal treatment and periradicular surgery. Pathogenesis is discussed, noting that while physical and chemical factors can induce inflammation, microbial infection is essential for progression of pulpal and periradicular disease. Routes of canal infection and the focal infection theory are also summarized.
Embedded teeth are unerupted teeth due to a lack of eruptive forces, while impacted teeth are prevented from erupting by a physical barrier. Common causes include lack of space, tooth rotation, and systemic diseases. Third molars are most frequently affected, and complications can arise like dentigerous cysts, periodontal infections near impacted teeth, and resorption of adjacent tooth roots. Surgical exposure or removal may be required to address problems caused by impacted teeth, with potential short-term complications including sensory loss, trismus, and infection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
cutting instruments in operative dentistry by dr. jagadeesh kodityalaJagadeesh Kodityala
This document discusses dental instruments used for cutting tooth structure. It begins by defining dental instruments and describing the main types as hand instruments and rotary instruments. It then discusses the history and evolution of hand cutting instruments from early bulky chisels to modern steel instruments. Different types of alloys used for instruments and their properties are outlined. Cutting instruments are classified and various types are defined, including excavators, chisels, and specialized chisels. Details are provided on handles, blades, beveling, and proper sharpening techniques. The document covers rotary instruments and alternative cutting methods as well.
This document discusses disease of the pulp, including classification and types. It describes reversible and irreversible pulpitis, with reversible pulpitis causing mild to moderate pain in response to stimuli that subsides after removal of the stimuli. Irreversible pulpitis causes persistent pain even after stimulus removal and can progress to pulp necrosis with total or partial death of the pulp. Other conditions discussed include chronic hyperplastic pulpitis, previously treated teeth, and teeth with previously initiated therapy.
The document discusses different types of cysts that can occur in the jaws.
It classifies cysts as either odontogenic or non-odontogenic, and lists examples of cysts that fall into each category such as dentigerous cysts, radicular cysts, nasopalatine cysts, and others.
It provides details on the pathogenesis, clinical presentation, radiographic appearance, and treatment of some of the more common odontogenic cysts like primordial cysts, dentigerous cysts, and radicular cysts.
This document discusses Necrotizing Ulcerative Gingivitis (NUG), also known as trench mouth. It defines NUG as a microbial disease of the gingiva caused by an impaired host response. Key clinical features include necrosis of gingival tissue and pain. Diagnosis is based on these clinical findings and microscopic examination. Management involves reducing the microbial load, removing necrotic tissue, treating any systemic conditions, and supportive periodontal therapy. Prognosis is generally good with treatment but recurrence is possible without ongoing maintenance of oral hygiene.
This document provides an overview of various classification systems for partially edentulous arches. It discusses the American College of Prosthodontists (ACP) classification system and the Index of Clinical and Keratinized (ICK) classification system in particular. The ACP system offers benefits like improved consistency, communication, education/research, and diagnosis. It classifies partially edentulous cases based on criteria like the location and extent of edentulous areas, condition of abutment teeth, occlusal scheme, and residual ridge.
The document discusses various verrucal-papillary lesions of the oral cavity including reactive lesions such as papillary hyperplasia, condyloma latum, squamous papilloma, condyloma acuminatum, and focal epithelial hyperplasia. It also discusses neoplasms like keratoacanthoma and verrucous carcinoma. Rare lesions of unknown etiology discussed include pyostomatitis vegetans and verruciform xanthoma. Each lesion is described in terms of etiology, clinical features, histopathology, differential diagnosis, and treatment.
This document discusses dental pulp inflammation. It defines dental pulp as the soft tissue within the tooth surrounded by dentin. The pulp has different zones including an odontoblastic zone, cell-free zone, cell-rich zone, and central zone containing various cells, blood vessels, and nerves. The pulp functions to induce dentin formation, provide nutrition, defend against trauma, and allow sensation. Causes of pulpitis include mechanical, thermal, chemical, and bacterial factors. Pulpitis is classified as reversible or irreversible, partial or total, acute or chronic, and open or closed based on severity and communication with the oral environment. Symptoms, clinical features, management, and types of chronic pulpitis are described.
The periodontal pocket is a pathologically deepened sulcus that is a key feature of periodontal disease. It develops as plaque causes gingival inflammation that leads to migration of the junctional epithelium and destruction of supporting tissues. Pockets are classified by morphology as gingival pockets from enlarged gingiva or periodontal pockets from true tissue loss, and by number of tooth surfaces involved. Periodontal pockets contain bacteria and experience cycles of activity and quiescence that further deepen the pocket and destroy bone and connective tissue.
This document discusses pigmented lesions that can occur in the oral cavity. It begins by explaining that pigmentation can be exogenous or endogenous in origin, with the main endogenous pigments being melanin, hemoglobin, hemosiderin and carotene. It then discusses several specific conditions that can cause oral pigmentation, including physiologic pigmentation, Peutz-Jeghers syndrome, Addison's disease, heavy metal exposure, Kaposi's sarcoma, drug-induced pigmentation, postinflammatory pigmentation, smoker's melanosis, vascular lesions, melanotic macules, pigmented nevi, blue nevi, melanoacanthoma, and oral melanoma. Differential diagnosis of pigmented lesions involves considering
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is initiated by specialized nerve endings called nociceptors and transmitted by neurons. There are four processes involved in pain: transduction, transmission, modulation, and perception. Pain can be classified as nociceptive (resulting from tissue damage) or neuropathic (resulting from damage or disease affecting the nervous system). A thorough history and clinical/radiographic examination is needed to diagnose the source and type of pain. Common sources of dental pain include pulpal and periapical diseases, periodontal diseases, fractures, cysts, and tumors. Non-dental sources can also mimic dental pain and should be considered.
An overview of the diagnostic process in endodontics, including information about the pain system, referred pain, non-odontogenic pain, the diagnostic process, tests and treatment planning in endodontics.
This document discusses dental diagnosis and summarizes various diagnostic methods and tests used in dentistry. It begins by defining diagnosis and differential diagnosis, and lists qualities of a good diagnostician such as knowledge, interest, intuition and patience. It then discusses the use of subjective and objective symptoms in diagnosis. Various types of dental pain are described. The document outlines steps in performing a thorough dental examination, including visual inspection, palpation, percussion, mobility testing, and thermal and electric pulp testing to evaluate the pulp and determine the nature of any dental issues.
The document provides details about taking a thorough case history for periodontal patients. It emphasizes that case history recording is the first and most important step, as it allows for correct diagnosis and treatment planning. The case history should include chief complaint, history of present illness, past medical/dental history, family history, personal habits, general examination, and intraoral and extraoral examinations. Taking a comprehensive case history provides important insights into the patient's condition and relevant social, medical, and dental factors.
This document provides guidance on diagnosing pulp pathosis through a systematic process of gathering information. It discusses the 5 stages of diagnosis: 1) chief complaint, 2) history, 3) examination, 4) tests, and 5) diagnosis. The history involves medical history, dental history, and clinician questioning. Examination includes extraoral, intraoral, and specific tests like percussion, mobility, and thermal/electric pulp tests. Diagnostic tests are used to reproduce symptoms, localize them, and assess severity. Differential diagnosis considers conditions that can mimic dental pain. A thorough process of information gathering through history, examination and tests allows for accurate diagnosis.
Assessment and diagnosis of pain in dental practiceDr. Sreelekshmi J
This document provides information on assessing and diagnosing dental pain. It defines pain and diagnosis, describes the trigeminal nerve pathway for facial pain sensation, and outlines the examination process for a patient in pain. This includes reviewing history, performing clinical tests like pulp sensitivity tests, and considering diagnostic tests and images. Common sources of dental pain are also explained such as pulpal and periapical issues, cracked teeth, temporomandibular disorders, sinusitis, and post-endodontic surgery pain.
Pain induced from occlusal errors of removable prosthesisAmalKaddah1
1. The document describes various types of pain that can occur with complete dentures, including localized, generalized, and diffuse pain.
2. Common causes of denture pain are incorrect vertical dimension, improper tooth positioning, and occlusal discrepancies.
3. Treatment involves identifying the specific error, such as reducing vertical dimension for high bite, and remaking or adjusting the dentures.
This document provides an overview of the components of a case history for dental patients. It discusses the importance of collecting demographic data, chief complaint, history of presenting illness, medical history, dental history, family history, and personal history from the patient. It also describes examining the patient's general health by checking vital signs, nutrition status, and for any signs such as cyanosis, pallor, or edema. Taking a thorough case history is important for diagnosis, treatment planning, and managing patients with underlying medical conditions.
Diagnosis and treatment planing of conservativeAjeet Kumar
This document provides an overview of patient evaluation, examination, diagnosis, and treatment planning for conservative and endodontic treatment. It discusses taking a thorough case history, medical history, and clinical examination including inspection, palpation, percussion, and exploration of the soft tissues, hard tissues, periodontal tissues, existing restorations, and use of radiographs and diagnostic tests to arrive at a diagnosis and treatment plan. The goal is to identify any dental or systemic issues, thoroughly examine the patient, and determine the appropriate treatment.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides information on taking a case history. It discusses the importance of gathering a patient's chief complaint, medical history, dental history, and personal history. It outlines the key components of a case history, including statistics, examination findings, diagnosis, and treatment plan. It also describes different methods for obtaining a patient's history, such as interviews, questionnaires, and a combination approach. The goal of a case history is to understand the nature of a patient's illness and provide relevant information to aid in diagnosis and treatment decisions.
Diagnosis and treatment planing in EndodonticsSalem Rekab
This document provides an overview of endodontic diagnosis and treatment planning. It discusses the importance of gathering a chief complaint, health history, dental history, and conducting a subjective and objective examination of the patient. The subjective examination involves questioning the patient about their symptoms such as the intensity, spontaneity, and persistence of any pain. The objective examination includes extraoral and intraoral soft tissue exams, examining the dentition, and performing clinical tests like percussion, palpation, and pulp vitality tests using heat, cold, or electricity. Together, the subjective and objective exams allow the clinician to make a tentative diagnosis which is then confirmed through further examination and testing.
The document discusses oro-facial pain and its management. It describes various types of dental pain, including short, sharp shooting pain which can be caused by conditions that expose dentin like caries, fractures, or gum recession. Tests that can help diagnose dental pain are discussed, like pulp sensitivity tests, percussion, probing, mobility and palpation. Radiographs may also reveal issues like recurrent decay or bone loss. The goal of acute pain management is to inhibit tissue damage signaling, block nerve impulses, and activate endogenous analgesia.
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.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
History taking involves gaining information from patients through directed questioning to aid medical diagnosis and care. It is critical for determining the cause of a patient's illness, as diagnosis is often based on clinical history alone. An accurate history is obtained by addressing key components in order: chief complaint, history of present illness, past medical history, family history, and personal history. Open-ended questions allow patients to provide their own perspective, while closed questions clarify specific details chronologically. History taking is an essential medical skill developed through focused practice and attention to patient communication.
This document provides information on case history taking in dentistry. It discusses the objectives, steps, and components of obtaining a patient's medical history. The key methods of history taking are interviews, health questionnaires, and a combination approach. Important parts of the case history include the patient's statistics, chief complaint, medical/dental history, examination findings, diagnosis, and treatment plan. Thoroughly understanding a patient's history is essential for establishing a diagnosis and appropriate treatment.
This document provides background on the history of oral surgery and dentistry. It discusses key figures like Hippocrates, Aristotle, Ambrose Pare, and Pierre Fauchard who contributed to the early development of the field. It also outlines the steps involved in making an accurate diagnosis, including taking a thorough patient history, clinical examination, radiological analysis, laboratory tests, and interpreting all findings to arrive at a final diagnosis. Specific components of an effective medical history are described, such as chief complaints, history of present illness, pain assessment using the SOCRATES mnemonic, past dental history, medical history, drug history, and personal/family history.
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4. Definition
Case history is a planned professional
conversation that enables a patient to
communicate his/her feelings, fear and
sequence of events leading to the
problem for which the patient seeks
professional assistance, to the clinician so
that patients’ real or suspected illness
and mental attitude of the patient can be
determined.
5. Therefore case history is an important
and integral part of treatment.
Ideally case history is taken in a
consultation room or a private .
A properly prepared case history alone
is sufficient to diagnose the disease
without examining the patient.
6. Note:
Eliciting accurate, detailed and unbiased
information from a patient is a skilled task
and Not simply a matter of recording the
patient’s responses to a checklist of
questions.
Avoid interrupting patients, when telling you
the story of the presenting features of the
illness.
Being a good listener will greatly help you
to establish a good relationship quickly
7. Why is case History Important
To provide information regarding etiology and establish
diagnosis of oral conditions
To reveal any medical problem necessitating precautions,
modifications to ensure that dental procedures do not
harm the patient and prevent emergency situations
Evaluation of other possible undiagnosed problems
Discovery of communicable diseases
Gives an insight into emotional and psychological factors
For effective treatment planning
Record maintenance for future reference and periodic
follow-up
Acts as evidence in legal matters.
8. Sequence of case recording
and evaluation:
General Information
Chief Complaint
History of Present Illness
Previous Dental History
Medical History
Family History
Personal History
General Physical Examination
Extraoral Examination
Intraoral Examination
Provisional Diagnosis
Investigations
Final Diagnosis
Treatment Plan.
9. General Information
Patient registration number
Date of clinic
Name
Age
Sex
Education
Address
Occupation
Religion
10. Chief Complaint
Established by asking the patient to
describe the problem for which he or
she is seeking help or treatment.
It is recorded in patient’s own words.
It is primarily a statement of the patient’s
signs and symptoms.
It is recorded in chronological order of
their appearance, and severity.
11. Why Chief Complaint??
The chief complaint aids in the diagnosis
and treatment planning and should be
given the first priority.
14. History of Present Illness
It is a chronological account of the
chief complaint and associated
symptoms from the time of onset to
the time the history is taken.
15. Questions to be asked:
– When did the problem start?
– What did you notice first?
– Did you have any problems or symptoms
related to this?
– What makes the problem worse or better?
– Have any tests been performed before to
diagnose this complaint?
– Have you consulted any other examiner for this
problem?
– What have you done to treat this problem? Etc.
16. The symptoms can be
elaborated under:
Mode of onset
Cause of onset
Duration
Progress and referred pain
Relapse and remission
Treatment
Negative history.
17. Detailed History of Pain
Pain:
The International Association for the
Study of Pain (IASP) defines pain as
“an unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage”.
18. The IASP classification
system
Recommends describing pain according
to five categories:
I. duration and severity
II. anatomical location
III. body system involved
IV. cause
V. and temporal characteristics
(intermittent, constant, etc.)
19. Note the following:
Anatomical location (site)
Origin and mode of onset
Intensity of pain
Nature of pain
Progression of pain
Duration of pain
Movement of pain
21. Four types of pain are
noticed:
1. Superficial: occurs due to direct irritation
of the peripheral nerve endings.
2. Segmental: occurs due to irritation of a
sensory nerve trunk or root.
3. Deep or visceral: occurs due to irritation
of deep structures in the body.
4. Psychogenic or central: pain arises from
brain, due to an emotional or hysterical
situation.
22. Factors to be considered
in pain:
Site of pain:
determining the original site of pain is important.
The clinician may ask the patient ‘where did the pain start’?
Origin and mode of onset: The clinician may ask the patient ‘how
did the pain start’?
The origin and mode of onset is important to determine the
chronicity of pain.
A long continued pain with insidious onset indicates chronic
nature of the disease,
whereas a recent onset of pain with sudden impact indicates
acute nature of disease.
Severity:
The perception of pain varies in different individuals.
A mild pain may be severe to others.
The severity of a pain gives an impression of the acuteness of
the symptoms felt by the patient, thus helping in constituting a
proper diagnosis.
23. Factors:
Type of pain:There are various types of pain.
The most common are:
– Vague pain: It is a mild continuous pain, e.g.
periodontal pain
– Burning pain: Pain usually occurs with the
burning sensation, e.g. reflex oesophagitis.
– Throbbing pain: Type of pressured throbbing
sensation is felt, e.g. in abscesses.
– Stabbing pain: Sudden, severe, sharp and
short-lived pain, e.g. acute pulpal pain.
– Shooting pain: Pain increases in severity in a
short period, e.g. trigeminal neuralgia.
24. Factors:
Progression of pain: The clinician asks the
patient ‘how is the pain progressing’?
Duration of the pain: In terms of
days/months/years.
The clinician asks ‘how long the pain lasts’? Pain
can be intermittant or continuous.
Radiation of pain: It is the extension of pain to
another site, while the original site is still painful.
The radiating pain has the same character as the
original pain. Referred Pain is a term used to
describe the phenomenon of pain perceived at a
site adjacent to or at a distance from the site of an
injury’s origin. (Dorland’s Medical Dictionary).
25. Factors:
Precipitating or aggravating factors:
different factors may worsen the pain
suggesting a specific diagnosis about the
disease.
For example, the pain of cracked tooth
syndrome occurs when the patient relieves
the occlusal pressure over the tooth.
Relieving factors: factors which reduce the
severity or frequency of pain are considered
important in diagnosis.
For example, in some cases, pain of
chronic pulpitis gets relieved by cold
application.
27. Factors:
Swelling:
Anatomical location (site)
Duration
Mode of onset
Symptoms
Progress of swelling
Associated features
Secondary changes
Impairment of function
Recurrence of swelling.
28. Swellings:
Duration: The clinician may ask ‘when was the swelling first
noticed’? Swellings that are painful and of shorter duration
are mostly inflammatory (acute), whereas those with longer
duration and without pain are chronic, e.g. a chronic
periapical abscess.
Mode of onset: The clinician may ask ‘how did the swelling
start’? The history of any injury or trauma or any inflammation
may contribute to the diagnosis and nature of the swelling.
Progression: The clinician should ask ‘has the lump
changed in size since it was first noticed? Benign growths
such as bony swellings grow in size very slowly and may
remain static for a long period of time. If the swelling
decreases in size, this suggests of an inflammatory lesion.
29. Site of swelling: The original site where it
started must be assessed.
Other symptoms: Pain, fever, difficulty in
swallowing, difficulty in respiration,
disfigurement, bleeding or pus discharge are
the common symptoms associated with
swellings in the orofacial region.
Recurrence of the swelling: many
swellings do recur after removal of the
tissue, indicating the presence of
precipitating factor, e.g. ranula.
30. Dental Hypersensitivity
Causes
Exposure of dentinal tubules due to : Wasting
diseases — attrition, abrasion, erosion,
abfraction
Gingival recession
Following periodontal surgery/root planing due
to removal of cementum over radicular dentin.
Patient History
Patients often report with complaint of a
sudden, short, sharp shock like sensation in
response to cold or hot, sweet or sour
substances, or touch.
31. Bleeding from the Gums
Patients often report with problems of chronic or recurrent
bleeding,
which is provoked by mechanical trauma (e.g. from tooth
brushing, toothpicks, or food impaction) or by biting into
solid foods such as apples.
History of Bleeding Gums
Duration
Amount/Quantity
Ease with which bleeding can be elicited
Associated symptoms (dull pain, sensitivity).
Causes
Chronic or recurrent bleeding: Most common cause is
chronic gingival inflammation.
32. Acute bleeding
Caused by injury or can occur spontaneously in acute
gingival disease
Acute Necrotizing Ulcerative Gingivitis (ANUG).
Gingival bleeding associated with systemic changes
Hemorrhagic disorders (Vitamin C deficiency, Schonlein-
Henoch purpura)
Platelet disorders (thrombocytopenic purpura)
Hypoprothrombinemia (Vitamin K deficiency)
Other coagulation defects (hemophilia, leukemia,
Christmas disease)
Deficient platelet thromboplastic factor (PF3) resulting from
uremia, multiple myeloma, postrubella purpura
Excessive intake of drugs (salicylates, anticoagulants —
dicoumarol and heparin).
33. Dry Mouth (Xerostomia)
The subjective feeling of oral dryness is termed
xerostomia. It is a symptom, not a diagnosis or a disease.
Causes of Xerostomia
Developmental (Aplasia and hypoplasia of the salivary
glands)
Drugs (Tricyclic antidepressants, antipsychotics,
antihistaminics, atropine, β-lockers)
Radiation therapy of head and neck
Oncologic chemotherapy
Infections and inflammatory conditions (Parotitis,
Mumps)
Benign or malignant tumors of the salivary glands
34. Psychological factors (affective
disorders)
Malnutrition (anorexia, bulimia,
dehydration)
Idiopathic disorders
Smoking, use of smokeless tobacco
products, alcoholism and
caffeine can aggravate dry mouth.
36. Dry Mouth due to Systemic diseases..
Diabetes
Amyloidosis
HIV infection
Thyroid disease
Late stage liver disease
Patients on hemodialysis for end-stage
renal disease
37. Burning Sensation of the Mouth
Burning sensations accompany many inflammatory or ulcerative
diseases of the oral mucosa, but term Burning Mouth Syndrome is
reserved for describing oral burning that has no detectable cause.
Local causes
Stomatitis
Ulcers
Infections (e.g. Candidiasis)
Dry mouth, salivary gland hypofunction
Mucosal disorders (Geographic tongue, lichen planus, etc.)
Trauma to oral mucosa (e.g. Poorly fitting dentures)
Gastroesophageal reflux disease.
Systemic causes
Vitamin B-12, folate, iron deficiencies
Medication (e.g. ACE inhibitors such as Captopril)
39. Loose Teeth or Tooth Mobility
Causes
Loss of tooth support (bone loss) due to
periodontal disease
Trauma (physical trauma from a fall or blow to
the teeth)
Trauma from occlusion
Abnormal occlusal habits (bruxism, clenching)
Hypofunction
Extension of inflammation from the gingival or
periapex into the periodontal ligament results in
changes that increase mobility.
40. Periodontal surgery temporarily
increases tooth mobility
Mobility may be increased in
pregnancy, or sometimes may be
associated with menstrual cycle or use
of contraceptive pills
Osteomyelitis of the alveolar bone
Cysts/tumors of the jaw.
41. Halitosis or Oral Malodor
“Halitosis may rank only behind dental caries and
periodontal disease as the cause of the patient’s visit to the
dentist.”
Origin may be either –Oral
Poor oral hygiene
Retention of odoriferous food particles on and between the
teeth
Coated tongue
Artificial dentures
Acute Necrotizing ulcerative gingivitis
Pericoronitis
Abscesses
Dehydration states
Ulceration in the oral cavity
42. Halithosis:
Hyposalivation/Xerostomia
Bone disease (Dry socket,
Osteomyelitis, Osteonecrosis and
malignancy)
Smoker’s breath
Healing oral wounds
Chronic periodontitis with pocket
formation.
43. Extraoral (Conditions that can Contribute to
Presence of Oral Malodor)
Sinusitis and other bacterial infections
Dry nasal mucosa
Blocked nose (which can cause mouth
breathing)
Tonsillitis/tonsil stones
Various carcinomas
Infections of the respiratory tract (bronchitis,
pneumonia, bronchiectasis)
Alcoholic breath
Uremic breath of kidney dysfunction
Acetone odor of Diabetes
45. Past Dental History:
Frequency of visit to a dentist: It provides the examiner with
information regarding the interest of the patient in his dental
health.
Frequency of dental prophylaxis: It may be valuable guide in
evaluating periodontal conditions which are present as well as
provides the dentist with prognostic information.
Past experience during and following local anesthesia: It
may alert the dentist to the necessity for investigation into
possible allergy to the anesthetic agent. It may also allow him to
anticipate possible syncope during the administration of LA in
future appointments.
Past periodontal therapy: Type of treatment and the time in the
past it was received, will help to evaluate the present status of
periodontal structure and planning of future periodontal treatment
for a patient.
Past orthodontic treatment: The condition which was treated,
the length of time of active treatment, the nature of the appliance
46. Fixed Bridges: The comfort level of
the bridge.
Surgical procedures in the mouth
other than extraction
47. Past Dental History:
provides a basis for the determination of the caries rate, the
rate of plaque and calculus formation, the susceptibility to
periodontal diseases, the resorption rate of edentulous
ridges.
If history of previous bad experience (pain, rude attitude of
dentist, etc.) is present then moulding of behavior is done
using behavior management technique.
Significant knowledge can be drawn about the patient’s
previous treatment procedures and can be helpful towards
the present situation.
Also the information regarding any complication faced
during the previous treatment/visit can be noted.
If this is the patient’s first visit to a dental clinic then reasons
for not visiting the dentist should be enquired:
◦ Patient feels that he/she has: No problem
◦ had some problem but thinks it will get corrected by itself
48. Medical history includes:
Diseases or conditions that contraindicate certain kind of dental
treatment.
Diseases that require special precautions or premedication prior to
dental treatment. For eg myocardial infarction, hemophilia, radiation,
etc.
Diseases under treatment of a physician with medication that
contraindicates the use of additional medication. For example,
Anticoagulants, steroid therapy, tranquilizers.
Allergies/untoward reaction towards penicillin/local anesthesia.
Diseases that endanger the dentist/other patients. For eg. Infectitious
diseases like hepatitis, tuberculosis
Physiological state of patient. For example, Pregnancy, aging.
Recording of past medical history includes history of past illnesses,
health care experiences, immunization, known allergy,
current treatment including medications, hospitalizations and
evaluation of the patient’s health based on the history provided by
the patient.
50. Family History
It includes:
Number of siblings and their age.
This gives an idea of:
Size of family and socioeconomic status.
Whether patient can afford for the time and treatment.
To know the child’s psychology which has an effect on his
behavior.
Children from larger families are more adjustable, cooperative,
willing to face the crisis/face challenges on their own.
To study the peer influence of dietary and oral hygiene practice.
History of any disease running in the family. For example,
Diseases like hemophilia, diabetes, and hypertension recur in
families’ generation after generation.
Prenatal, Natal and postnatal history should be taken in case of
pediatric patients
51. Personal History
It includes:
Oral habits
Oral hygiene habits
Adverse habits
Diet history.
52. Various Habits are:
Thumb sucking
Finger sucking
Tongue thrusting
Pacifier or dummy sucking
Lip biting
Nail biting
Cheek biting
Pencil or foreign object sucking
54. ORAL HYGIENE HABITS
Includes:
Regularity of brushing
Frequency and method of brushing
Use of fluoridated and nonfluoridated
tooth pastes
Type of brush and how often it is
changed
Use of other oral hygiene aids.
55. Adverse Habits
Includes:
Smoking: Record the type, frequency
and duration
Alcohol consumption: Record the
amount, frequency and duration
Tobacco chewing Arecanut
chewing/Paan chewing: Record the
type, amount, frequency and duration.
56. Dietary Habits
1. Each detail about what you eat or drink
in the order in which it is eaten should be
recorded with time.
2. The frequency of eating important;
therefore between meal-snacks, candies,
gum, etc. should be included along with
meals.
3. The following information is essential:
The amount in household measurements
57. Clinical Examination
To perform the examination, you need:
Adequate knowledge of the anatomy and
physiology of the region
A well practiced technique for
examination providing minimal discomfort
to the patient
Knowledge of the disease process
affecting the head and neck region.
58. The basic techniques of diagnosis are:
visual inspection,
palpation,
olfaction,
auscultation,
percussion
and aspiration.
59. Visual inspection: It is a standardized
observation of the anatomical landmarks of the
head and neck region to ensure the completeness
and accuracy of the examination. Visual
inspection involves evaluating the bilateral
completeness of the facial structures.
Palpation: It is used to determine the size,
texture, consistency, symmetry, temperature, etc.
which are sensed by touch. Palpation may be
done by either hand or by both hands (bimanual
palpation). Findings related with the palpation
techniques are confirmed with percussion and
auscultatory techniques.
60. Olfaction: Some odors can be associated
with conditions of the patient such as
smoking habits, poor oral hygiene, sinusitis,
metabolic disorders, gastrointestinal
disorders, etc.
Auscultation: It is the listening to sounds. It
is performed by the unaided ear or by the
assistance of a stethoscope. You should
evaluate the sounds of crepitus or popping
like in case of TMJ, blood pressure sounds,
etc.
61. Percussion: It is performed by gentle
tapping over the area with fingers or an
instrument(???) to determine the relative
consistency of the structure with its
surroundings.
Aspiration: It is the removal of whole or a
part of fluid from a body cavity. The area
aspirated is usually a soft tissue or a bony
lesion having a fluid filled cavity. The
aspirated fluid is thus evaluated for its
consistency and components.(?Cystic
fluid)
62. The examination includes :
General examination
Local examination: includes extraoral
examination and intraoral examination.
63. General Examination
Nourishment
Gait
Posture
Built
Blood pressure
Pulse
Temperature
Respiratory rate
Pallor
Cyanosis
Edema
Icterus
Body mass index
(BMI)
64. Extraoral Examination-
Includes the examination of:
Skin appearance
Any lesions
Head
Face
Nose
paranasal sinuses
external ear
nasal mucosa
Lips
Cheeks
lymph nodes
TMJ
Muscles of
mastication
and salivary
glands.
65. Skin
Note changes in appearance or any rashes,
sores or ulcerations.
Generalized pallor is seen in severe anemia.
Pallor is seen in hypopituitarism, shock,
syncope and left heart failure.
Yellowness of skin is seen in carotenemia.
Check out for texture : dry and inelastic in
dehydration and greasy in acromegaly.
Skin gets atrophied with age and with steroid
medications.
66. Skin
Also note abnormal signs such as
petechial hemorrhages (e.g. in blood
dyscrasias), any eruptions, erosions,
pigmentations
67. Head
Patient should be evaluated for head
region in terms of its appearance, its
circumference, etc.
68. Shape of the Head
The head can be classified into one of the
following three types:
1. Mesocephalic: Average shape of head.
Patient usually possesses normal shaped
dental arches.
2. Dolichocephalic: Long and narrow
shaped head. Patients usually have narrow
dental arches.
3. Brachycephalic: Broad and short shaped
head. Patients usually have a broad dental
arch.
69. Facial Forms
The overall shape of the face is generally
classified into following three types:
1. Mesoprosopic: It is an average or
normal facial form.
2. Euryprosopic: This type of face is
broad and short.
3. Leptoprosopic: It is a long and narrow
form.
70. Facial Symmetry
Asymmetries that are gross and identifiable
should be noted and recorded.
Gross facial abnormalities can result from:
Congenital defects
Hemifacial hypertrophy/hypotrophy
Unilateral condylar ankylosis/hyperplasia
Chronic abscesses/presence of a large
cyst/space infections (facial swellings)
Facial fractures, etc.
71.
72. Facial Profile
Profile of the patient is determined by
visualizing the patient from the side.
Profile assessment helps in diagnosing
gross deviations in the
maxillomandibular relationship.
73. Facial Profile
Three types of facial profiles have been classified:
1. Straight profile: an imaginary line is drawn
from the forehead to the upper lip and another line
from the upper lip to the anterior point of chin.
Both these lines when joined form a nearly
straight line.
2. Convex profile: the two imaginary lines form
an angle with the concavity facing the tissue. This
type of profile is seen in a prognathic maxilla or a
retrognathic mandible.
3. Concave profile: the two imaginary lines form
an angle with the convexity towards the tissue.
This type of profile is associated with a prognathic
mandible or a retrognathic maxilla.
74. NOSE, PARANASAL SINUSES,
EXTERNAL EAR AND NASAL MUCOSA
Examine for any sinus pain, discharge,
obstruction, continuous sneezing, periorbital
swelling or inflammation.
Observe:
Apical abscess of upper tooth which may
lead to acute sinusitis.
Nasal obstruction may lead to mouth
breathing habit
Epistaxis (nasal bleeding) is seen in
severe conditions like cerebral
hemorrhage.
75. Lips
Note the lip color, texture, and any
surface abnormalities as well as angular
or vertical fissures, sores, ulcers,
nodules, plaques, scars and swellings.
Notice the vermillion border and the
presence of fordyce’s granules.
76. Cheeks
Note any changes in pigmentation and
linea alba, any hyperkeratotic or any
hyperpigmented patch, swellings,
nodules, scars or ulcers.
77. Lymph Nodes
Examination of neck nodes is
important, particularly in head and
neck malignancies and a systematic
approach should be followed.
Neck nodes are better palpated while
standing at the back of the patient.
Neck is slightly flexed to achieve
relaxation of muscles.
78.
79. Lymph nodes of Head and
Neck
When a node or nodes are palpable, look for the
following points:
Location of nodes
Number of nodes
Size—Abnormal Nodes
– Greater than 1.5 cm in jugulo digastric area (level I, II, III)
– Greater than 1cm elsewhere
Consistency: Metastatic nodes are hard; lymphoma nodes
are firm and rubbery; hyperplastic nodes are soft. Nodes of
metastatic melanoma are also soft
Discrete or matted nodes.
Tenderness: Inflammatory nodes are tender.
Fixity to overlying skin or deeper structures.
Mobility should be checked both in the vertical and
horizontal planes
80. Temporomandibular Joint
The importance is to determine deviation of
jaw from the midline during the opening and
closing of the jaws.
Causes of jaw deviation:
Traumatic injuries of the joint
Infection of the jaw
Fractures of the jaw
Muscular hypertrophy and hypotrophy.
Dislocations
81. Muscles of Mastication
Palpate the origin of the masseter along the
zygomatic arch and continue to palpate down
the body of the mandible where the masseter is
attached.
Parafunctions such as bruxism and clenching
also gives rise to masseter pain that is
frequently associated with pain in the temporalis
muscle.
The temporalis is palpated in much the same
manner to detect lateral interferences.
The lateral pterygoid muscle is sometimes
painful on the contralateral side in patients with
nonworking side interferences
82. Salivary Glands
Parotid Gland
Check for any swelling over the region. Note the extent,
size shape and consistency of the gland over the area.
The position determination is vital so as to rule out the
lymph node swellings that may be confused with parotid
swellings.
In case of parotid abscess, the skin over the area becomes
edematous with pitting on pressure.
Examine the area for presence of any fistula, and
enlargement of lymph nodes or involvement of facial
nerves.
The parotid gland duct (stenson’s duct) opens in the
buccal mucosa opposite to the crown of maxillary second
molar. Retract the cheek for its proper examination.
83. Submandibular Gland
History of the patient is to be noted, e.g. swelling
with pain at the time of meals suggests
obstruction in submandibular duct.
Calculi are more common in submandibular
gland as compared to others major salivary
glands.
Check for any nodal swelling, it may suggest of
lymph node enlargement.
Inspection over the area of the gland should be
done to check the overlying skin color and
distension of the mucosa and the orifice of the
Wharton’s duct.
84. Submandibular Gland
Bimanual palpation — in the open mouth, the
physician’s finger of one hand is placed on the
floor of the mouth and pressed as far as
possible.
The finger of the other hand is placed on the
exterior at the inferior margin of the mandible.
These fingers are pushed upwards and
palpation is achieved.
If the gland or duct is infected, slight pressure
over the gland will exudates pus from its orifice.
85. Extra Oral Examination
Examination of Lips and Labial
Mucosa:
The clinical features of normal lips and
labial mucosa are:
Reddish color over the area
Folds and sulci over the surface of lips
Absence of any plaque or patchy area
Absence of any erosive areas
86. In case of abnormalities-Record for:
Competency
Color
Texture
Fissuring
Shape
Presence of any lump or hard tissue.
87. Some of the common conditions that
manifest as lip abnormalities are:
1. Lip pits and commissural pits:
These are congenital defects of lip and
labial mucosa that result in unilateral or
bilateral depression or pit that may occur
on the lip region or on the commissures
(angles of mouth).
2. Cleft lip: These are one of the most
common developmental malformations.
89. 3. Angular cheilitis: Inflammatory lesion
at the labial commissure, or corner of the
mouth, and often occurs bilaterally.
The condition manifests as deep cracks
or splits.
4. Angioedema: Diffuse edematous
swelling occurring as a result of allergic
reactions. Spreads to other tissues very
rapidly and should be treated instantly.
90. Buccal Mucosa
Buccal mucosa is the internal lining of
the cheek region.
The mucous membrane often varies
considerably in thickness from one area
to another but it is generally thick and
pink like the labial mucosa with which it
is continuous.
91. Abnormalities of Buccal Mucosa:
1.White lesions of oral cavity: Such as
hyperkeratosis, leukoplakia, actinic
keratosis, candidiasis, chewer’s mucosa,
white sponge nevus, lichen planus, etc.
2. Red lesions of oral cavity:
Hemangiomas, varix, erythroplakia,
ecchymosis, etc.
3. Ulcerative lesions of oral cavity:
Trauma, apthous stomatitis, herpangina,
behcet’s syndrome, etc.
92. Examination of the Floor of the Mouth:
The floor of the mouth is a narrow, horse shoe
shaped depression lying between the base of
the tongue and alveolar processes of the
mandible.
The midline has a Lingual Frenulum,
connecting the inferior surface of the tongue
with the floor of the mouth.
Clinically, a normal floor of mouth presents:
Shiny pink surface
Presence of normal lingual frenal attachments
Absence of any patchy or ulcerated lesion.
93. Abnormalities of floor of Mouth:
Mandibular tori: A physiologic
enlargement of alveolar process on the
lingual surface that can be seen while
examining the floor of the mouth.
Ranula: A traumatic swelling that
occurs on the floor of mouth as a result
of calculi in the duct of salivary gland or
obstruction of minor salivary glands on
the surface.
96. Examination of the Tongue:
The dorsum of a healthy tongue is covered by a mucous
membrane, which is rough due to the presence of thousands of
papillae projecting onto the surface.
There are three types of papillae present on the surface:
1, Filiform papillae: these are the most numerous type of papilla,
with small, spike like projections covering most of the surface of
tongue.
This papilla does not contain taste buds and are responsible for
surface roughness.
2. Fungiform papillae: these are the second most numerous
papillae,
containing taste buds, having mushroom shaped projections, most
commonly on the lateral borders and on the tip of tongue.
3. Circumvallate papillae: these are 7 to 14 in number, present
slightly anterior to the sulcus terminalis (a v-shaped groove on the
posterior part of tongue), running parallel to it.
Each circumvallate papilla is surrounded by a trough or crypt, into
which numerous taste buds open.
97. A normal tongue presents the
following characteristics:
A moist, reddish mucosa over the dorsal
surface
Roughness over the dorsal surface
indicating the presence of papilla
Absence of any plaque or ulcer.
99. Note:
The dorsal and lateral surfaces of the
tongue are best examined by asking the
patient to open his mouth wide and the
tongue thrust forward.
A piece of gauze is wrapped around the
tip of the tongue, enabling the clinician
to manually move the tongue by itself,
for examining the lateral borders.
100. Abnormalities of the Tongue:
Aglossia: Absence of tongue
Microglossia: Decrease in size of tongue
Macroglossia: Increase in size of tongue
Ankyloglossia: Also known as ‘tongue-tie’. A
condition, where lingual frenum attaches overly
to the bottom of the tongue and restricts its free
movement
Sprue: A common condition seen in
malabsorption syndrome where tongue
becomes severly ulcerated and inflamed with a
painful, burning sensation
105. Examination of the Hard and Soft Palate:
The hard palate consists of:
An incisive papilla, a soft tissue portion
overlying the incisive canal,
a median palatine raphe, which can be
distinguished by a shallow depression or a low
ridge extending to the soft palate
and palatine rugae, which are dense ridges of
mucosa present on anterior hard palate.
The soft palate consists of:
Soft tissue projection in the midline termed as
the uvula.
107. Cleft palate:
A common developmental anomaly
resulting in incomplete fusion of the two
lateral processes creating a gap in the
palatal shelf.
Cleft palate may be complete (involving
the hard and soft palate)
or incomplete (involving only the hard
palate or only the soft palate)
109. Torus palatinus: A slow growing,
physiologic, bony protuberance occurring
in the midline area of the palate.
Smoker’s palate: A common condition
where multiple petechiae are seen over
the hard palate, as a result of
inflammation of minor salivary glands and
hyperkeratosis in response to tobacco
smoking
111. Examination of Swelling:
Inspection: A good observation of the lump is
important for determining the nature of the
swelling.
A few points must be considered:
– Site of the swelling
– Shape of the swelling
– Size of the swelling
– Surface mucosa
– Edges
– Number
– Movement with deglutition
– Movement with protrusion of tongue.
112. Examination of Ulcer
Inspection: following points should be considered:
– Size and shape: different diseases produce a variety of
ulcers (for example, syphilitic ulcers are circular or
semilunar, carcinomatous ulcers are irregular in shape,
traumatic ulcers take the shape of the injurious agent, etc).
– Number: ulcers of neoplastic origin, tuberculous ulcers,
etc. are solitary while other are numerous in number. For
example, recurrent apthous ulcers.
– Position: position of the ulcer over the face or in the oral
cavity itself gives clue about the diagnosis (ulcers of
squamous cell carcinoma reside mostly in the middle third of
face, position of traumatic ulcers in denture wearers gives
the idea of the offending artificial tooth, etc.)
– Edges: It suggests of both the diagnosis and the condition
of the ulcer.