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oral medicine
- 1. The systematic approachto get the final diagnosis A series of relevant events and situations to get differential diagnosis then the final diagnosis Prepared by : الفيتوري رمضان السالم عبد سمية
- 2. INTRODUCTION In routine dentalpractice patients seek oral care for various reasons. Some of these reasons are ..pain, swelling and ulcers ,etc … Accurate diagnosis is the only true cornerstone on which rational treatment can be built. (1)C Noyek
- 3. General look Taking history Careful examination Defineyour investigations Which should be Sensitive and specific To get correct diagnosis
- 4. First step : Cluesof general look
- 5. Importance of generallook Give you hints about patient’s : •Chief complain •Mentality •General health •Altitude and education •May help in discovering undiagnosed diseases •Planning of treatment Don’t depend on general look only
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- 9. Second step : Takinghistory
- 10. Taking history History ofpresent illness Dental history Medical history / systemic review Social history / habit Family history Chief complain Drug history / allergy Common symptoms of oral and maxillofacial disease processes include the following: Discomfort: Pain, ache, numbness, itching (pruritus), burning, tenderness, and clicking/popping of temporoman- dibular joint (TMJ) . Also may the patient complain of : Sores , gingival /intraoral bleeding , burning mouth/ tongue , loosing of teeth , delay tooth/teeth eruption , sudden change in occlusion , halitosis .. Etc
- 11. Causes of painfelt in the oral tissues (2) • Disease of teeth and/or supporting tissues • Oral mucosal diseases • Diseases of the jaw • Pain in the edentulous patient • Postoperative pain • Pain triggered by mastication • Referred pain • Neurological diseases • Psychogenic (atypical) facial pain Painful jaw diseases Fractures Osteomyelitis Infected cysts Malignant neoplasms Sickle cell infarcts
- 12. (3)Pain from extra-oraldisease • Diseases of the maxillary antrum: Acute sinusitis , Carcinoma, particularly when it involves the antral floor • Diseases of salivary glands : Acute parotitis , Salivary calculi , Sjogren's syndrome • Malignant neoplasms • Diseases of the ears : Otitis media , Neoplasms in this region • Myocardial infarction • Painful intracranial and psychological disorders
- 13. Third step : Clinicalexamination
- 14. Clinical examination Extra- oral Intra-oral teeth/soft tissues /hard tissues • Inspection • Palpation • Percussion • Auscultation • General examination • Vital signs • lymph nodes • Cranial nerves You should know the normal variations
- 15. Common signs oforal and maxillofacial disease processes include the following: • Soft-tissue changes . • Hard-tissue changes (Clinical/radioghraphical). • Neuromuscular functional changes.
- 16. Sebaceous glands lying superficiallyin Usually labial mucosa and buccal mucosa. Fordyce spots A milky white translucent whitening of the oral mucosa which disappears or fades on stretching. Commoner in black races Leukoedema ExostosesTori horizontal streak on the inner surface of the cheek, level with the biting plane Linae alba The keratinized mucosa, in particular the gingiva, is most commonly affected Physiologic Pigmentation Gingival Grafts Lingual Tonsil Must know the landmarks and anatomical variations
- 17. oral mucosal lesions: •surface lesions - epithelial thickening, surface debris, and sub-epithelial change •Pigmented lesions : 1. Generalized pigmented surface lesions 2. Localized pigmented surface lesions - intravascular blood, extravascular blood, melanin pigment, and tattoo • Vesicular-ulcerated-erythematous surface lesions - hereditary, autoimmune, viral, mycotic, and idiopathic • Reactive soft tissue enlargements of oral mucosa • Benign tumors of oral mucosa - epithelial, mesenchymal, and salivary gland • Malignant neoplasms of oral mucosa • Cysts of oral mucosa
- 18. Sub mucosal swelling(by region) • Gingival • Tongue • Lips and buccal mucosa • Floor of the mouth • Palate • Neck Jaw lesions • Cyst of jaw • Odontogenic tumors • Inflammatory disease • Non odontogenic tumors • Malignancy of jaw • Metabolic and genatic diseases
- 19. Upon the finding, choose your investigation Fifth step : Investigation
- 20. Most used investigations /testsin clinical examination
- 21. Vitality tests of Pulp Electrical pulptest Thermal test Unfortunately it may not be apparent that a pulp test result s misleading. Care must always be taken to avoid causes of false positive or false negative results).
- 22. Other tests todetermine the offending tooth : By air syringe By using local anesthesia Percussion horizontal/ vertical Bleeding provoked / spontaneous Frimatus test
- 23. Imaging investigation Intra_oral Extra_oral Peri-apicalrx Bitewing rx Occlusal rx Panorama and other extra oral rx techinque Ultrasound Cbct MRI
- 26. Milking test forparotid gland
- 27. Chief complain analysisClinicalexaminationRadiological examination List of possible lesions with similar features Classify the lesion Development of differential diagnosis
- 28. Make differential diagnosis ** Dependon : •Age •Gender •Race •Country of origin •Anatomical location •Onset and course •Habits Rate the lesion/ condition/pain from most common to least common , according a relative frequency of occurrence .
- 29. Development of final diagnosis Developmentof final diagnosis needs further investigations to find the correct diagnosis and exclude other possible diseases .
- 30. BIOPSY * BRUSH BIOPSY *SMEAR BIOPSY * FINE NEEDLE ASPIRATIRATION * INCISIONAL BIOPSY * EXICISIONAL BIOPSY UNDER LIGHT MICROSCOPE FLOUROCENCE •DIRECT •INDIRECT biopsy specimen for histopathological examination Exfolaitive cytology Content of lesion
- 32.
- 33. Haematology, clinical chemistry andserology Types of blood test useful in oral diagnosis • Cbc • Peripheral blood film • ESR • Serum iron and total iron binding capacity / Serum ferritin • Autoantibodies • Viral antibody titres • Paul-Bunnell or monospottest • Syphilis serology • Complement tests • Serum calcium, phosphate, and parathormone levels • HIV test • Skeletal serum alkaline phosphatase
- 34. Examples of othertests patch test relies on the principle of a type IV hypersensitivity reaction Nikolsky sign Diascopy test Urine analysis Hb electrophersis Bacteriological diagnosis pathergy test
- 35. Color atlas ofcommon oral disease
- 36. Formulating final diagnosis History Examination Special investigation Final /Definitive diagnosis -/+ therapeutic trials may be in order ; example: traumatic bone cyst , stafne bone cyst .
- 37. Formulating a Treatment Plan thefollowing management strategies are considered: (1) no treatment, (2) surgical removal, (3) pharmacologic agents, (4) palliative treatment, (5) behavioral or functional treatment (6) psychiatric therapy. (7) Referral to a medical or dental specialist may be required follow-up
- 38. Conclusion So , diagnosisis systematic process started from patient’s entry with complain to the patient discharge with treatment .
- 39. Reference (1) http://pocketdentistry.com/3-diagnosis- investigations/ (1) (2)Clinical outline of oral pathology : DIAGNOSIS AND TREATMENT FOURTH EDITION, Lewis R. Eversole 2011 . (3) CAWSON'S ESSENTIALS OF ORAL PATHOLOGY AND ORAL MEDICINE SEVENTH EDITION , R. A. CAWSON , E. W. ODELL , S. PORTER 2002 (2),(3) . (4) Wood & Goaz differential diagnosis of oral maxillofacial lesions .
Editor's Notes
- #3 http://pocketdentistry.com/3-diagnosis-investigations/
- #11 Clinical outline of oral pathology
- #12 Cawsen
- #13 Cawsen
- #17 Cawsen
- #18 Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions Michael W. Finkelstein, DDS, MS Continuing Education Units: 4 hours
- #22 Oral pathology clinical pathological correlation 6th ed
- #26 Wood & goaz
- #29 Wood and Goaz
- #37 Cawsen Clinical outline of oral pathology
- #38 Clinical outline of oral pathology