Oral Medicine Lecture for the Fifth Stage PDF

Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad The Examinati...

Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad The Examination of the patient EXTRA ORAL ( head and neck) examination A complete examination covers the following three areas: The General Examination: briefly assesses the patient’s general appearance The Extraoral Head and neck Soft Tissue examination: focuses on the head and neck. The Intraoral soft tissue examination: determines if the soft tissue is within normal limits (WNL) A. General examination A thorough examination includes observing the patient's general appearance. The examination starts as soon as the patient enters the dental operatory. The patient’s general appearance may give clues to medical conditions. As the patient enters the room, and during history taking, observe the patient’s general appearance, symmetry, gait, and mobility. During the history taking, note any facial asymmetries, lesions or scars. For example, if the patient is in a wheelchair, the dentist need to find out the reason for this in your medical history. This could affect dental treatment in several ways. If the patient had suffered a stroke, they may need assistance transferring to the dental chair. As well, the medications the patient is taking following a stroke could affect your treatment. Additionally, the patient could have trouble maintaining adequate oral hygiene due to physical limitations. If the patient has decreased mobility of the head and neck, this should be noted, as it may affect the patient's ability to tolerate dental procedures. 1  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad I. Asymmetries Asymmetries of the head and neck are assessed by standing directly in front of the patient.so the patient may have to sit on the side of the chair. Compare one side of the head and neck to the other. Most people are not completely symmetrical, but significant asymmetries should be noted and the cause obtained from the patient if known. Examples of asymmetries are: previous surgeries, nerve paralysis from CVA/stroke, tumors, and infections. Details of the asymmetries should be noted in the chart - such as "3 cm scar in left submandibular area from submandibular gland stone removal. II. Abnormal color of the face The patient's exposed skin should also be examined. Clues to the patient's medical status may be obtained. If petechiae, ecchymosis, or hematoma are seen, then further information should be obtained from the patient about bleeding problems, or medications such as blood thinners. If the patient's skin appears yellowish, more information is needed about possible jaundice or liver problems. Clubbing of the fingers may be a sign of heart or respiratory problems. Other causes should be noticed by the dentist. 1.Vitiligo: is a condition in which the skin loses its pigment cells (melanocytes). This can result in discolored patches in different areas of the body, including the skin, hair and mucous membrane. 2.Melasma: Melasma (also known as chloasma) is noticed by tan or brown patches that may appear on the forehead, cheeks, upper lip, nose, and chin. Although this condition is often called the "pregnancy mask," men can also develop it. It may also occur in women who are taking birth control pills or postmenopausal estrogen. Melasma may go away after pregnancy, but if it remains, it can be treated with certain prescription 3.Pigmentation alteration (change): as a result of skin damage (post- inflammatory hyper- or hyperpigmentation). If the patient have had a skin infection, blisters, burns, or other trauma to the patient here there will be 2  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad decrease or increase of pigmentation in the affected area. This type of alteration is usually not permanent, 4. Other factors: including lifestyle modifications, hormonal changes, excessive exposure to the sun, repeated friction/exfoliation, and just growing older. 5. Yellowing of the skin and the whites of the eyes: — the main sign of infant jaundice usually appears between the second and fourth day after birth. (To check for infant jaundice, press gently on baby's forehead or nose. If the skin looks yellow where pressed, it's likely that baby has mild jaundice) Jaundice is a condition in which the skin, whites of the eyes and mucous membranes turn yellow because of a high level of bilirubin, a yellow-orange bile pigment. Jaundice has many causes, including hepatitis, gallstones and tumors. In adults, jaundice usually more serious 6. Pale skin can be a sign that patient have a shortage of normal red blood cells (anemia), which means that less oxygen is delivered to the body. This can be from a nutritional deficiency, blood loss, or a blood cancer like leukemia. Other causes of pale skin include low blood pressure or infection. 7. Brown spots are caused by the overproduction of melanin in the skin. Melanin is the pigment that gives the skin, hair and eyes their color. produced by cells called melanocytes. melanocytes as sponges that soak up sunlight 8. kidney toxins: When the kidneys stop working as they should, toxins build up in skin This build-up can cause color changes to the skin. Other causes of skin discoloration is related to pigments called urochromes being retained in the skin. Normally these are excreted by healthy kidneys. Patients with this condition tend to have a grayish, almost metallic color skin. Another discoloration is called uremic frost 9. The presence of the basal cell carcinoma 10. Blue nevi are localized benign proliferations of melanocytes. They may be congenital or acquired. There are two types. Common blue nevi range in size from 2–10 mm. They present as small round to oval, smooth-surfaced, well-defined papules with a bluish-black pigmentation. Cellular blue nevi are less common and tend to be >1 cm. They are also bluish-black and may be mistaken for nodular melanoma. Rarely, cellular blue nevi can undergo malignant transformation 3  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad III. Facial features A- Moon facies: Face has gradually swollen into a rounded shape, this is moon facies. Also called moon face. Moon facies occurs when extra fat builds up on the sides of the face. It is often related to obesity but can be from Cushing's syndrome. That's why people sometimes refer to it as a Cushingoid appearance. Cushing's syndrome occurs when the body is exposed for long periods to high levels of a hormone called cortisol. Symptoms and Causes of Moon Facies Moon facies may cause the face to gradually become round, full, or puffy. The sides of face may become so round from the buildup of fat that the ears can't be seen from the front of face. Fat deposits in the sides of the skull can also make the face look rounder. A high release of hormones, especially cortisol, is a cause of moon face. This is called hyperadreno corticalism or hypercortisolism.( The adrenal glands, triangular- shaped glands that sit on top of the kidneys, release the cortisol). Conditions Related to Moon Facies The conditions that most commonly lead to hypercortisolism and the symptom of moon facies include: Increased release of a hormone (ACTH) Increased release of a hormone (ACTH) from the pituitary gland; ACTH prompts the adrenal gland to produce cortisol. Nonpituitary tumors -- such as tumors of the lung, pancreas, or thymus -- which may also cause big releases of ACTH Benign tumors or cancers in the adrenal gland 4  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad Long-term use of steroid medications like prednisone for conditions such as rheumatoid arthritis or other autoimmune conditions To confirm that moon facies is the result of abnormal cortisol levels, blood and urine tests. should be done to confirm the cause of high cortisol levels, other tests, such as an MRI or CT scan. Moon Facies and Cushing Syndrome Note: It can be difficult to diagnose Cushing's syndrome. That's because signs and symptoms such as facial swelling can be caused by other conditions. But it is more likely to be Cushing's syndrome if moon facies gets worse gradually along with other characteristic symptoms. Moon Facies and Steroid Treatment Long-term use of steroids such as prednisone can cause many of the same signs and symptoms of Cushing's syndrome. In fact, weight gain with fat redistribution such as moon facies is one of the most common signs of steroid use. the risk of developing these signs depends on the dose of medication and how long take it. With steroid use, an increase in appetite and food intake may contribute to weight gain. Symptoms usually occur as the result of long-term use of oral steroids. But less commonly, injected or inhaled steroids may cause Cushing's signs and symptoms, too.myopathy. B. Hypotonic faces Along with the rest of the muscles in the body the muscles in the face can also be slightly weaker which sometimes means that the children may lack a puzzled expression or generally not be very expressive at all. Noses 5  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad They may have a prominent bridge/root, a bulbous or dimpled/creased tip and the nostrils are narrow and it looks as though the part just below where glasses would sit bulges out slightly. Eyes They can be small, almond shaped and either upward or downward sloping with hooded upper and lower eyelids. They can also be wide set. Mouth This is generally noted as being small, sometimes with a thin upper lip and long featureless philtrum (the channel that runs between the nose and the mouth) so that sometimes the top lip is straight i.e. it doesn't have a 'bow shape'. Face The cheekbones may be flat, this is called malar flatness. As the children get older it is sometimes the case that their faces become longer and the flatness then becomes more apparent. The forehead can also seem broad and flat. C. Down syndrome: often have a characteristic facial appearance that includes a flattened appearance to the face, outside corners of the eyes that point upward (upslanting palpebral fissures ), small ears, a short neck , and a tongue that tends to stick out of the mouth Three features that are found in nearly every person with Down syndrome are: Epicanthic folds (extra skin of the inner eyelid, which gives the eyes an almond shape) Upslanting palpebral fissures (slanting eyes) Brachycephaly (a smaller head that is somewhat flattened in the back) The nose is pinched, the eyes are sunken, the temples hollow, the ears cold and retracted, the skin of the forehead tense and dry, the complexion livid, the lips pendent, relaxed, and cold. D.Malar rash: is a red or purplish facial rash with a “butterfly” pattern. It covers your cheeks and the bridge of the nose, but usually not the rest of the face. The rash can be flat or raised. A malar rash can occur with many different diseases and conditions, from sunburn to lupus. E. Face of mal nutritional: Acute malnutrition pertains to a group of linked disorders that includes kwashiorkor, marasmus, and intermediate states of marasmic kwashiorkor. They are distinguished based on clinical findings, with the primary distinction between kwashiorkor and marasmus being the presence of edema in kwashiorkor 6  Oral medicine lecture for the fifth stage Lec 2 Mohammed Mahdi lafta M.Sc. oral medicine reference Prof. Dr. Fawaz Al-Aswad F. SCALY SKIN Repeated skin irritation due to environmental factors, such as the sun, the wind, dryness or excessive humidity, may cause skin desquamation, that is the detachment of big scales from the epidermis, which sometimes look like fine dust. However, desquamation may also be the result of some condition, such as an allergic reaction, a fungal or staphylococcus infection, an immune system disorder or cancer, and of oncological treatments. In these cases, desquamation is usually accompanied by itching. G. RED SPOTS There is a large number of dermatological causes and diseases for the appearance of red spots or rash, including infections, heat, allergens, immune system disorders and medications. H. SKIN MOLES Moles are dark dots or spots on the skin that usually appear during childhood and adolescence. They are caused by groups of pigmented cells. In general they are harmless, but it is best to check them with a dermatologist if they change size, shape or color, or if itching or bleeding occurs, since some may become cancerous. In general, it is important to pay attention to skin appearance because, regardless of the type of skin, there are certain characteristics that could be a sign of a skin problem. 7