Oral Diagnosis Lecture Notes PDF Fall 2024

Oral diagnosis Dr.Noha Dawoud B.D.S - M.Sc - PHD Lecturer of Oral Medicine, Oral daignosis and Periodontology Future University In Egypt Fall 2024  I– Patient identification  It is the simplest method for the...

Oral diagnosis Dr.Noha Dawoud B.D.S - M.Sc - PHD Lecturer of Oral Medicine, Oral daignosis and Periodontology Future University In Egypt Fall 2024  I– Patient identification  It is the simplest method for the dentist to know the patient.  The patient should write the information by himself on a printed form to avoid misspellings and other errors.  The Administrative chart Dentist’s name: Patient registration  Code number ………………………………  Date ……………………………………….  Name ……………………………………...  Date of birth (Age) …………………………  Sex ……………  Male  Female  Birth place …………………………………  Address …………………………………….  Phone number: Home.…………… Office…………… Mobile …………  Occupation …………………………………  Marital status ……………………………… Significance of components of the administrative chart 1- Code number : It is essential for record keeping and retrieval of the patient’s file. 2– Date of examination:  It helps in retrieval of the file.  In recall visits, it helps in certain recurring conditions e.g. allergic seasonal diseases, aphthous ulcer…etc. 3– Name :  Patient’s full name and how he or she prefers to be addressed should be recorded.  Patient’s name is important for: a) Record keeping and retrieval of the file. b) Administrative purposes. c) Better communication between the dentist and the patient. 4 – Date of birth (patient’s age) :  Certain diseases occur in certain age groups and rarely in others. For example:-  Childhood: candidosis, measles and mumps.  Old age: squamous cell carcinoma. 5– Sex (gender) :  It is important in those who carry names that could be taken for both sexes e.g. Amal, Esmat…etc.  Some diseases are common in: - Males: prostatic carcinoma, leukoplakia and carcinoma of the lip. - Females: iron deficiency anemia and lupus erythematosis. 6– Birth place :  It is important to detect diseases acquired in childhood (endemic diseases). For example:-  Chronic dental fluorosis resulting from drinking water from wells in Libia and Saudia Arabia.  Bilharziasis is of common occurrence in Egyptian villages. 7– Address :  Address may help in knowing the patient’s social and home background.  Patients living near factories are liable for pulmonary diseases.  The address may be useful for recalling the patient. 8– Phone number : The telephone number of home, office and mobile is important for recalling the patient especially after oral biopsy when malignancy is suspected. 9- Occupation :  In some instances, the diagnosis of some diseases will be based on the knowledge of the patient’s occupation or the nature of his work.  Occupational diseases results from the effect of the harmful factors of the working environment.  Acids cause tooth erosion and inflammation of the mucosa.  Bacteria from cattles cause cervicofacial actinomycosis.  Dusts e.g. ferrous metal cause attrition of teeth.  Heavy metals e.g. Lead (water pipes) and Mercury (fluorescent lamp) cause metal intoxication. Non – metallic elements e.g. flourine (fertilizers and insectisides) cause intoxication. Trauma in glass blowers and shoe makers cause notching of incisors. Carcinogenic agents e.g. arsenic and tar cause malignancy. 10– Marital status :  Psychological stress of some married people may predispose to certain oral diseases such as lichen planus and aphthous ulcers.  It may be a source of infection in certain diseases such as T. B., AIDS, and other viral infections.  II – Chief complaint (cc) It is a symptom (or symptoms) described by the patient in his own words. (cc) is a statement of why the patient consulted the dentist: “What brought you to see me today” Shaping of the chief complaint:  Specific and understood by the examiner.  Patient's own diagnosis should be avoided.  It may be a single or multiple complaints.  Multiple complaints are listed in the order of importance to the patient. Factors which govern shaping of the chief compliant by the patient: 1- Age 2- Degree and type of education 3- Language 4- Mental status 5- Memory of the patient 6- Pain threshold 7- The prestige of the dentist Common chief complaints 1–Pain 2– Swelling 3 – Bleeding 4 – Oral ulceration 5 – Burning sensation 6 – Sensitivity to hot and cold 7 – T.M.J. disorder 8 – Paraesthesia and numbness 9 – Functional disorders 10 – Bad breath (halitosis) 11 – Esthetic problem N.B. Regular check up (notation – no chief complaint)  III – History of chief complaint (Hx cc) It is the story of the chief complaint from its onset to the time of taking the history in chronological order.  Chief complaint chart Chief complaint ……………………………………………. ……………………………………………………………………… History of chief complaint ………………………………. 1 – Onset: ……………… Date: …………………Character: ……. 2 – Date of presentation ………………………………………… 3 – Duration ……………………………………………………… 4 – Character and severity of the complaint ………………… 5 – Course ……………………………………………………… 6 – Location and site ……………………………………………. 7 – Distribution …………………………………………………. 8 – Precipitating factors ……………………………………… 9 – Associated phenomenon ……………………………………. 10 – Relieving factors ………………………………………………. 11 – Previous medications …………………………………… 1] Onset : Character of onset: Sudden Gradual Insidious Acute conditions Chronic Congenital conditions malformation Allergic conditions Neoplastic lesions Physiologic conditions Date of onset : Recorded in day, month and year e.g. 22/9/ 2007  Duration: Recorded in hours, days, weeks, months and year The duration of the complaint = (Date of onset) – (Date of presentation)  Character and severity: (mainly of pain) Severity: mild, moderate or severe Character of pain - Throbbing pain - Electric shock like pain - Sharp shooting pain - Dull aching pain  Location and site: Location : is the anatomical area: tongue, cheek, gingiva, etc Site: is the specific location in an anatomical area e.g.lateral aspect of the tongue  Course: Progressive: (increasing in severity) e.g. tumors, acute inflammatory lesions. Regressive (decreasing in severity) e.g. self drained abscess Recurrent, intermittent, remission and exacerbation  Recurrent Intermittent Remission/Exacerbation - One lesion - Lesion is - Lesion is present all heals. present all the the time. time. - A similar one appears - Signs and - Signs are present. at another symptoms site. disappear then - The change is in the reappear. severity of symptoms. aphthous salivary gland lichen planus ulcer stone accomp. by swelling  Distribution: A Solitary Multiple e.g. traumatic ulcer Unilateral Bilateral e.g. Herpes Zoster symmetrical asymmetrical e.g. lichen e.g. erythema planus multiforme  (B) Restricted to one region of the oral cavity: Anterior part of palate as 1 ry herpetic gingivostomatitis Posterior part of palate as herpangina. (C) Intra oral only e.g. traumaticulcer, RAU. Extra + intra-oral e.g. Dermatologic diseases with oral manifestations as lichen planus, lupus erythematosis.  Precipitating factors and relation to other activities: a) Precipitating factors: eating, swallowing, sleeping, cold or hot drinks. b) Relation to other activities: Pain on exertion (cardiac patient ). Pain in upper teeth which increase with leaning downwards (sinusitis).  Relieving factors: Rest Medications as simple analgesics. Cold water or hot fomentation.  Associated phenomena: These are manifestations associated with the complaint. Fever (with acute abscess). Prodrome of fever, malaise, lymphadenopathy as in1 ry herpetic gingivostomatitis. Others: e.g. nausea, vomiting, trismus, numbness...etc.  Previous medication: The dentist should ask about : Mouth washes, analgesics, antibiotics previously used by the patient. Their effect on the c/c Duration of treatment should be noted.  Pain as chief complaint Pain is an unpleasant sensation due to noxious stimulus. According to origin pain may be: (1) Somatic pain: Due to noxious stimulation of normal neural structures that innervate body tissues. (2) Neurogenic pain: due to pathology or abnormality in the neural structures themselves (within the nervous system), i.e. neuropathy. Neuropathy : a) Neuritis: inflammation in nerve trunk. b) Neuralgia: paroxysmal pain along the nerve distribution due to vascular spasm, CNS disease or of unknown etiology. (3) Psychogenic pain: due to psychic stress. Somatic pain Neurogenic Pain Psychogenic Pain - Usually acute - Usually chronic chronic - Cause is apparent - No cause is usually - No apparent causes (usually inflammation) apparent (except with neuorotropic viruses infection e.g. Herpes zoster) Character: - Lancinating, - No specific Character Throbbing, aching, stabbing, electric shock sharp, mild , moderate like - May be progressive in - constant in severity - Bizarre pattern severity (variable in severity) - Localized at affected - Localized to affected - No localization; vague, region and may cross nerve distribution and diffuse distribution, mid line usually not crossing mid (crossing anatomical line boundaries e.g. bilateral - May be referred to - Not referred - Referred to neighboring or abnormal locations opposing structures on the same side. - No trigger zones - There may be - No trigger zones. trigger zones (½ inch sign of trigeminal neuralgia) e.g. (1)pulpal pain e.g. (1) trigeminal (2) pain from neuralgia History of psychic supporting (2) causalgia stress or structures (Periodont (3) viral neuralgia antidepressant drug al ligament / bone) therapy (3) pain from mucosal lesions  Swelling as C/C Onset Sudden : *Acute inflammatory condition *Allergic condition Gradual : *Chronic inflammatory condition. *Neoplasm *Salivary gland disease *Bony lesion Duration Short: hrs, days: acute inflammation Long: months, yrs: chronic inflammation, benign neoplasms. Course Progressive: * acute inflammation * neoplasms Regressive: * self-drained abscess Intermittent: s. gland stone (repeated swelling with meals and relief in between meal times). Exacerbation and remission: chronic periapical abscess History of recurrence : may imply chronicity e.g. Acute exacerbations of chronic periapical abscess. Distribution: Unilateral : Acute dentoalveolar abscess Bilateral: Mumps, allergy. Associated phenomena: Fever = acute inflammation Pain + ve with acute inflammation - ve with neoplastic lesions Salty taste: cyst Previous medication: Drugs to which the patient is allergic. Antibiotics: if good response, thus swelling is caused by bacterial infection. Location and site: May give information about tissue constituents of neoplastic growths. Periapical, periodontal and gingival abscesses can be usually differentiated by their site in relation to the vestibule and gingiva.  Swelling as C/C Chief complaint ……………………………………………. History of chief complaint ……………………………… 1 – Onset: ……………… Date: …………………Character: ……. 2 – Date of presentation ………………………………………… 3 – Duration ……………………………………………………… 4 – Character and severity of the complaint ………………… 5 – Course ……………………………………………………… 6 – Location and site ……………………………………………. 7 – Distribution …………………………………………………. 8 – Precipitating factors ……………………………………… 9 – Associated phenomenon ……………………………………. 10– Relieving factors ………………………………………………. 11– Previous medications ……………………………………  Bleeding: as C/C Local causes: periodontitis, trauma and postoperative infection. Systemic causes : Platelet disorder Clotting disorder Blood vessel abnormality Evaluation of the case before management : 1) Patient at low risk: No history of bleeding disorder. Non specific history of excessive bleeding and normal bleeding parameters. These patients can be managed by normal protocol. 2) Patients at moderate risk: Patients on anticoagulant therapy. Patients on chronic aspirin therapy. Modify the treatment plan before dental therapy. 3. Patients at high risk: Patients with known bleeding disorder. Patients without known bleeding disorder, but with abnormal bleeding parameters. Dental management requires : Coordination with the patient's hematologist. Hospitalization. Thankyou