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Oral Medicine, Fifth class 2024-2025 The Principle of oral diagnosis and clinical examination Lect.1 College of Dentistry...

Oral Medicine, Fifth class 2024-2025 The Principle of oral diagnosis and clinical examination Lect.1 College of Dentistry Oral Diagnosis (Oral Medicine) Assist. Professor HUSSEIH SH. AL-ESSA B.D.S., M.Sc. (oral medicine), PhD. (Physiology) [email protected] https://scholar.google.com/citations?user=UZ5Xa https://www.researchgate.net/profile/Hussein-Al https://www.scopus.com/home.uri References: 1. Burket’s oral medicine. Michael Glick, Martin Greenberg, Peter Lockhart and Dtephen Challacombe. 13th edition.2021, Wiley Black well. 2. Bumann, A., & Lotzmann, U. TMJ disorders and orofacial pain. The role of dentistry in a multidisciplinary approach. 2011, Thieme. 2  Introduction : Oral Medicine is defined by the American Academy of theOral Medicine goal of as isthe root canal therapy discipline to remove bacteria from an infected root canal; nevertheless, this procedure is not of dentistry concerned with without risk, and side effectsthe oral There are possible. healthis a retreatment the goal of root canal therapy is to remove care of medically bacteria from an complex patients infected root canal; – nevertheless, this including theprocedure diagnosis and management of is not without risk, and side effects are possible. There is a retreatment option accessible in case medical conditions the o that affect the oral and accessible in case the outcome is un maxillofacial region. 3 Introduction : Oral medicinethe represents the clinical arm of goal of root canal therapy is to remove bacteria from oral pathologyan infected and dealsroot canal;with diagnosis nevertheless, andis not this procedure without risk, and side effects are possible. There is a treatment of soft-tissue retreatment the goal lesions, whereas of root canal oral therapy is to remove histopathologybacteria is from procedure the is an infected root canal; nevertheless, this specialty not without risk, and sidearea that effects are focuses on thepossible. microscopic the o diagnosis of soft- There is a retreatment option accessible in case and hard-tissueaccessible lesions of the in case theoutcome headisandun neck. 4  The following strategies are common to all methods of history taking:- ❖ Review available patient information prior to meeting the patient. ❖ Make the patient feel comfortable and pay attention to the patient’s concerns; do not rush the interview process. ❖ Use the patient’s own words to describe her primary reason(s) (“CC”) to seek care/consultation. ❖ Use open-ended questions that allow the patient to express herself. 5 There are three categories of oral medicine consultations:- ❖ Diagnosis and nonsurgical treatment of orofacial problems. This includes oral mucosal disease, temporomandibular and myofascial dysfunction, chronic jaw and facial pain, dental anomalies and jaw bone lesions, salivary hypofunction and other salivary gland disorders, and disorders of oral sensation, Such as dysgeusia, dysesthesia, and glossodynia. ❖ Dental treatment of patients with medical problems that affect the oral cavity or for whom modification of standard dental treatment is required to avoid adverse events. ❖ Seeking an opinion on the management of dental disease that does not respond to standard treatment, such as rampant dental caries or periodontal disease in which there is likelihood that systemic disease is an etiologic cofactor. 6  The SOAP Note (concept): The four components of a problem—subjective, objective, assessment, and plan (SOAP)—are referred to as the SOAP mnemonic for organizing progress notes or summarizing an outpatient encounter. The components of the SOAP mnemonic are as follows: ❖ S or subjective: The patient’s complaint, symptoms, and medical history (a brief review). ❖ O or objective: The clinical examination, including a brief generalized examination, and then a focused evaluation of the CC or the area of the procedure to be undertaken. ❖ A or assessment: The diagnosis (or differential diagnosis) for the specific problem being addressed. ❖ P or plan: The treatment either recommended or performed. The SOAP note is a useful tool for organizing progress notes in the patient record for routine office procedures and follow-up appointments. It is also quite useful in a hospital record when a limited oral medicine consultation must be documented. 7 Taking a history History-taking needs to be tailored to suit the individual patient but it is sometimes difficult to get a clear idea of the complaint. Many patients are nervous, some are inarticulate, others are confused. Initial questions should allow patients to speak at some length and to gain confidence. It is usually best to start with an 'open' question. Type of question example Open Tell me about the pain? Closed What does the pain feel like? Leading Does the pain feel like an electric shock? 8 The case history traditionally consists of the following subcategories:- Presenting complaint (PC) History of presenting complaint (HPC) Past medical history (PMH) Family history Social history Review of systems (ROS) 9 10 Pain :- is a subjective symptom in which the clinician relays on the description of the patient. 1-Character of pain:- dull, sharp, throbbing, burning. 2-Severity of pain:- mild, moderate, sever. 3-Onset of pain:- to determine the duration of pain. 4-Continuous or intermittent:- dental pain---continuous. Psychogenic pain---intermittent 5-Is it increase or decrease in severity. 6- Point of maximum intensity. 7- Area to which pain spreads:- e.g. abscess. 8-Area to which pain radiate or referred. 9- What makes it worse. 10-Are there other symptoms. 11 Examination of a lump (swelling or neoplasm) Before examining a lump or a mass make sure of the following:- ❖ How long the swelling has been present ❖ Is it getting larger. ❖ Is there a history of trauma 12 Examination of a lump (swelling or neoplasm) On clinical examination of a lump evaluate the following:- ❖ Is it single or multiple. ❖ Shape of swelling. ❖ Size of swelling. ❖ Are there associated lymph nodes enlarged. ❖ The surface, smooth or irregular. ❖ The exact anatomical situation. Skin, subcutaneous tissue, muscles, bone or any organ. 13 Examination of a lump (swelling or neoplasm) On clinical examination of a lump evaluate the following:- ❖ 7-consistency:- ✓ Soft----lipoma ✓ Firm---fibroma ✓ Bony hard---osteoma ✓ Rock hard---malignant lymph node ✓ Rubbery hard---lymph nodes of Hodgkin’s lymphoma ❖ The edge: diffuse or clearly defined. ❖ Is the lump tender to palpation ❖ Is it fluctuant ? 14 Examination of an ulcer ❖ situation or site ❖ single or multiple ❖ size ❖ shape: round. Oval, irregular ❖ base: soft or indurate (malignant)? ❖ floor: G.T, smooth, fungated 15 Examination of an ulcer ❖ edge : ✓ Undermined(tubercular) ✓ Punched(gumma) ✓ Rolled, rasied and reverted(malignant ulcer) ❖ Surrounding tissue:-healing or inflamed 16