Oral Diagnosis PDF

 Oral Diagnosis By Dr: Abdullah Ibrahim Lecturer of Oral Medicine, Periodontology, Oral Diagnosis & Dental Radiology Faculty of Dental Medicine, Al Azhar University  Clinical examination Is the second phase of the diagnostic proced...

 Oral Diagnosis By Dr: Abdullah Ibrahim Lecturer of Oral Medicine, Periodontology, Oral Diagnosis & Dental Radiology Faculty of Dental Medicine, Al Azhar University  Clinical examination Is the second phase of the diagnostic procedure. It helps the clinician to record objective findings (signs) relating to the patient's complaint. Means of clinical examination 1. Inspection 2. Palpation 3. Percussion 4. Auscultation 5. Probing 6. Olfaction 7. Aspiration  1- Inspection By using sense of Vision 1. The dentist (should know the normal appearance (normal anatomic variation) of the tissues he examined in order to assess abnormalities. 2. For bilateral structures. the examiner should compare the appearance of one side with the other. 3. By inspection the examiner records the color and surface contours of the lesion as well as the functional movement of some oral structure e.g. tongue 4. The dentist should looked good for anatomical physiological and psychological landmarks of his patient and any deviation from the normal must be recorded  Good light Transillumination is of great value in detection of interproximal caries in anterior teeth by the use of light cure equipment. rules must Effective patient be taken position during inspection. Washing and irrigation of the lesion Suction, retractor, tongue depressor and dental mirror The normal color of the oral mucosa include the range of pink taking into consideration any physiologic pigmentation that might be present. The white color indicate the presence of : More keratin in the epithelial surface, Pseudo membrane formation Reticular type of lichen planus at buccal mucosa  The red color indicate thinning of the lesions i.e. erosion or atrophy of epithelial surface and may be due to increase of vascularity of the underlying submucosa. Erosive areas on palate of lupus erythematosis patient  the yellow color indicate the presence of anemic pallor, increase the level of bilirubin “ jaundice”  Brown, bluish or black discoloration indicates the presence of: e.g. metallic intoxication , melanin pigmentation. Melanin pigmentation of the gingiva  2- PALPATION  By using sense of Touch to detect tissue abnormalities. Palpation is performed by: 1. Compressing the examined tissues or structures between two fingers or two hands as in oral soft tissue e.g. tongue, lip and buccal mucosa 2. Compressing the tissues against the bone when the tissue are supported by bone e.g. attached gingiva and mucosa of the hard palate.  Features that can be revealed by palpation include; 1. Consistency 2. Mobility 3. Extension of the lesion  1. Consistency The following terms are commonly used to describe the consistency Soft: compressible under pressure as lipoma or mucocele. Firm: tissues cannot be easily compressed under pressure with minimal shape alteration occurs. Many benign neoplastic and hyperplastic enlargements are firm.  Hard: sensation of bony tissue and implies calcification Indurated: means hardness without calcification. Induration is a feature of many malignant neoplasm’s. Spongy: tissue respond to pressure then quickly regains the original contour after release of pressure  Pitting: tissue respond to pressure then slowly regains the original contour after release of pressure, e.g. edema Collapsing: tissue respond to pressure, remains deformed after the release of pressure. Rough or smooth  2.Mobility Palpation reveals whether a mass is fixed or mobile in all direction Freely movable masses in all directions benign lesion AS epidermoid cyst. Fixed masses AS squamous cell carcinoma at this stage fixes the skin or mucous membrane to the deeper tissues.  3.Extension of the Lesion The lesion may have: Ill defined borders (malignant lesion that infiltrates adjacent tissue). well defined borders (encapsulated). Round or ovoid masses are suggestive for cyst, benign tumor or lymph nodes. Irregular shapes are suggestive for malignancy The palpation may be bi-digital or bi-manual  Bidigital palpation: means examination of the tissue between two fingers of one hand of the examiner.  Bimanual palpation: means examination of the tissue by using two hands or finger of both hands.  Bimanual palpation The good example is the examination of the floor of the mouth. The technique of this type of palpation as the following: The examine index finger of one hand should express the floor of the mouth while, the opposing finger of the other hand compress the tissues to detect salivary gland calculi  Palpation of the tempromandibular joint  Use light pressure.  Place your finger just anterior to the tragus of the ear.  Instruct the patient to slowly open, close, and move the mandible from one side to another “bimanual”.  Palpation of submandibular area  Instruct the patient to tilt her head pack slightly and carefully palpate the submandibular area “bimanual”.  Palpation of submental area  Instruct the patient to bite together tightly and place the tongue into the palatal fold, this will result in stretching of the mylohyoid muscle.  The dentist can palpate the submental soft tissues against the muscle.  Bidigital palpation The good example of this type of palpation is the examination of some lesions affecting oral mucosa such as leukoplakia of the oral cavity, different types of lichen planes, gamma of the tongue and palate in tertiary stage of syphilis, median rhomboid glossitis and palpation of the submandibular lymph nodes and submental area.  gamma of the tongue and palate in tertiary stage of syphilis, median rhomboid glossitis  3- Percussion  Percussion means striking of the tissues by an instrument to listen to the result sounds and also to evaluate the reaction of the patient to percussion i.e. painful or not.  Percussion as one of means of clinical examination is used for evaluation and localization of the inflammatory condition involving the teeth and supporting structures e.g. periodontal and periapical abscess.  Technique of teeth percussion:  Striking of the cusp or incisal edge of each tooth.  The examiner should use a gentle stroke of instrument with blunt end e.g. explorer No 17.  The blow of percussion should be directed to the long axis of the tooth.  Tooth with healthy periodontium exhibit solid sound on percussion, while the tooth with any pathologic condition the dentist feel dull sound on percussion.  Apical percussion to detect the preapical lesion.  Lateral percussion to detect the periodontal condition.  Percussion of the muscles done by sharply tapping on the area to be examined with the tip of two or three fingers. By this technique the clinician can obscure the muscles reflex mechanisms and tenderness.  In patient with hypoparathyrodism “Tetany” the percussion can be performed by tapping over the facial nerve in front of the ear, the results will be twitching of the facial muscles (chivostek’s sign)  4- Auscultation  Means listening for sounds within the organ e.g. heart or structure as tempromandibular joint.  In dentistry the auscultation as one of clinical examination means is commonly used during examination of tempromandibular joint e.g. TMJ clicking.  5- Probing  The probing mainly restricted on detection of carious lesion of the teeth or detection and measurement of pocket depth , so this technique is most commonly used during intra-oral examination.  Probing of the teeth is performed by use of dental explorer, and measurement of pocket depth by use of calibrated or graduated periodontal probe.  6-Olfaction The sense of smell occasionally contributes to diagnostic information as: Fetid odor of bacterial infection ANUG. Garlic or bad odor of periodontitis. Acetone odor in diabetes. Urine smell in renal failure.  7- Aspiration This is performed to obtain specimen from cystic or fluctuant mass. A large needle and syringe is used to pierce the wall of the lesion and suction to deliver the specimen. Pathology Aspirate colour Odontogenic keratocyst Thick yellow cheesy material Dentigerous cyst Straw colored fluid Radicular cyst Straw colored fluid Residual cyst Amber colored fluid Traumatic bone cyst Non-productive Aneurysmal bone cyst Red colored fluid Infected cyst Pus Ameloblastoma Straw colored fluid Hemangioma Red colored fluid