Oral Diagnosis & Treatment Planning Finals PDF

PRDM 142: ORAL DIAGNOSIS & TREATMENT PLANNING FINALS DENT 4- I 4th Year, 2nd Semester | 2023-2024 Professor: Dr. VC TAN MODULE / TOPIC function is to serve as the entrance of...

PRDM 142: ORAL DIAGNOSIS & TREATMENT PLANNING FINALS DENT 4- I 4th Year, 2nd Semester | 2023-2024 Professor: Dr. VC TAN MODULE / TOPIC function is to serve as the entrance of the alimentary tract and to initiate the FONT STYLE: Lexend normal - digestive process by salivation and DEFINITION FONT SIZE: 9 propulsion of the alimentary bolus TITLE: LEXEND MEDIUM into the pharynx. It also serves as a TITLE IN THE BOX: LEXEND secondary respiratory conduit, a site SEMIBOLD of sound modification for the production of speech, and a TITLE chemosensory organ. SUBTITLE SUB SUBTITLE Oral Tissues and Structures SUB SUB 2 Landmarks of the oral tissues include the palate, tongue, cheeks and floor Module 6: Examination of Soft of the mouth. It is significant to Tissues recognize the normal appearance of these structures during an intraoral An important part of a patient’s first examination of the patient. visit to a dental office is the examination of the head and neck. 1. Fauces – Passageway from The clinician will be checking to see if oral cavity to pharynx. these structures are normal or if there 2. Frenum – Raised folds of are any conditions requiring further tissue that extend from the investigation. This includes an alveolar and the buccal and examination of the soft tissues of the labial mucosa. head and neck as well as the inside of 3. Gingiva – Mucosal tissue the mouth. This should be performed surrounding portions of the thoroughly and systematically to maxillary and mandibular ensure that no parts are missed. If an teeth and bone. abnormality is seen, the clinician 4. Hard palate – Anterior portion should note details such as the type, of the palate which is formed size, color, location, surface texture, by the processes of the and consistency of the abnormality. maxilla. 5. Incisive papilla – A tissue M6 Lesson 1: Normal and Abnormal projection that covers the Soft Tissue Conditions incisive foramen on the anterior of the hard palate, The oral cavity represents the first just behind the maxillary part of the digestive tube. Its primary central incisors. 6. Maxillary tuberosity – A bulge 16. Uvula – A non-bony, muscular of bone posterior to the most projection that hangs from the posterior maxillary molar. midline at the posterior of the 7. Maxillary/Mandibular tori – soft palate. Normal bony enlargements 17. Vestibule – Space between the that can occur either on the maxillary or mandibular teeth, maxilla or mandible. gingiva, cheeks and lips. 8. Mucosa – Mucous membrane 18. Wharton’s duct – Salivary lines the oral cavity. It can be duct opening on either side of highly keratinized (such as the lingual frenum on the what covers the hard palate), ventral surface of the tongue. or lightly keratinized (such as what covers the floor of the Tongue mouth and the alveolar Landmarks of the tongue include the: processes) or thinly keratinized (such as what covers the 19. Apex of the tongue – The tip cheeks and inner surfaces of of the tongue. the lips). 20. Circumvallate papillae – Two 9. Palatine rugae – Firm ridges v-shaped rows of larger, flat, of tissues on the hard palate. cup shaped papillae on the 10. Parotid papilla – Slight fold of posterior dorsum of the tissue that covers the opening tongue. Each contains taste to the parotid gland on the buds. buccal mucosa adjacent to 21. Dorsal surface – The top maxillary first molars. surface of the tongue. 11. Pillars of Fauces – Two arches 22. Filiform papillae – Fine, small, of muscle tissue that defines cone shaped papillae covering the fauces. most of the dorsum of the 12. Soft palate – Posterior portion tongue. They are responsible of the palate. This is non-bony for giving the tongue its and is comprised of soft tissue. texture and are responsible for 13. Sublingual folds – Small folds the sensation of touch. of tissue in the floor of the 23. Foliate papillae – These mouth that cover the openings papillae are large, red and to the smaller ducts of the leaf-like. They are located on sublingual salivary gland. the posterior, lateral surfaces 14. Submandibular gland – of the tongue. They contain Located near the inferior some taste buds. border of the mandible in the 24. Fungiform papillae – Deep submandibular fossa. red in color and are distributed 15. Tonsils – Lymphoid tissue over the dorsum of the tongue. located in the oral pharynx. Each one of these mushroom  shaped papillae contains a associated with medical taste bud. disease such as diabetes, 25. Median sulcus – Slight heart disease, and adverse depression in the middle of the pregnancy outcomes dorsum of the tongue running Abnormal color appearances, from the tip to the base of the or swellings MAY be indicative tongue. of a malignancy or a cancer 26. Ventral surface – The underside of the tongue. Table of Common Oral Conditions (read niyo na lang yung pdf under M6 Deviation from the Normal Lesson 1 Part 3-2 for better viewing kasi panget pag tinable sobra haba) It goes without saying that before any abnormalities can be identified, it is necessary to have a working familiarity not only with the normal appearance of all these tissues in health, but also with the variations of a normal presentation that are not indicative of a significant problem. With this in mind, clinicians and dental students should periodically refresh their memory of the soft tissue lesions which might be encountered in and around the oral tissues, their etiology and presentation, and their management. The soft tissues can reveal several matters of health importance: Within the mouth fibrous cheek lines tell us that you may be grinding your teeth. Grinding can be very destructive and result in complete unsalvageable breakdown of teeth which are heavily filled Inflamed or bleeding gums indicate that you have gum disease. Apart from loss of teeth, gum disease is  performing a complete oral examination. Knowledge of clinical characteristics such as size, location, surface morphology, color, pain, and duration is helpful in establishing a diagnosis. Monitoring the health of the oral soft tissues presents clinicians with a particular challenge because of the relative lack of objective measures to facilitate meaningful comparisons from one examination to another. This makes the soft tissue examination very different from orthodontic monitoring (where study models can be used), or the monitoring of caries or periodontal disease. Furthermore, caries and periodontal disease are more prevalent than the pathology affecting the oral soft tissues, and it is perhaps not surprising that historically, these diseases have been the focus of the greatest attention. Most clinical records tend to contain information about the status of the M6 Lesson 2: Sequence of teeth and restorations than of the Examination, Evaluation & Diagnosis periodontal tissues, and in turn, more information about the periodontal tissues than about the health of the soft tissues in and around the mouth. What is a Soft Tissue Intraoral Exam? The intraoral soft tissue examination includes checking the soft tissues of the mouth, the throat, the tongue and the gums. A consistent, reproducible approach should be taken, examining each of the tissues in turn, and recording the findings individually Recognition and diagnosis require (from the tongue, lips, palate, floor of taking a thorough history and mouth, retromolar area, etc). Any unusual presentation should be noted, opinion. A picture can also assist the which may take the form of changes specialist team to prioritize patients. in: 1. Colour (inflammatory changes, dark or pale appearance, white patches or other discolouration). 2. Surface profile/texture (for example, swelling, ulceration, induration, loss of normal roughness/smoothness). 3. Shape and anatomical features (for example, loss of papillae, asymmetry, etc). Sequence of Oral Tissue Examination While it is possible to record the 1. Lips and Labial Mucosa location, size and shape of lesions or areas of unusual appearance by The Soft Tissue Intraoral exam begins means of diagrams, and this is with an examination of the lips and certainly better than nothing, intra the mucosa inside the lips called the oral photography has the added labial mucosa. The labial mucosa will advantage that it can capture be examined by gently turning the lip changes in color and surface profile out. The labial mucosa should appear that could otherwise become very wet and shiny. difficult to record with any degree of accuracy. 2. Buccal Mucosa and Vestibular Mucosa The key to monitoring the health The examination proceeds to the of the oral soft tissues is the ability to inside of the cheeks, called the buccal compare the appearance and mucosa. Two mirrors will be used in a presentation from one visit to another. thorough and stepwise process, moving from one side of the mouth to Capturing and retaining such the other. images digitally is convenient, cost-effective and can be integrated 3. Hard and Soft Palate, and Throat very easily into a patient's electronic record, which is precisely where this The hard palate is the firm area of the information needs to be stored. This roof of the mouth, and the soft palate approach also makes it very much is the soft area behind the hard easier to transmit the information to palate. The Dentist will examine both third parties to whom the patient areas visually, and shine a light in the might be referred for a second throat, to look for anomalies.  4. Tongue reveal tenderness that could be the result of infection or inflammation. The top of the tongue will be examined first, followed by the sides From PPT of the tongue. The tip of the tongue will be held with a piece of soft gauze and the tongue will be moved gently from one side to the other. The Dentist is looking for swelling or palpated areas, and possibly ulcers. The tissue in this area should be soft. The underside of the tongue will also be examined. Particular attention is paid to the sides of the tongue and the floor of the mouth, as cancers develop in these areas more frequently than on the top of the tongue or the palate. Oral cancers may have the appearance of ulcers, masses, red areas, or white areas. 5. Floor of the Mouth Now the clinician will examine the floor of the mouth. He or she may feel the saliva glands, which usually feels ropey or lobulated. A salivary stone in this area would feel hard. This examination is not painful, but it is a slightly odd feeling. 6. Gingiva and Alveolar Mucosa Finally, the clinician will examine the gums, which are called the gingiva. Healthy gingiva is pink, and regular. Some abnormalities include generalized or localized swelling, redness, ulceration or bleeding. The clinician may also palpate the area over the jaws to check for lumps and bumps. This examination may also  Module 7: Examination of Periodontium The dental health professional has a role of preventing the spread of tooth decay to maintain the oral health of our patient. While preventing tooth decay, these professionals are also tasked to help patients avoid gingivitis. It is recognised that a healthy mouth decreases the risk of serious health problems. Oral conditions strongly impact the overall health of an individual. By understanding the supporting structures of the teeth, clinicians can thereby prevent and halt the spread of gum disease.  taken, it means that which is "around the tooth The periodontium is composed of the gingiva, alveolar mucosa, cementum, periodontal ligament, and alveolar bone. These components serve to support the teeth in their alveolar bone. SUBTITLE SUB SUBTITLE M7: Lesson 1 - Anatomy of the Periodontium In order for the dental clinician to understand the disease process affecting the periodontium, it is important to know and understand the periodontal structures and its Gingiva function. The periodontium includes the investing and supporting tissues of the teeth, and it consists of the The gingiva constitutes the visible attachment apparatus and the part of the periodontium. It surrounds dentogingival unit. The primary the tooth necks and covers the functions of the periodontium are to alveolar bone. allow the tooth to be attached to the bone and to provide a barrier for the underlying structures from the oral microflora. Periodontium Refers to the specialized tissues that both surround and support the teeth maintaining The gingiva is divided into three parts: them in the maxillary and Free gingiva - Unattached mandibular bones. coronal portion of the from the Greek terms peri-, marginal gingiva. meaning "around“ odons, meaning "tooth.“ Literally  Interdental Papilla - Located between the proximal surfaces beneath contact points Free Gingival Groove - Demarcates the free gingiva from the adjacent attached gingiva (COL - saddle-like depression joining 2 pyramid-shaped papilla) Alveolar Bone The alveolar bone surrounds the tooth and holds it in place. Periodontal Ligament Attached Gingiva It ensures that the tooth is attached firmly to the alveolus. Consists of stippled tissues tightly bound down to the underlying bone and cementum of the tooth and Cementum extends from the free gingival groove to the mucogingival junction which Serves to anchor the tooth. demarcates it from the alveolar mucosa. Gingival Sulcus Potential space encircling the tooth sulcus with depth varying from 0.5-3mm.  M7 Lesson 2 Examination of Periodontium Examination can also be done through radiograph. As part of the overall treatment plan, periodontic examination should be performed to assess the periodontal status of the patient. Basic periodontal probing should be carried out to appraise problems arising from the periodontium since this will set the indication for the future treatment plan. Periodontal probing measures pocket depths, the width of keratinized gingiva, and the amount of attached gingiva and establishes a bleeding index. However, this RADIOGRAPHIC SURVEY procedure should be confined to fully erupted teeth. Check for: Height and form of interdental Adolescents are the most common alveolar bone crest age group affected with periodontal Lamina dura disease. Furthermore, recent studies Status of interradicular areas indicate that teenagers suffer tooth Overhanging margins loss due to periodontal disease. Width of periodontal ligament Therefore a thorough evaluation of space the supporting structures is necessary. Periapical bone status EXAMINATION OF THE PERIODONTIUM: MOBILITY (MILLER’S) VISUAL EXAMINATION OF THE GINGIVA 1st degree - distinguishable Aside from inspection, sign of movement up to 1mm examination can be done in a horizontal direction through probing (probing of 2nd degree - movement of gingival sulci). >1mm from normal in a horizontal direction 3rd degree - severe mobility in a horizontal and vertical direction  PERIODONTAL CHARTING - Depth of periodontal pockets Tooth mobility and malposition Bifurcation involvement (multirooted teeth) Plaque and gingival bleeding indices EXAMINATION OF THE GINGIVA CLINICAL SIGNS OF A NORMAL GINGIVA COLOR Pale or coral pink for a healthy gingiva but also dependent on the Records the level of the free vascularity of mucosa, gingival margin Hemoglobin in blood, degree Records level of attachment of keratinization, pigmentation and position of the free of the epithelium (pigmented gingival margin relative to the for dark-skinned people), CEJ presence of inflammation Depth of Periodontal pockets Level of bone around the teeth FORM OF CONTOUR OF INTERDENTAL Tooth mobility PAPILLAE (TRIANGULAR), FREE Malposition and Loss GINGIVA MARGIN AND ATTACHED Dental Caries GINGIVA Plaque and Calculus Index Periodontium Status has scalloped contours with knife-edged margins BUT is 6 points: (per tooth) lost with spacing, recession, - FACIAL: mesial, center, distal and inflammation - LINGUAL: mesial, center, distal 1 mm gradations Calibrated probe marked at 3, 6, 8mm PERIODONTAL CHART Clinical attachment loss - Free gingival margin level  DENSITY OR CONSISTENCY GINGIVAL SULCUS Normally firm, resilient, tightly Depth may vary during active bound to alveolar process eruption, average except at free margin and 0.5-3mm in adults, no bleeding interdental papilla borders on gentle probing On palpation, attached gingiva should feel primarily the contours of underlying bone and slight movement or resiliency of the interposed attached gingiva Free gingiva should yield slightly more to pressure and give a faint sense of movement M7 Lesson 3 Findings in Diseases Early stages of periodontal disease present gingival tissue that is swollen, red, and may bleed. For some, they may experience bad breath, pain during mastication, and a consistent Surface palpation and light bad taste in the mouth. If left rubbing will reveal the degree of untreated, periodontal disease may stippling and some extent the degree contribute to the susceptibility of an individual to systemic health concerns. CDC reported that apart from tooth decay, periodontal disease is the two biggest threats to dental health. It is also revealed that in the United States, periodontal disease is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%). Certain factors increase the risk for periodontal disease: Central or peripheral cyanosis Acute inflammations Smoking Metallic pigmentation Diabetes Tissue necrosis - gray Poor oral hygiene discoloration Stress Heredity Crooked teeth Underlying immuno-deficiencies—e.g., AIDS Fillings that have become defective Taking medications that cause (Tissue necrosis) dry mouth Bridges that no longer fit properly FINDINGS IN DISEASE (PRINCIPAL CLINICAL CHANGES) ALTERED COLOR An initial bright red erythema is usually associated with inflammation (Addison’s disease) and if it will not worsen will revert back to its original healthy color. Acute inflammation gives rise to a bright red erythematous discoloration Plaques and necrotic tissue may also alter the color Toothpaste and drugs Grayish slough easily removed suggests necrosis with pseudomembrane formation indicates ANUG (Acute Necrotizing Ulcerative Anemia Gingivitis) Polycythemia Addison’s disease (abnormal melanin formation GINGIVAL BLEEDING EVEN WITH CLINICAL ATTACHMENT LOSS GENTLE PROBING Below CEJ One of the earliest sign of From CEJ to junctional gingival inflammation epithelium Precedes change in color or any other visual signs of inflammation Indicated and epithelial and connective tissue inflammatory lesion ALTERED GINGIVAL FORM Loss of stippling Loss of knife-edge free PERIODONTAL DISEASE gingival margins Rounded interdental papilla Periodontal disease ranges from simple and early inflammation of marginal gingiva to advanced gingivitis and subsequently periodontitis. Inflammation of gingiva by bacteria is the most common cause. The primary cause of gingival inflammation and INCREASED SULCULAR DEPTH periodontal destruction is bacterial plaque. More than 3mm DENTAL PLAQUE Dental plaque is a resilient yellow-grayish substance that adheres to the intra-oral hard surfaces, including the prosthesis. The formation of plaque is a complex procedure initially involving the formation of a pellicle around the tooth surface.  Facultative aerobic PERIODONTITIS AS MANIFESTATION OF gram-positive microorganism SYSTEMIC DISEASES (Actinomyces and \S. Sanguis) are the first colonizers which Classification of these adheres to the pellicle through conditions should be based on adhesins. the primary systemic diseases As plaque maturation takes according to the International place, there is co-aggregation Statistical Classification of of secondary colonizers Diseases and Related Health (Fusobacterium n., P. Problems (ICD) codes. intermedia, P. gingivalis). Thus in the maturation of PERIODONTITIS plaque, there is a transition from aerobic gram-positive a. Stages: based on severity and facultative microorganisms to complexity management anaerobic gram-negative - Stage I: Initial microorganisms. Periodontitis - Stage II: Moderate M7 Lesson 4 Classification of Disease Periodontitis - Stage III: Severe As an overview, staging is dependent Periodontitis with on the severity of disease as well as potential for additional on the complexity of disease tooth loss management. Grading provides - Stage IV: Severe supplemental information about Periodontitis with biological features of the disease, potential for loss of the including a history based analysis of dentition the rate of disease progression, b. Extent and distribution: assessment of the risk for further localized; generalized; progression, anticipated poor molar-incisor distribution outcomes of treatment, and c. Grades: Evidence or risk of assessment of the risk that the rapid progression, anticipated disease or its treatment may treatment response negatively affect the general health of - Grade A: Slow rate of the patient. progression - Grade B: Moderate rate FORMS OF PERIODONTITIS of progression - Grade C: Rapid rate of NECROTIZING PERIODONTAL DISEASES progression Necrotizing Gingivitis Necrotizing Periodontitis Necrotizing Stomatitis NOTE: the findings combined with 1. Severity - interdental clinical recognition of the signs and obtaining attachment level (CAL) at site symptoms experienced by the patient. with greatest loss; Patients seek treatment as soon as radiographic bone loss and they feel the discomfort and pain. It is tooth loss in the hands of a skilled clinician to 2. Complexity of management: synthesize and analyze the probing depths, pattern of information to empower him and bone loss, furcation lesions, come up with a good treatment plan. number of remaining teeth, The process of listing significant tooth mobility, ridge defects, findings will facilitate the treatment masticatory dysfunction plan process. The clinical decision will 3. Add to stage as descriptor: also depend on the diagnostic and localized