CC OS - INTRO

• Diagnosis


  The art and science that deals with identification of diseases and anomalies using logical analysis of information obtained from history-taking and examination procedures
• Diagnostic Process


  1. History Taking

  2. Clinical Examination

  3. Correlation of Information
• Supplemental Diagnostics


  • Imaging (Radiographs, CT scans / CBCT, Magnetic resonance imaging (MRI), Sonography, Sialograms)
  • Laboratory examination (Complete blood count (CBC), Culture and sensitivity test, Cytology examination, Histopathologic examination)
  • Supplemental tests (Thermal test for vitality, Electronic pulp testers)
• History Taking


  Gathering of data using various interviewing techniques to determine changes experienced by the patient, taken before doing examination procedures
• Questions in History Taking

  • What?
  • Why?
  • How?
  • Where?
  • When?
• Accurate History Taking


  Based on intelligent and skillful interview
• Interview as a Clinical Procedure


  Helpful and most valuable tool in the management of pain conditions, dysfunction, and online consultation
• Objectives of the Initial Interview

  • Obtaining information
  • Establishment of a professional relationship
  • Understanding the total patient
• Obtaining Information


  Conversation between two parties where one participant makes a conscious effort to obtain information from the other (chief complaint, history of chief complaint, medical history, dental history, family history, social history)
• Establishing the Professional Relationship


  Professional competence includes the behavioral skills necessary to develop good relationships with patients
• Importance of Establishing a Professional Relationship

  Leads to patient being more receptive of the dentist's professional judgment and treatment recommendations, better understanding, acceptance and compliance of any advice and instruction given, and patient openly relating details of his/her health
• Understanding the Total Patient


  Considering factors other than teeth and supporting structures, such as patient's desires/capabilities, systemic health, occupation, and availability for treatment
• Quality of Life


  Individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns
• Clinical Examination


  Process of investigating the body of the patient for signs of disease, including visual inspection, palpation, percussion, and auscultation
• Detection is the first step to investigation
• It is better to see and not know rather than to know but not see
• Oral lesions escape detection of the dentist because patients do not come for regular check up, dentists don't do thorough oral examination, and dentists regard patients as just a set of teeth
• Requirements for Good Oral Examination

  • Assumed knowledge of anatomy
  • Proper examination techniques
  • Use of proper diagnostic tools
  • Adequate lighting condition
• Dentists is no longer treating teeth in patients, but rather patients who have teeth
• Deviations from Normal that Do Not Necessarily Require Treatment

  • Indentations and Crenations
  • Fordyce granules/spots
  • Bifid Uvula/ Cleft Uvula
  • Black Hairy Tongue
  • Fissured Tongue
  • Bone Exostosis
• Differential Diagnosis


  Torus palatinus will always grow on the midline, growths that are off mid-line should suggest other pathology
• Distinguishing Acute Infections vs. Cysts and Tumors

  • Rate of Growth (Infection - recent and rapid course, Cysts and Tumors - Much slower course and insidious growth)
  • Associated Symptoms (Infection - Associated with severe pain, Cysts and Tumors - Commonly pain absent)
  • Identifying Possible Causative Factors (Infection - odontogenic infections are caused by necrotic teeth, Cysts and Tumors - lack of clinical evidence for the cause of the growth)
  • Color and Location of the Lesion (Lipoma, Mucocele, Ranula, Vascular Lesions)

  
• Sometimes extra-oral swellings can be deceiving, as the actual site of the problem may be distant from area of swelling
• Sialolithasis


  Salivary Gland Calculi, causing swelling of the gland, constant pain in affected gland, and peri prandial increase in intensity of pain and swelling
• Papilloma


  Benign epithelial growth, solitary, 0.5-1.0mm in size, no malignant transformation, not life threatening
• Human Papillomavirus (HPV)


  Viral infection responsible for cervical cancer, some variants associated with oral cancer, appears as clusters of papillomatous growth larger than 1cm
• Hyperplastic and Fibromatous Conditions


  • Fibroma
  • Leaf Fibroma
• Parotid Gland


  Largest of the major salivary glands, located at the posterior area of the ramus, duct (Stensen's) courses forward and terminates at on opening on the cheek called the parotid papilla
• Milking the Parotid Gland


  Good lighting is essential, retract cheek to expose parotid papilla, dry the area thoroughly, keep eyes on the papilla, compress the parotid gland and observe if saliva is excreted

  
• Necrotizing Sialometaplasia


  Benign, ulcerative lesion, usually located towards the back of the hard palate, caused by ischemic necrosis in response to trauma, mimics a number of malignant conditions
• Denture-induced fibrous hyperplasia (Epulis Fissuratum)


  • Adaptive growth located over the soft tissues of the vestibular sulcus
  • Caused by chronic irritation from poorly adapted prostheses
  • Variable degrees of hypertrophy and hyperplasia
• Diagnosing denture-induced fibrous hyperplasia


  1. Correlate with denture

  2. Instruct patient not to wear dentures for 2 weeks

  3. If lesion disappears, ulceration is caused by trauma

  4. If ulceration persists, perform biopsy

  
• Herpes simplex virus


  • Caused by HSV I
  • Preceded by vesicles
  • Short course of development non-raise ulcerations
  • Very Painful
  • Associated with prodromal signs/symptoms (fever, nausea, vomiting)
• Squamous cell carcinoma


  • Painless ulceration
  • Insidious course
  • Ulceration with raised rolled in borders

  
• It is important to remember that a lot of lesions may look similar to cancer

  
• Diagnosing oral lesions


  1. Review history (lesion, medical, family, social)

  2. Review risk factors (smoking, drinking)

  3. Examine carefully

  4. Consider 2-week wait

  5. Be prepared to do biopsy

  
• Leukoplakia


  • White lesion that cannot be rubbed off and cannot be clinically identified as other known lesions
  • Not associated with physical or chemical cause other than smoking
  • Most frequent potentially malignant disorder of the oral cavity
  • May occur anywhere in the oral cavity
  • Not always white and may be yellowish or grayish

  
• Classification of oral leukoplakia

  • Homogenous - flat, thin homogenous appearance
  • Non-homogenous - speckled or erythematous (erythroleukoplakia), nodular, verrucous
• White Sponge Nevus


  • Rare hereditary dyskeratotic hyperplasia
  • Autosomal dominant trait inheritance
  • Defect in keratin 4 and 13
  • Usually appear at birth or early childhood
  • White, symmetric corrugated or velvety plaques
  • Often mistaken as candidiasis, verrucous carcinoma
  • Cheek is most common site but may occur in lips, gingiva and floor of mouth
  • No treatment is required

  
• Geographic Tongue


  • Condition that has depapillated areas of the tongue
  • The white areas are actually the unaffected portions
  • Affected areas are red and smooth
  • Condition produces a map-like appearance of the tongue
  • Areas of depapillation may transfer locations
  • Also called benign migratory glossitis
  • Condition may come and go
  • Etiology is unknown