Introduction pdf - د.اشور

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Oral medicine:

is that branch of dentistry which is concerned with the

diagnosis and non-surgical management of disease of the oral and
maxillofacial region, along with health of medically compromised patients.
Or it may be defined as the diagnosis and treatment of diseases with non-
surgical management.

Oral diagnosis

: a systematic method of identifying an oral problem.

Diagnosis process

(sequence): it is divided into four steps:

1. Taking and recording patient history
2. Examination of patient which includes both clinical and laboratory
investigations
3. Diagnosis by evaluation of history, physical and laboratory
investigations
4. Treatment plan.

1. Taking patient’s history

a. Routine data: name, age, sex, race and telephone number.
b. Chief complaint: recorded by patient’s own words, reason for patient

visit, usually related to uncomfortable sensation, best treatment is
achieved if chief complaint is properly recorded.

c. HPI: account of chief complaint from onset of the disease until the

history is taken.

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d. Past and present medical history: (serious illness, hospitalization,

transfusion, allergy, medications, childhood diseases, pregnancy, review
of systems) is important because of:

a. Identification of systemic diseases that modifies treatment plan
b. Identification of drugs that interfere with treatment
c. Identification of contagious diseases
d. Facilitate effective communication with the physician
e. Provide medicolegal protection

e. PDH: includes what have been done and outcome of previous visit and

reason for previous visit as well as type of treatment

f. Family history: to discover:

a. Cause of death of relatives due to hereditary disease
b. Any disease with familial tendency (D.M, H.T, migraine,

psychologic disease)

c. Any contagious disease that infect the members of the same

house (hepatitis, AIDS, syphilis)

g. Social history: marital status, any habits (smoking, addiction)

2. Examination of patient:

principles of clinical examination:

a. Visual inspection: systematic observation of the patient. Needs good

light, mirror and probe with removal of any barrier

b. Palpation: bidigital (fingers) or bimanual (one hand intraoral and the

other is extraoral), palpation give an idea for:

i. Texture: feel the surface of any lesion with fingertip> soft,

lobulated, smooth or irregular.

ii. Dimension: with texture assessment to know the depth of mass

iii. Consistency: compressibility of the lesion:

Soft>lipoma, firm>fibroma, rubbery>Hodgkin’s lymphoma, rocky
hard>metastatic tumor

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iv. Temperature: best examined by dorsal surface of the hand (thin

skin, well innervated)

v. Functional events: any movement (tooth mobility)

c. Probing: periodontal probe, lacrimal duct probe.
d. Percussion: striking the tissue with finger or instrument and noticing

the response of the patient.

e. Auscultation: listening to the sound of the body cavity with stethoscope

(TMJ, heart, blood pressure)

f. Aspiration: withdrawal of fluid from body cavity and examining the

aspirate

i. Nothing withdrawn: wrong position, empty space, solid.

ii. Yellowish to straw blood tinted colour> cyst

iii. White> keratocyst
iv. Reddish> hemangioma

Fluctuation: a sign indicating presence of fluid within a cavity

g. Diascopy: specific method done by using glass slide, used to diagnose if

any reddish, pinkish or bluish lesion is vascular in nature (positive:
hemangioma, hemorrhagic telangiectasia, varices, spider angioma),
(negative: amalgam tattoo, purpura –ecchymosis or petechia- or any
other pigmented lesions)

h. Evaluation of function:

i. Tears: Schirmer test

ii. Salivation: massage or milking

iii. Taste: different materials applied on tongue
iv. Mastication v. Neurological: sensory and motor, convulsions

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General examination

Vital signs:

a. R.R.: normal: 14-16 breath/m, tachypnea: > 10 breath/minute

b. Pulse: best measured by radial and carotid artery

i. H.R.: 60-100 bpm

ii. Rhythm: regular or irregular

c. Temperature: oral 37, axillary 63.3, rectal 37.7

d. BP: 120/80 mmHg

Examination of the head

A. Skull B. Ear

C. Skin

D. TMJ

E. Eye colour(red> allergy, trauma, inflammation), (yellow> jaundice

due to hemolytic anemia, cholecystitis, hepatitis), (bluish>

osteogenesis imperfecta)

F. Post and preauricular lymph nodes

Examination of the neck:

thyroid, trachea, common carotid artery,

sublingual lymph nodes, submental lymph nodes

Oral examination:

tongue, floor of the mouth, buccal mucosa

Laboratory investigations:

to support clinical examination, including:

1. Radiographic examination

a. Conventional x-ray radiography

b. Contrast medium (water soluble or water insoluble), used for TMJ

(arthrography) to detect : (perforation, shape of disc, loose body

within joint compartments), for salivary glands called sialography

c. C.T. scan> bone

d. MRI: cancer and soft tissue imaging

e. Ultrasound: stone in salivary gland

f. Scintigraphy: giving radioactive isotope to the body, taken by

active tissue, imaged, excreted from the body.

2. Supplemental diagnostic aids:

a. Bacteriological

i. Stain smear from oral cavity

1. To identify the microorganism by gram stain or PAS stain

2. For diagnosis of premalignant lesion by Papanicolaou stain

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3. Diagnosing unusual cells : giant cells, Tzanck cells (Giemsa stain)

ii. Culture and sensitivity test: done for patient with extensive mucous

membrane, skin or bone infection. Used in:

1. When patient relapses

2. Disease is severe

3. Cause is uncertain, and there is no response to treatment

Methods are: disc fusion, test tube fusion, agar media fusion

Biopsy:

surgical removal of part or whole lesion of living tissue for the

purpose of histopathological examination, indicated in:

i. Confirmation of diagnosis in clinically malignancy-suspected lesions

ii. For diagnosis of undiagnosed lesions

iii. To evaluate the exact histopathological nature of any soft tissue of

bone lesion

Types:

i. Excisional or treatment biopsy: removal of the entire lesion, for

small lesion, diagnosis and treatment

ii. Incisional or diagnostic biopsy: used in large lesion, the surgeon

takes part from normal an abnormal tissue by wedge shaped

incision with certain depth

iii. Fine needle aspirate: microscopical examination of aspirate

obtained by insertion of needle in lesion, painless, fast and safe

procedure, used for lymph nodes and salivary glands

iv. Intraosseous biopsy: less performed, surgical drilling deep into

bone or cartilage to confirm diagnosis of radiographic changes

v. Frozen section: to get immediate histopathological report of

lesion, indicated in:

a. Confirmation of malignancy

b. Evaluate margins of lesion

c. Confirm removal of entire lesion

vi. Punch biopsy: sharp hole is made with several mm in diameter by

rotating a circular blades into the lesion until underlying bone or

muscle is reached

vii. Oral CDX system: highly specialized computer assisted analysis of

oral brush biopsy, it is a recent method that determines need for

further scalpel biopsy in benign-looking mucosal leukoplakia

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viii. Oral exfoliative cytology: microscopical examination of surface

cells scraped from oral mucosa, smear is then fixed on slide

Indications

a. Large lesion distributed over large area in oral cavity

b. Diagnosis of clinically undiagnosed lesions

c. Patient refuse surgical biopsy

Contraindicated in deep lesion or lesion covered by

pseudomembrane, necrosis, keratin or normal mucosa

c. Hematological tests:

i. Complete blood picture: MCV, MCH, MCV, ESR, PCV, Hb…

ii. Blood chemistry: auto analyzers gives information about different

enzymes, hormones and other materials in blood (ex. Glucose).

iii. Serological tests: measurement of antibodies that increase in

concentration in serum, saliva or other body fluid upon

inflammation, for examples: Wassermann test for syphilis.

iv. Immunofluorescence: direct (biopsy and serum), indirect (serum

only) or sandwich

Diagnosis:

identification of disease by investigation of sign and symptoms

Differential diagnosis:

redetermination by systematic comparison and

contrast of symptoms from which patient is suffering

Prognosis:

forecast of probability of disease results

Successful treatment plan is always based on careful planning

The goal of treatment plan is to devise best disease treatment for the

patient including what to do and when to do

Phases of treatment

a. Priority treatment

b. Disease control

c. Restoration of function

d. Reevaluation

e. Recall

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introduction

part 1

Oct 3

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Introduction

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Oct 4