Investigations in oral medicine

Prepared by: Jamal Q Ahmed

Supervised by: Prof.Dr.Ali Al
Zubaidi
Blood testing
 Indications in oral medicine
1. Patients with recurrent aphthous stomatitis
2. Patients with a persistently sore or dry mouth
3. Patients with oral lesions with an atypical history or
unusually resistant to treatment
4. Patients complaining of a sore mouth or dry mouth
despite no mucosal changes can be seen
5. All patients with orofacial candidosis
6. Patients following abnormalities following an initial
screening
 Full blood count and film examination
 From this anemia are demonstrated by a change in red
cell morphology and lowered hemoglobin concentration
contd
 Erythrocyte sedimentation test it increase in
 Tuberculosis/acute hepatitis/acute myocardial

infarction/rheumatic fever/rheumatoid
arthritis/malignancies/multiple myeloma/temporal
arteritis
 Heamatinics
 Ferritin increase in leukemia, some liver

disease,hemachromatosis
 Decrease in iron deficiency anemia

 Iron/iron deficiency anemia

 Folate and vitB12 in megaloblastic and pernicious

anemia
 transferin
contd
 Red cell indices
 MCV/ normocytic ,microcytic (iron deficiency anemia) or
macrocytic(megaloblastic anemia)
 MCHC normochromic, hypochromic(iron deficiency anemia)
hyperchromic (pernicious anemia)

 Blood grouping and cross match

 Serology for detection of antibodies in serum, either

in infectious diseases like
syphlysis,gonorrhea,tuberclosis,or in autoimmune
disease SLE,rheumatoid artheritis,ceolic
disease,sjogren syndrome
Skin testes
 Patch test
 Prick test
 Scratch test
Clinical chemistry

 Glucose: increase in diabetes mellitus, cushing’s syndrome

 Decrease in diabetic patients in excessive use of insulin, in sever
liver diseases
 Urea: increase in dehydration, renal failure
 Creatinine: increase in renal failure
 Electrolytes
 Sodium: raised in dehydration, low in cardiac failure

 Potassium: raised in renal failure, diabetic ketoacidosis, low

in diuretic use
 Calcium: high in hyperparathyroidism, malignancy, vitaminD

excess low in rickets, osteomalatia, hypoparathyroidism

 Phosphate: high in renal failure, low in rickets, osteomalatia
contd

 Alkaline phosphatase: raise in paget’s

disease, rickets, osteomamalatia ,cholestasis
 Total protein: raise in dehydration, liver
diseases,myeloma,sarcoidosis,connective
tissue diseases low in overhydration,renal
failure,enteropathy
 Liver enzymes: disturbed in liver diseases,
some drug therapies like carbamazepine,
phenytoin,phenobarbitone
Immunological tests

 Auto antibodies
 Coelic disease (anti gliadin ,anti endomysal,anti reticulin
antibody), lupus erythematous (anti nuclear antibodies)
sjogren syndrome (SS-A,SS-B), pemphigus (antibody against
desmosomes) pemohigoid (antibody against basement
membrane)
 Viral antibodies:AIDS,EBV
 C-reactive protein increase in inflammatory
conditions and malignancies
 Direct and indirect immune fluorescence
 Complement tests: C1 esterase inhibitor deficiency
Endocrine function

 Importance in oral medicine

 Diagnosis of diabetes
 Orofacial disorders due to poorly controlled
hormonal imbalances
 Hormonal imbalance due to therapy of
orofacial disorders
 Managment may influenced by endocrine
disease or hormone replacement therapy
Urinalysis
 Glycosuria: diabetes mellitus
 Ketonuria: diabetic ketoacidosis, starvation
 Bilirobin or urobilinogen: hemolytic anemia
 Proteinuria
 Infections/vascular/drugs/autoimmune diseases
 Heamaturia
 Infection/antibodies/inherited hemolytic
diseases/mechanical causes/chemicals
Microbiological investigations
 Microbiological investigation done for detection of:

 Viable organism/microbiological products/antibody

detection

 Bacteriology: culture and sensitivity test,

 Mycology: swab, smear ,oral rinse

 Virology: tissue culture, antigen detection, identification

of genetic material (PCR,FISH)
Biopsy
 Indications:
 Lesions which have neoplastic or
premalignant features
 Lesions of uncertain etiology
 Persistant lesions failing to respond
treatment
 Confirmation of clinical diagnosis
Types of biopsy
 Excisional
 Incisional
 FNA
 Frozen section
 Oral brush biopsy
Investigation of specific
medical problems
 Anemia
 Haemoglobin concentration
 A full blood film
 Red cell indices
 White cell count and differential
 Deficiency anemia
 Iron deficiency anemia/ folate deficiency/vitamin
B12/multiple heamatinic deficiencies
 Sickle cell anemia
 Full blood picture
 Simple solubility test
 Heamoglobin electrophoresis
contd
 Bleeding tendencies
Platelete count: increase in
1. Myeloproliferative diseases
2. Malignancies specially disseminated one
3. Chronic inflammation like in RA, inflammatory bowel disease, collagen
diseases
 thrombocytopenia
1. Decreased Platelete production like in aplastic
anemia,radiotherapy,nutritional deficiencies, drug effects like alcohol
,chemotherapy,
2. Antiplatelete antibodies like in autoimmune thrombocytopenia, SLE, acute
leukemia
3. Drugs like heparin, quinine
4. Increased Platelete consumption like septecemia,massive blood loss
5. Hypersplenism like cirrhosis, after massive transfusion, renal insufficiency
 APTT, PT and INR
 prolonged in inadequate vitaminK in diet
 Premature infants
 Poor fat absorption( obstructive
jaundice,coelic disease,fistulas,colitis)
 Sever liver damage
 Drugs (warfarin, heparin)
 Bleeding time
Adrenocortical function testing
 Blood pressure: hypotension in addison’s
disease, hypertension in cushing’s syndrome
 Plasma cortisol level :in addison’s disease
decrease, in cushing’s syndrome increase
 Synacthen test
 Serum antibodies
 Electrolytes: sodium decreases and potassium
increases in addison’s disease
contd
 Diabetes
 RBS more than 11mmol/l or FBS more than
7mmol/l
 hyperparathyroidism