Hi, 1. Why cysts in maxillary sinus appear radiopaque. 2. How you screen to rule out cancer in 90 sec.

Hi Karthi These are what I can think of now: 1- Because maxillary sinus is full of air so anything eles, even a cyst full of liquid would look radio-opaque in comparison to the air. 2- In which area? Extra oral (head and neck) or intra oral? Normally we say a wound that does not heal within 14 days should be suspected for a malignant lesion and inflation of the borders, history ( individual and familial) and there is some neat technique called vizilite . the results are not 100% but it is a cute little machine that is fun to work with. Please correct me if I am wrong. Thank you all. after all it was my humble two cents cheers In perio. If the patient has generalized gingival recession due to mechanical. CAL is 3-4mm.Probing depth is 1-2mm. BOP in 2teeth. How to give a diagnosis. I think the patient only has localized marginal gingivitis No periodontistis there. Since there is loss of periodontal tissues i think we should still give a diagnosis as periodontal disease. Just now i spoke to a periodontist in India. this is a point that should be discussed . In australia they just see the pocket depth and diagnose the case -thats -what i presume. nobody is sure about this.if there is no active disease you can term it as loss of periodontium rather than periodontitis . Even me too suffered a lot from this i did a diagnosis of severe periodontitis in a case where there was average pocket depth of 3-5 mm plus 2 mm gingival recession. In the opg there was almost 60 % bone loss.in 80% of the areas. I didnt give a diagnosis of gingivitis along with periodontitis as -my idea was just to give the the more advanced diagnosis.

in fact i couldnt pass CD2 becoz of these reasons as discussed in the post exam counselling-my diagnosis was not right it was generalised moderate periodontitis according to the examiners.i overdiagnosed the case and i did miss an ulcerative lesion on gingiva-diagnosis of ulcerative ginigvitis. .they are very stringent about some ideas.they dont look at CALat all-thats what my knowledge is .If anybody can give a clear idea of whats needed it would highly appreciated. hello all! this is a point that should be discussed .Dear tom, I really understand what u mean. Believe me , I struggled too. In australia they just see the pocket depth and diagnose the case ( For Ivan Darby, the head of perio dept in melbourne uni, it is all about probing depth. He says , if there is probing depth there is perio and if there is no probing depth there is no perio)-thats -what i presume. nobody is sure about this.if there is no active disease( From the recent articles , only a examination on a patient at two points of time, can say about the activity of the disease or the examination of a patient at alongitudinal point of time or taking a radiogrpaph at two points of time)can term it as loss of periodontium rather than periodontitis . Even me too suffered a lot from this i did a diagnosis of severe periodontitis in a case where there was average pocket depth of 3-5 mm plus 2 mm gingival recession. In the opg there was almost 60 % bone loss.in 80% of the areas. I didnt give a diagnosis of gingivitis along with periodontitis as -my idea was just to give the the more advanced diagnosis.( I feel you had to give gingivitis because a perio case comes only after the stage of gingivitis even we know that not all cases of gingivitis proceeds to perio) (Your diagnosis is absolutely fine because articles maintain the stand that CAL is still the gold standard of diagnosis of perio because CAL indicates destrucution of perio tissues inspite of the etiology and the best indicator for future loss of attachment in the same pace irrespective of the ettiology. So your diagnosis is right. But at the end of the day if it is an examiner who is not related to perio coming on that day what can we do? This happened to me. The lady was an CD1 examiner in my first appearance who came for my CD2 exam in the second appearance and it was hard to convince her just because they are not willing to change their stance for us and we be the vicitms. So this how this exam becomes a slight unpredictable. But keep up the spirit and we.re in the right direction.) in fact i couldnt pass CD2 becoz of these reasons as discussed in the post exam counselling-my diagnosis was not right it was generalised moderate periodontitis according to the examiners.i overdiagnosed the case and i did miss an ulcerative lesion on gingiva-diagnosis of ulcerative ginigvitis.(Yeaah, it would be better not to miss any obvious lesions which adds up the salt )

.they are very stringent about some ideas.they dont look at CALat all-thats what my knowledge .If anybody can give a clear idea of whats needed it would highly appreciated. Regards Tom Hi Karthi Regarding your Perio case ,there is no probing depth beyond 3mm , so we can't diagnose the condition as periodontitis.I think localized gingivitis is a correct diagnosis. presence of periodontal tissue loss (recession) is not enough to making Dx. it maybe related to past perio dx which is stable& non progressive now or due to other causes such as occlusal trauma. Regards MD yes,pocket is current indication of periodontitis..where as recession with no pocket or else healty is indication of previous desease..not current..this is very important to consider for diagnosis All the best Farida Hello all, Just a bit curious.( for a polite and healthy discussionn) a) Is there a reference to quote about, when we see a patient on the first visit whether the disease is stable or active? The epidemology chapter in Lindhe clearly states about the uniqueness of periodontal infections. or why periodondidits is diffferent from other infections in the body and the similarities it shares with other infections. One of the uniqueness of periodonditis is we cannot say whether the disease is stable or active at one point of time. There need to be two reference points to be compared with ,to say whether a disease is in active state or stable. Having said so ,I clearly agree with the relevance of probing depths in diagnosis but I politely disagree if probing depth is the sole mode of diagnosing and if it is the means of saying that disease is active or not. I believe we have to corelate the paramneters , (all the parameters ) with the given patient and come to a diagnosis which is appropriate for the patient. The reason being by no means a patient should miss the benefit of a maintenance protocol for an affected dentition or in other words we dont want to give an inappropriate diagnosis for the patient in the first visit. When I mention parameters above, let uus consider Karthi's scenario with the patient having very mid generalised bone loss (an example of a parameter), what would be the diagnosis? I think the diagnosis should be mild perio instead of

gingivitis. Does occlusal trauma cause generalised bone loss? The main reason for occlusl trauma would be excessive loading on some teeth due to various factors. So I feel we should see a widening of periodontal space before bone loss. Now if bone loss happens due to occlusal trauma then the patient had a previous periodondidits which gets aggrevated upon. Even I dont believe that tooth brush trauma causes generalized bone loss. Past periodonditis is one of the best predictors for having future breakdown.or in other words it is a risk indicator. So the pateint will have to be seen in once in three months. Then appropriately we can change the diagnosis. My point is ,it would not be appropriate to give diagnosis as gingivitis superimposed ona healthy periodontium in the first visit just becuase we are seeing the patient for the first time . And the AAP articles clearly states that CAL is the gold standard for diagnosis. I think , melbourne uni supports probing depths because it eliminates so much of confusion. And it is easy for us too. At the end of the day we have to defend the case in whichever means it is and make them know that we know about what we,re defending about. Please consider from a discusion point of view, Regards Bishop hello i totally agree with you Bishop.Periodontitis is a disease of bone too.the disease activity is not just limited to the pocket. for eg-if given an opg if there is 50% bone loss in the opg the case qualifies for being clasified as severe periododntitis.here if the pocket depth is 3mm would youclasify it just as gngivitis??? But if we go according to the pocket depth -better we should clasify this as loss of periodontium.may thats what the examiner needs. the strange thing i felt was when we say the diagnosis ,even if its not tallying with that of examiner .atleast they should ask how we come to the diagnosis??instead they just laugh at you they- dont express their dissatisfaction and believe you dont have any idea about periodontal diagnosis.I think it all depends on the examiner ,its high time they give guidelines for the candidates. here i attach a manual of perio from a reputed university on how they asess the perio examination. may be this is irrelevant for the -ADC examination sake -you got to follow what the examiner believes. but just for the discusion!!!!!!!!!just go through page 11. It would be nice if somebody could come with the final picture of whats needed?? here i am assuming things as a part of of my post examination analysis.

regards tom Hi Karthi, If the patient has no active periodontal disease, we should not diagnose as such. If the patient had periodontal disease in the past, it is a past history of periodontal disease. In the scenaio you mentioned, there is no probing depth beyond 3mm (probing on depth 1-2mm), so there is no sign of periodontis. however there is BOP in 2 teeth that should be investigated. It must be due to very inflamed gingiva, hard to think on periodontis with 1-2mm PD.... The Attachment loss, recession is not very important when making diagnosis, at least here in Australia. They say , basically for 2 reasons: 1st, AL is regarded as a sign that there was disease in the past, they use the metaphor of an amalgam filling....when you do find an amalgam filling in a tooth, it means that there was a disease in the past (caries) , but you would not say caries when seeing an amalgam...get it?. 2nd, Attachment loss could be caused not only by periodontal disease, but also by occlusal trauma , traumatic toothbrushing, etc Why do you people think?

hi all, The answer to How you screen to rule out cancer in 90 sec.: Brush
Biopsy (very similar to PAP smear for detecting cervical cancer and is used as a routine in-office procedure for detecting those suspicious cancerous lesions which are not yet sinister looking) . For further details u can easily google it. Most importantly u do not need to anesthetize the area to perform the brush biopsy. All the best madan

hi karthi all theory questions were clinicaaly oriented.all had accompanying photos and radiographs. in perio they had given a full set of PAs and charting. tabular columns were given with each teeth number. we were asked to fill in relevant details for each tooth. i found it a bit difficult. prostho was like usual.

cd3 pics of radiographs were given and we were asked to mark all relevant things in it. pics were provided in oral med. where we had to give DD and reasons. in cd1 they asked different options of replacing a missing premolar and what all factors we will consider before replacing.few more questions were there.

Hi Madan, Brush biopsy cannot be done in 90 sec. As Macula densa said i think it should be Vizilite. It can also be node detection bcos node canbe fixed ipsilateral or contralateral. but i am not sure about my opinion. Previously they used a stain called toludine blue. This stain willtake uo the site which is dysplastic. The FDA has approved a device to detect oral cancer called a VELscope. The VELscope is non-invasive and uses a bright blue light to emphasize any changes in the mouth that a dentist or hygienist could not normally see. Dr. Kenneth Magid, a professor at New York University College of Dentistry, states on the Oral Cancer Foundation website, "The problem, for the most part, is that early oral cancer looks like everything else. It looks like a million other injuries and changes in the tissue in the mouth. It's a red spot or a white spot. We see them all the time." But using the VELscope to detect oral cancer can make abnormalities stand out like sore thumbs.