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Oral Medicine I
Assessment & investigation of
dental patient
Dr. Rami Aljuidi
Patient Assessment
History
- Complaint
- Medical history
- Drug history
- Social history
Clinical examination
- Extra-oral
- Intra-oral
Investigations
- Blood
- Biochemical
- Radiographic
- Histological
History
-
Basis of investigation
Complaint in patients own words
Clinician should not try to influence patients response
Should not hurry
Confidentiality
History of any previous dental treatment, oral/panoral abnormality,
systemic disease, skin disorder, trauma/accident, major surgery
- Drug therapy
- Use of alcohol & tobacco
- Consult patients general practitioner or go through patients file
Clinical examination
Extra-oral:
- General appearance
Wasted, mal-nutritioned, anxiety, agitation?
- Breathlessness
Cardiorespiratory problem?
- Face
Shape & symmetry
Cranio-facial syndromes
Cushingoid appearance?
Neurological deficits?
Cyanosis?
- Scalp & face
Scant hair
- Eyes
Conjuctival sacrring (pemphigoid)
Pale, yellow or blue sclera
Exophthalmia
- Neck
Lymph nodes
Goitre
- Hands
Raynauds phenomenon
Koilonychia
Joints
Palmar keratosis
-Wrists
Purple papules
-Skin
Petechiae or ecchymoses, cyanosis. Jaudice, pigmentation
Normal Structures :
Normal Structure within the mouth are sometimes mistaken for pathological
conditions. Examples:
Special Investigations
Special investigation should only be requested to answer
specific question
Some investigation have high specification and sensitivity for
particular Disease
Few diseases like mumps may be diagnosed on the basis of a
single test, but others such as Sjogrens syndrome may require
many tests
Clinical investigation
Percussion test
Palpation test
Thermal changes test: - Heat test - Cold test
Electric sensitivity testing
Imaging
Conventional Radiography:
Intra-oral [occlusal, Periapical, bitewing]
Panorama
Cephalometric
Computerized tomography (CT scan)
Sialography & Arteriography
MRI
Ultrasound
Indication: To detect: Caries Periodontal disease Periapical lesion.
Neoplasm cysts TMJ disease - Results of trauma to teeth or Jaws
to locate foreign objects and to find impacted teeth.
Ultrasound
Ultrasound examinations use high frequency sound
pulses. Ultrasound requires expertise.
Indication:
-Used to determine whether any structure is solid or
cystic [solid objective absorb almost all of the sound
and are less echoes than the soft tissue].
- Examination of salivary gland (Tumors, cyst, stones).
- Detect the lesion in the thyroid gland and neck.
- Evaluation of lymph node, post surgical edema and
hematoma.
Sialography
Radio-opaque contrast agent like (Iodine derivative) is
infused into the ductal system of salivary gland. There
is low radiation exposure.
Disadvantages:
-There is some discomfort or pressure when the contrast
material is injected into the ducts.
-The contrast material may taste unpleasant.
Contraindication:
Sialography is contraindicated in acute infection of
salivary gland. We use with acute infection the ultrasound
to demonstrate the abscess. Salivary calculi is
questionable
Histopathology
Biopsy: Removing tissue from a patient for histopathological
examination.
Indications
1- Persistent oral ulcers.
2- Persistent red and white lesion
3- suspected neoplasm or any unidentical tissue masses.
A- surgical biopsy
1-Excisional 2-Incisional
1- Excisional biopsy: is the removal of whole lesion.
- Can be performed when the lesion no larger than 1 cm in diameter
- When it is removal doesnt necessitate a major surgical procedure
General principles:
sterilization protocols to be followed
Patient consent & councelling
LA to be given in the adjacent area & not within the lesion
Better taken with a knife than with a cutting diathermy
Specimen should be big enough to allow the pathologist to
make a diagnosis
Specimen should preferably at least 1x 0.6 cm x 3mm deep.
Specimen edges should be vertical not beveled
After excision, put into a fixative (10 formol saline being the
standard solution)
Apply stitches to the specimen for orientation
If the specimen is thin, lay it on a piece of card
Label the container with patients name & age & site of biopsy
Fill the biopsy form, draw the specimen diagram if necessary
D- Exfoliative cytology
It is examination of cells scraped from the surface of the
lesion
Indication:
- Most useful for detecting virally- damaged cells, acantholytic
cells of pemphigus or candidal hyphae.
- Used for patient who should be biopsied but for whom
surgical risk or some other factors prevent it.
- For patients refuse biopsy.
Contraindication:
- In obvious malignancy.
- In leukoplakia
Microbiology
1- Culture and antibiotic sensitivity testes
a) Detect un usual pathogens e.g: Actinomycosis in soft tissue
infection.
b) Antibiotic sensitivity for all infections, especially:
-Osteomyelitis and acute facial soft tissue infection.
-Throat infection.
-Exudates from sinus infections.
-Root canal infections.
-Skin, mucus membrane infection.
2- Smear for candida: for candidiasis.
3- Viral culture or antigen screen.
4- Plain swab
5- Concentrated oral rinse
Indications:
- Diagnosis of Disease such as leukaemia, Myloma and
leukopenia which have oral manifastation.
- Diagnosis of other conditions such as some infections, sore
tongue and recurrent aphthae which are sometimes associted
with anaemia.
OTHER TESTS
URINE TEST
Diagnosis of diabetes, autoimmune conditions which damage the
kidney
TEMPERATURE TEST
- if the bone or soft tissue infection are suspected
- It helps distinguish facial inflammatory odema from cellulitis
- Systemic effect of infection and the need for more aggressive
treatment
BLEEDING TIME TEST
CLOTTING TEST
BLOOD PRESSURE
- Hypertension
- Hypotension
Thank You