Oral Diagnosis Lecture 25092010

8/8/2019 Oral Diagnosis Lecture 25092010

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ORAL DIAGNOSISORAL DIAGNOSIS

Clinical Methods And DocumentationClinical Methods And Documentation

ByBy

Dr. Maher M. ELDr. Maher M. EL--TonsyTonsy

Professor of Oral Diagnosis& Oral RadiologyProfessor of Oral Diagnosis& Oral Radiology


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a. Is the process of determining by accurate examination the

nature and circumstances of a diseased condition.

b. The treatment planning from such an examination will be

decided.

Used Abbreviation: Dx

dia-

a prefix from Greek to mean thoroughly, or completely.

-gnosis

mean knowledge

ORAL DIAGNOSISORAL DIAGNOSIS


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Essentials of the Diagnostic ProcessEssentials of the Diagnostic Process

To qualify the meaning of diagnosis, often adjectives are added with the worddiagnosis:

1. Clinical Diagnosis: through history and physical examination.

2. Radiographic Diagnosis.

3. Microscopic Diagnosis.

4. Working or Tentative Diagnosis: Means that the available information

points to a certain diagnosis, but further diagnostic studies will be necessary

to substantiate this impression.

5. Differential Diagnosis: This involves a list of diseases or conditions in order

of diagnostic probability. In formulating a differential diagnosis, it is

important to mention evidence that is for and against each of the entitiesthat are listed.

6. Final Diagnosis: is the definitive diagnosis made on the basis of all available

observations and laboratory investigations.


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The most important factors which determine aThe most important factors which determine a clinician'sclinician's ability to makeability to makea diagnosis includea diagnosis include::

The knowledge of how to conduct a thorough search of a problemThe knowledge of how to conduct a thorough search of a problem

The knowledge of how to observe and differentiate deviations fromThe knowledge of how to observe and differentiate deviations from

normalnormal The knowledge of diseases or conditions that might be causing theThe knowledge of diseases or conditions that might be causing the

problemproblem


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BASIC APPROACH TO DIAGNOSISBASIC APPROACH TO DIAGNOSIS

AAsystematicsystematic andand scientificscientific approach to the patient's problems isapproach to the patient's problems is crucialcrucial to theto the

diagnostic processdiagnostic process..

CollectionCollection of data from the patient's history, physicalof data from the patient's history, physical

examination and from relevant adjunctive diagnosticexamination and from relevant adjunctive diagnostic

procedures.procedures.

AnalysisAnalysis of information gathered to assess its clinicalof information gathered to assess its clinical

implication.implication. FormulationFormulation of a differential diagnosis.of a differential diagnosis.

MMaking aaking a final diagnosisfinal diagnosis on the basis of information gatheredon the basis of information gathered

from the history, physical examination, differential diagnosisfrom the history, physical examination, differential diagnosis

and diagnostic tests.and diagnostic tests.


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CollectionCollection of Informationof Information

1.1. HistoryHistory

IsIs obtainedobtained fromfrom thethe patientpatient byby questioningquestioning.. ItIt isis generallygenerally

acceptedaccepted thatthat 8585 toto 9090%% ofof diseasesdiseases cancan bebe discovereddiscovered byby aawellwell--conductedconducted healthhealth historyhistory.. TheThe patientpatient isis encouragedencouraged toto

provideprovide aa narrativenarrative ofof his/herhis/her healthhealth problemsproblems inin

chronologicalchronological orderorder fromfrom thethe onsetonset toto thethe presentpresent timetime.. TheThe

patients'patients' problemsproblems areare calledcalled symptomssymptoms.. SymptomsSymptoms areare

subjectivesubjective manifestationsmanifestations ofof diseasedisease andand representrepresent problemsproblems

suchsuch asas pain,pain, swelling,swelling, andand difficultydifficulty inin openingopening thethe mouthmouth

andand soso onon..


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Cont.Cont. CollectionCollection of Informationof Information

22..Physical ExaminationPhysical Examination

ItIt involvesinvolves differentdifferent clinicalclinical methodsmethods employedemployed toto identifyidentify changeschanges

producedproduced byby thethe diseasedisease..

StructuralStructural andand functionalfunctional changeschanges cancan bebe observedobserved (inspection),(inspection), feltfelt

(palpation)(palpation) andand testedtested byby otherother clinicalclinical examinationexamination methodsmethods..

ChangesChanges detecteddetected byby thethe clinicianclinician usingusing anyany ofof thesethese methodsmethods areare

referredreferred toto asas signssigns.. SignsSigns ofof thethe diseasedisease thereforetherefore areare objectiveobjective

manifestationsmanifestations ofof diseasedisease.. Ulceration,Ulceration, swelling,swelling, blistersblisters areare somesome ofof thethe

examplesexamples ofof signssigns.. TheThe clinicianclinician mustmust alsoalso possesspossess adequateadequate knowledgeknowledge

andand skillsskills forfor differentiatingdifferentiating abnormalabnormal structuresstructures fromfrom thethe normalnormal andand fromfrom

thethe structuralstructural variationsvariations.. ee..gg..,, Fordyce'sFordyce's spotsspots (ectopic(ectopic sebaceoussebaceous glands)glands)

lyinglying superficiallysuperficially onon thethe posteriorposterior partpart ofof thethe buccalbuccal mucosamucosa oror onon thethe

labiallabial mucosamucosa areare oftenoften mistakenmistaken forfor diseasedisease..


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Cont.Cont. CollectionCollection of Informationof Information

3.3.Adjunctive Diagnostic TestsAdjunctive Diagnostic Tests

- Diagnostic tests offer supportive evidence to reach a final diagnosis.- X-rays and clinical laboratory tests, including blood tests, microbiological

tests and urinalysis are some examples in this category.

- Microscopic examinations carried out on biopsy specimens are of

immense value particularly in providing confirmatory evidence of life-

threatening conditions such as oral cancer.* It must be borne in mind that the diagnostic tests should not replace

history-taking and physical examination of the patient evaluation process.


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Analysis ofAnalysis of InformationInformation

Data that have been collected from the history, clinical examination and

diagnostic laboratory tests need to be evaluated in an organized manner

in order to be able to arrive at a diagnosis.

- The process of data evaluation is an ongoing procedure and starts

quite early in the diagnostic process. Every bit of information

gathered is significant even if the finding is negative.

- Analysis of information provides useful clues to understand the

nature of the disease process as to whether it is inflammatory,

degenerative, or neoplastic and so on. This categorization of diseaseentities limits the number of diseases to be considered in differential

diagnosis.


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Formulating Formulating Differential DiagnosisDifferential Diagnosis

Differential diagnosis essentially involves consideration of a host of

diseases or conditions that share similar features and eliminating them

one by one based on the evidence available.

- Differential diagnosis leads to a working diagnosis. In general, a list

of differential diagnosis is established once the database from history

and physical examination has been completed. In some conditions,

however, signs and symptoms may indicate a primary bone disease

involving the jaw or may point to a systemic process. In these

situations radiographs, biopsy or other relevant laboratory diagnostictests may be required.


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Diagnostic SequenceDiagnostic Sequence

It is important that during the early part of their clinicaltraining, students should repeatedly perform a comprehensive

and sequential examination in order to gain proficiency in all

aspects of examination methods.

A systematic, sequential and comprehensive examination hastwo major purposes:

It serves the patient by minimizing his discomfort

and

It maximizes the examiners' efficiency.Variations and 'shortcuts' in the order of examination are acceptable only

when the presenting symptoms demand urgent attention by the clinician. For

example, an acute symptoms restricted to a tooth, an extensive examination

that includes structures of the head and neck would be unnecessary at that

visit.


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PATIENTPATIENT CATEGORYCATEGORY

PatientsPatients seekingseeking oraloral carecare broadlybroadly fallfall underunder thethe followingfollowing

categoriescategories::

ThoseThose seekingseeking diagnosisdiagnosis andand treatmenttreatment forfor specificspecific

complaint(s)complaint(s) suchsuch asas toothtooth decay,decay, bleedingbleeding gums,gums, pain,pain,

swelling,swelling, ulcerulcer etcetc..

ThoseThose seekingseeking aa routineroutine dentaldental checkcheck--upup

ThoseThose seekingseeking periodicperiodic oraloral hygienehygiene maintenancemaintenance ororpreventivepreventive carecare

ThoseThose seekingseeking appliancesappliances andand prosthesisprosthesis etcetc..


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A

fterA

fter carryingcarrying outout thethe historyhistory andand patientpatient interviewinginterviewing partpart ofofthethe diagnosticdiagnostic process,process, thethe comprehensivecomprehensive clinicalclinical examinationexamination

shouldshould bebe carriedcarried outout inin aa sequentialsequential mannermanner..

1.1. GENERALGENERAL APPRAISALAPPRAISAL OFOF THETHE PATIENTPATIENT

11..11 GeneralGeneral surveysurvey ofof thethe physicalphysical andand mentalmental statusstatus11..22 DeterminationDetermination ofof thethe vitalvital signssigns

11..33 GrossGross examinationexamination ofof thethe skin,skin, handshands andand nailsnails

Evaluation of the patient's general state of health is important forEvaluation of the patient's general state of health is important for

several reasons:several reasons:

ProtectionProtection of the patient against harm that might be caused by dentalof the patient against harm that might be caused by dental

treatment.treatment.

ProtectionProtection of the dentist andof the dentist and hishis staff against possible contagious diseasesstaff against possible contagious diseases

such as Hepatitis B.such as Hepatitis B.

OpportunityOpportunity for the examiner to suspect or detect early systemic diseasefor the examiner to suspect or detect early systemic disease..


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2.2. EXAMINATIONEXAMINATION OFOF SPECIFICSPECIFIC EXTRAEXTRA--ORALORAL STRUCTURESSTRUCTURES

2.1 Examination2.1 Examination of the headof the head

2.2 Examination2.2 Examination of the faceof the face2.3 Examination2.3 Examination of the neckof the neck

2.4 Evaluation2.4 Evaluation of the cranial nerve functionof the cranial nerve function


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3.3. EXAMINATION OF INTRAEXAMINATION OF INTRA--ORAL STRUCTURESORAL STRUCTURES

3.1 Assessment of the overall oral hygiene status

3.2 Examination of the intra-oral soft tissues and evaluation of thesalivary function and taste sensation

3.3 Examination of the teeth, dentition and occlusion

3.4 Examination of the periodontium


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EXAMINATION OF THEEXAMINATION OF THE

SYMPTOMATIC DENTAL PATIENTSSYMPTOMATIC DENTAL PATIENTS

WhenWhen aa lesionlesion oror discomfortdiscomfort suchsuch asas pain,pain, swellingswelling oror ulcerulcer

isis detected,detected, thethe physicalphysical examinationexamination needsneeds toto bebe

appropriatelyappropriately modifiedmodified::

AnalysisAnalysis ofof chiefchief complaintcomplaint

ClassificationClassification ofof thethe diseasedisease processprocess

ListList ofof possiblepossible diagnosesdiagnoses

DevelopmentDevelopment ofof thethe differentialdifferential diagnosisdiagnosis

DevelopmentDevelopment ofof thethe clinicalclinical impressionimpression

FormulatingFormulating aa finalfinal diagnosisdiagnosis

Oral Diagnosis Lecture 25092010

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