Diagnosis and Management of Oral Disease Flashcards
How can we get the most information for disgnosis?
by taking an in depth history as well as an intra and extra oral examination
when do we take biopsies?
- To confirm the diagnosis (e.g. oral lichen planus)
- To exclude other pathologies (e.g. oral epithelial dysplasia)
- When we are not sure of the diagnosis (e.g. white patch
– frictional keratosis? Lichen planus? Chronic hyperplastic candidosis? Dysplasia?) - When we remove a lump (e.g. mucocele, polyp – the tissues are sent for histopathological examination)
- When a lesion changes (e.g. known lichen planus plaque becomes speckled)
when do we take blood tests?
- To check there is no underlying condition leading to the oral disease (e.g. anaemia or haematinic deficiency leading to mouth ulcers or uncontrolled hyperglycaemia leading to oral candidosis)
- To monitor the condition (e.g. Sjogren’s syndrome patients developing lymphoma)
- To ensure it is safe for a patient to receive the treatment (e.g. prior to commencing systemic immunosuppressants to control severe erosive oral lichen planus)
- To monitor it is safe to continue the treatment (e.g. systemic immunosuppressants)
what are the different types of blood tests?
- Haematology (e.g. full blood count)
- Clinical chemistry (e.g. liver and renal profiles)
- Coagulation (e.g. INR)
- Immunology (e.g. autoimmune profile)
- Microbiology/virology (e.g. syphilis, HIV, actinomycosis)
name special tests used for oral diseases?
- Biopsies (be aware of risk of parathesia following labial gland biopsy)
- Blood tests
- Imagining – radiographs, CBCT, ultrasound, MRI, sialography
- Oral rinses, swabs (microbiological tests)
- Sialometry – saliva flow rate
- Shirmer’s – if pt are producing tears – not done often now
- Dental – probing, percussion, vitality
- Clinical – e.g. applying a pressure with a glass slide on a suspected vascular lesion to see if it blanches.
how can we manage a patient that has an oral disease?
- reassure pt if appropriate
- listen to patient concerns
- educate
- address risk factors
- review
name the two types of biopsies
- Incisional : part of the lesion is removed - Used for large lesions, to establish the diagnosis or where treatment depends on the diagnosis
- Excisional: the entire lesion is removed - Part of the management of the lesion. Used for small lesions to confirm the diagnosis and for more sinister lesions to establish completeness of excision.
what is the name of the solution biopsy is placed into and what happens?
Formalin (10% formol saline)
biopsy shrinks
what are the features of a good inscisional biopsy?
Remove some normal tissue with some diseased tissue
Full thickness of lesion and deep enough to see connective tissue
how are biopsy specimens transported?
screw top jar
placed in bag
placed in secondary leakproof container with absorbent material
in a rigid strong outer container
must comply with IATA 650 packing instructions.
UN3373 Biological Substance Category 3
which ways can we carry out microbiological testing?
- aspirate sample (make sure needle is made safe before sending off)
- swab (we with transport medium)
- oral rinse - 10 ml sterile saline, rinse mucosa 30 seconds, spit into sterile bottle/tube
- paper points (sent in transport medium)
why is it important to be quick testing microbiological samples?
- Pathogens may die in transit thus -> false negative results
- If transport is delayed, a transport medium should be used
what is contained in the transport medium to try to preserve microbiological sample?
- A reducing agent such as thioglycolate can be added to preserve anaerobes but allows aerobes to survive
- CO2 can be included to support viability of certain pathogens (e.g. Neisseria gonorrhoeae and Streptococcus pneumoniae)
- Charcoal, gelatin, or corn starch can be included to absorb toxic metabolic products of the host or the hosts normal microbes – most critical for particularly fastidious pathogens (e.g. Legionella)
what information is placed on the specimen request form before sending to the local lab?
– State type of sample, where from, clinical signs & symptoms, provisional diagnosis
– Ask for “culture and sensitivity”
– Separate pocket of bag from specimen
– Take as soon as possible
* same day
* refrigerate if delay
what are category A biological substances?
- Category A infectious substance is one which when exposure to it occurs, is capable of causing permanent disability, life-threatening or fatal disease to humans or animals
– HIV
– Hepatitis B or C
– Mycobacterium tuberculosis - This only applies to ‘cultures/concentrates’ - not swabs or aspirates from infected patients taken for diagnosis
