Diagnosis and Management of Oral Disease Flashcards
Steps to diagnosis?
History Examination Diagnosis or differential diagnosis Special tests and investigations Refine/modify diagnosis Management strategy
Why take a history?
Gain info about:
- The condition (C/O or PC)
- HPC
- Previous experience of dentistry PDH
- Health of the pt PMH - Management, oral manifestations of systemic conditions, iatrogenic disease
- FH
- SH
Can lead to diagnosis
Help decide special investigations, understand best management for pt, build up the pt - trust
What to find out from the pt?
Concerns, ideas, beliefs
What their goals are
What their preferences are
What to ask if a pt has recurrent oral ulcers?
Onset How many, how often Size Shape Healing time Areas affected Max ulcer free period Effect of quality of life Previous tx
Family history? Genital ulcers? Skin rashes? GI problems? Joint problems? MH? Drug history? Recent smoking cessation? Impact of stress?
Why do special tests with recurrent ulcers?
Detect predisposing/exacerbating factors
Monitor some drug therapies
Why is PMH important?
Oral disease may be a manifestation of a systemic disease (e.g. oral ulceration in inflammatory bowel disease)
Oral disease may be iatrogenic (e.g. oral ulceration due to nicorandil (drug to treat high BP)
Management of oral disease may be affected by systemic disease
Extraoral exam steps?
General appearance
Symmetry/swellings
Lymph nodes
TMJ and muscles
Intraoral exam steps?
Mucosa
Lubrication
OH
General dental condition
When to do biopsies?
To confirm the diagnosis
To exclude other pathologies
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 (mucous cyst) , polyp
When a lesion changes e.g. known lichen planus plaque becomes speckled
What are the types of biopsies?
Incisional
Excisional
Core
Fine needle aspiration - when you want part of a lump
When to do blood tests?
To check there is no underlying condition leading to the oral disease (e.g. anaemia or haematinic deficiency leading to oral candidosis)
To monitor the condition (e.g. Sjogrens syndrome pts developing lymphoma)
To ensure it’s safe for a pt to receive the tx (e.g. prior to commencing systemic immunosuppressants to control severe erosive oral lichen planus)
To monitor it is safe to continue the tx (e.g. systemic immunosuppressants)
Types of blood tests?
Haematology (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)
Special clinical chemistry (e.g. tumour markers, enzymes)
What other special investigations can be completed?
Radiographs, CBCT, ultrasound, MRI, sialography
Oral rinses, swabs
Sialometry
Shirmers
Dental - probing, percussion, vitality
Clinical - e.g. applying pressure with a glass slide on a suspected vascular lesion to see if it blanches
What to consider with xerostomia?
Underlying medical problems
Drug therapy
Auto-immune disease
Candida infection
What are the immediate aims of the consultation?
Make a working diagnosis and arrange special tests if required to confirm it
Address pt’s concerns and reassure if appropriate
Inform the pt of the diagnosis and discuss it - give pt info leaflet
Consider pt’s discomfort and dysfunction - pain relief (e.g. benzydamine hydrochloride mouth rinse in oral ulceration)
Education - smoking and alcohol, diet, OH, dental follow up
Can the problem be easily solved e.g. adjusting dentures, smoothing sharp filling/cusp
