Diagnosis and management of oral medicine problems Flashcards
Why is past medical history important?
Oral disease may be a manifestation of systemic disease
Oral disease may be iatrogenic
Management of oral disease may be affected by systemic disease e.g. pregnancy
When do you take a biopsy?
To confirm diagnosis To exclude other pathologies When we are not sure of the diagnosis When we remove a lump When a lesion changes
What are the 4 types od biopsies
Incisional
Excisional
core
fine needle aspiration
When do you take blood tests to help diagnosis?
To check there’s no underlying condition e.g. anaemia leading to mouth ulcers or controlled hyperglycaemia leading to oral candidosis
To monitor condition e.g. Sjogrens pts developing lymphomas
To make sure it is safe for a pt to receive the treatment e.g prior to starting immunosupressants in lichen planus
To monitor if it is safe to continue treatment
What are other special investigations?
Imaging Oral rinses/swabs sialometry Shrirmer's Dental Clincal
What is difflam?
benzydamine hydrochloride mouth rinse
what is the immediate aim for the consultation?
Make working diagnosis and arrange special test to confirm
Address pt’s concerns and reassure
consider pt’s discomfort and dysfunction e.g. pain relief
Educate - smoking, diet, OH
Can the problem be easily solved?
What is the short-term management?
Reassure Educate - condition and management address risk factors can it be managed with medications more investigations needed? Arrange follow up
What is the long-term management?
Reassure
Educate
Address risk factors
What can be done to control the condition? e.g. steroid mouth rinse for oral ulceration, immunosuppressants for erosive oral lichen planus
What is a biopsy?
Removal of tissue for histological examination
What are incisional biopsies for?
For large lesions to establish diagnosis or where treatment depends on diagnosis.
When pre-malignant or malignant
How do you take an incisional biopsy?
take of part of the lesion and normal mucosa too.
Why do you not remove it all?
Differential diagnoses
Examples where incisional biopsies are used?
SCC, pre-cancer, dysplasia, candida
What is an excisional biopsy?
Entire lesion is removed
When do you use excisional biopsy?
Small or certain it is not precancer or cancer.
For small lesions, used to confirm the diagnosis or for large lesions to establish the completeness of excision
When do you do fine needle aspiration?
to obtain cells from deep lesions.
suspected malignancy or cystic lesions.
NOT for oral cavity
What is core/needle biopsy used for?
obtain a small sample or core of the tissue from a deep lesion preserving the architecture.
(has a cutting edge)
What are smears used for?
examination of cells
Generally for fungal infections
Which lesions should be biopsied?
When confident of the diagnosis and able to carry out treatment
What 2 things do you not biopsy?
Bone (unless apicectomy)
Any lesion you suspect is malignant - send via hospital pathway
How do you send of tissue for histopathological diagnosis?
10% formol saline: screw top jar
What do you include on form for the tissue?
Clinical details Description of lesion Site, size duration Associated lesion systemic disease incisional biopsy hard or soft tissue
What must the carriage of specimens in the post comply with?
IATA 650 packaging instructions UN3373
What is good sampling practice for micro-biological tests
Collect prior to anti-microbial therapy
Specimens must be from the actual infection site e.g. deeper into the site
sample collection and transportation critical
How would you collect a sample from a cyst?
Aspirate
take 1ml
sheath on needle and tape up to send off
Why is the black top swab sample better than red top?
Helps keep the microbes alive
Has minerals and isotonic salts
charcoal absorbs secondary metabolites
Soft agar jelly - keeps culture alive, does not culture
What is the transport medium used for?
No growth supporting nutrients, objective is to maintain vitality
Want to maintain vitality but not support growth as commensals would out-compete and kill pathogens
What are the special additives in the transport medium
A reducing agent - thioglycolate - preserves anaerobes but allows aerobes to survive
CO2 support vitality of certain pathogens e.g. Neisseria gonorrhoea and streptococcus pneumoniae
Charcoal, gelatine or corn starch can be added to absorb toxic metabolic products of the host or the hosts normal microbes
How would you collect/send off pus sample?
Swab
Clean mucosa
Send in transport medium - water, isotonic salts, reducing agent, activated charcoal
How would you collect a potentially viral sample?
Need the viral transport medium
Protein stabiliser: salts, gelatin, water, sometimes antibacterial agent
Vesicle fluid: aspirate into tuberculin syrinige
How to take an oral rinse sample?
10ml Sterile saline
rinse mucosa 30 secs
spit into sterile bottle/tube
What is in the viral transport medium?
modified Hank’s balanced salt solution supplemented with bovine serum albumin, cysteine, gelatin, sucrose, glutamic acid
pH buffered with HEPES
Antibiotics inhibit growth of competing bacteria and yeast
What is written on the specimen request form?
Type of sample where it is taken from Clinical signs and symptoms Provisional diagnosis Ask for culture and sensitivity]
How do you post the sample?
Label as diagnostic specimen or biological substance category B
Place leak proof, rigid container conforming wit p:650-UN3373
White aspirates in absorbent material in case of leakage
Itemise list of contents enclosed between the secondary and outer packaging
What are category A substances?
Infectious substance:
when exposed to it is capable of causing permanent disability, life threatening or fatal disease to humans of animals
examples: HIV, HEP B or C, mycobacterium TB, only cultures or concentrates not swabs or aspirates taken for diagnosis
What do you expect back from the lab?
at least 48 hours required
Microscopy, culture
Results will not give species, will tell you what antibiotics it is sensitive to,
